acetaminophen / chlorpheniramine / dextromethorphan / phenylephrine
Alka-Seltzer Plus Severe Cold and Flu is a combination of four medications: acetaminophen (an analgesic), chlorpheniramine (an antihistamine), dextromethorphan (a cough suppressant), and phenylephrine (a decongestant). It helps relieve symptoms from the common cold or flu in adults and children. This medication is available as capsules, effervescent tablets, and oral liquid. It's taken by mouth every 4 hours when you have symptoms. Some people might feel drowsy after they take the medication, while others might have trouble sleeping. Additional side effects include dry mouth and dizziness.
What is Alka-Seltzer Plus Severe Cold and Flu?
What is Alka-Seltzer Plus Severe Cold and Flu used for?
Short-term relief of symptoms from the common cold or flu:
Minor aches and pains
Headache
Nasal congestion
Sinus pressure and congestion
Cough
Sore throat
Runny nose
Sneezing
Fever
How Alka-Seltzer Plus Severe Cold and Flu works
Alka-Seltzer Plus Severe Cold and Flu is a combination of four medications that relieve different symptoms caused by the common cold or flu.
Acetaminophen is an analgesic. It blocks inflammatory chemicals in your body that play a role in causing pain and fever. By blocking these chemicals, acetaminophen helps relieve pain and lower fever.
Chlorpheniramine is an antihistamine. It blocks a natural substance in your body called histamine that normally causes common cold symptoms. By blocking histamine, chlorpheniramine lessens inflammation (swelling) and relieves runny or itchy nose, sneezing, and watery eyes.
Dextromethorphan is a cough suppressant. It works in the brain to lower your urge to cough.
Phenylephrine is a decongestant that clears your sinuses to relieve sinus pressure.
Drug Facts
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What are the side effects of Alka-Seltzer Plus Severe Cold and Flu?
Common Side Effects
- Sleepiness
- Restlessness
- Dizziness
- Dry mouth
Other Side Effects
- Headache
- Trouble urinating
Serious Side Effects
- Allergic reactions: rash; hives; difficulty breathing; swelling of face, lips, tongue, or throat
- Serious skin reaction: skin reddening, skin peeling, blisters, rash
- Liver damage: severe stomach pain, yellowing of skin or eyes, nausea, vomiting, loss of appetite
- Excessive sleepiness or dizziness
- Serotonin syndrome: fast heart rate, sweating, muscle stiffness or spasms, high fever, confusion
- Accidentally taking too much medication: seizures, heart rhythm problems, hallucinations, confusion, flushed skin, skin that's warm to the touch, vision changes, severe stomach pain, yellowing of skin or eyes
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart palpitations—rapid, pounding, or irregular heartbeat
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Trouble passing urine
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Anxiety, nervousness
- Confusion
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Fatigue
Pros and cons of Alka-Seltzer Plus Severe Cold and Flu
Pros
Can treat a wide variety of common cold or flu symptoms
More convenient to take four medications in a single dose
Available over the counter
Can be used in children (check product for specific ages)
Comes in different dosage forms (e.g., capsules, dissolvable tablets, liquid)
Cons
Might need to take as often as every 4 hours to relieve symptoms
More difficult to customize the dose since it's a fixed combination of four medications
Might not be the best choice for people over 65 years old; people with glaucoma; or people with liver, breathing, or urinary problems
Dissolvable tablets might not be a good option for people following a low-sodium diet, since they contain sodium (salt).
Pharmacist tips for Alka-Seltzer Plus Severe Cold and Flu
You can take Alka-Seltzer Plus Severe Cold and Flu with or without food. Try taking the medication with food if it upsets your stomach to help lessen any stomach side effects.
You can take Alka-Seltzer Plus Severe Cold and Flu as needed for cold and flu. But you might get the most symptom relief from the medication if you take it as directed on the package label when you have symptoms.
Alka-Seltzer Plus Severe Cold and Flu can make some people sleepy or dizzy during the day. This can affect your ability to focus, think, or react. Don't drive until you know how the medication affects you.
It's possible for children who take Alka-Seltzer Plus Severe Cold and Flu to become overly excited or energetic. Talk to your child's pediatrician if this happens to your child.
Stop using Alka-Seltzer Plus Severe Cold and Flu and contact your primary care provider if your pain, cough, or nasal congestion gets worse or lasts more than a week; your fever gets worse or lasts more than 3 days; or your cough comes back or occurs with a rash or headache. You might need other treatment for your symptoms.
Also stop using Alka-Seltzer Plus Severe Cold and Flu and call your primary care provider if you start to feel nervous or dizzy; have trouble sleeping; or notice any redness, swelling, or any new symptoms. You might need to get examined by your primary care provider.
Speak to your primary care provider if your sore throat pain is severe or if it lasts more than 2 days. Also contact them if you have a sore throat with a fever, headache, rash, nausea, or vomiting.
Don't start any new medications while you're taking Alka-Seltzer Plus Severe Cold and Flu without talking to a healthcare professional first. Tell your primary care provider and pharmacist about all the medications you're taking, especially if you're taking warfarin (Coumadin), other antihistamines, sedatives, or medications containing acetaminophen. Your care team can make sure that all your medications are safe for you to take.
Frequently asked questions about Alka-Seltzer Plus Severe Cold and Flu
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What are the risks and warnings for Alka-Seltzer Plus Severe Cold and Flu?
Alka-Seltzer Plus Severe Cold and Flu can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver damage
Risk factors: Drinking three or more alcoholic beverages a day | Taking other medications containing acetaminophen | Taking too much Alka-Seltzer Plus Severe Cold and Flu | History of liver problems
Taking too much acetaminophen (an ingredient in Alka-Seltzer Plus Severe Cold and Flu) can cause permanent and life-threatening liver damage. For adults, the maximum amount of acetaminophen you can take is typically 4,000 mg in a 24-hour period. But it can be lower depending on your primary care provider's instructions and risk for liver damage. For children, ask your child's pediatrician how much acetaminophen your child can take in a day.
Speak to your primary care provider before you use Alka-Seltzer Plus Severe Cold and Flu if you have liver problems. It's possible for this medication to cause further damage to your liver. Limit or avoid drinking alcohol while you're taking this medication.
Call your care team right away if you notice signs or symptoms of liver problems. Signs and symptoms can include feeling tired or having dark urine, upset stomach, stomach pain, or yellowish skin or eyes.
Serotonin syndrome
Risk factors: Taking monoamine oxidase inhibitors (MAOI) 14 days before starting Alka-Seltzer Plus Severe Cold and Flu | Taking other medications that raise serotonin levels in your brain
Serotonin syndrome is a rare, but potentially life-threatening condition that happens when there's too much serotonin in the brain. Serotonin is one of the chemicals in your brain responsible for your mood.
It's possible for dextromethorphan (an ingredient in Alka-Seltzer Plus Severe Cold and Flu) to raise your serotonin levels. The risk for serotonin syndrome goes up if you take Alka-Seltzer Plus Severe Cold and Flu with other medications that can also affect serotonin levels, such as antidepressants, MAOIs, and migraine medications called triptans. Make sure your healthcare team knows about all the medications you take (including over-the-counter medications and supplements). They can check that Alka-Seltzer Plus Severe Cold and Flu is safe for you to take.
Get medical help as soon as possible if you have symptoms of serotonin syndrome, like fast heart rate, sweating, muscle stiffness or spasms, high fever, and confusion.
Accidentally taking too much medication
Alka-Seltzer Plus Severe Cold and Flu contains an analgesic (acetaminophen), antihistamine (chlorpheniramine), a cough suppressant (dextromethorphan), and a decongestant (phenylephrine). These ingredients can all be found in many other over-the-counter products.
Using more than one medication containing acetaminophen, chlorpheniramine (or other antihistamine), dextromethorphan, or a decongestant raises the risk that you might accidentally take too much of an ingredient. This can lead to serious side effects, including liver damage, high blood pressure, seizures, or hallucinations (seeing things that aren't real).
To lessen the risk of accidentally taking too much medication, be sure to carefully read package labels. Ask a pharmacist if you're not sure whether a product has any of the same or similar ingredients. Get medical help or call a Poison Control Center at 1-800-222-1222 right away if you think you or your loved one accidentally took too much medication.
Worsening of certain medical conditions
Risk factors: Liver problems | Heart disease or high blood pressure | Thyroid problems | High blood sugar (diabetes) | Glaucoma | Cough from smoking, asthma, or emphysema | Mucus-producing cough | Breathing problems (e.g., emphysema, long-term bronchitis) | Urinary conditions
Let your primary care provider or pharmacist know about the medical conditions you have. Ask them whether Alka-Seltzer Plus Severe Cold and Flu is safe and appropriate for you to take.
People who are 65 years of age or older might feel side effects from this medication more intensely. Alka-Seltzer Plus Severe Cold and Flu might also worsen certain medical conditions, such as liver problems, high blood pressure, and glaucoma. Additionally, this medication might not be appropriate for certain medical conditions. For example, you might need other treatment if you have a cough that's lasted for a long time; a cough that occurs with smoking, asthma, or emphysema; or a cough with a lot of mucus.
Allergic skin reactions
Although rare, Alka-Seltzer Plus Severe Cold and Flu can cause serious skin reactions, such as rash, blisters, skin reddening, or skin peeling. Stop using this medication and call for medical help right away if you notice concerning changes in your skin.
Alka-Seltzer Plus Severe Cold and Flu dosage forms
Typical dosing for Alka-Seltzer Plus Severe Cold and Flu
Note: This medication is made by several manufacturers. Some products might differ in dosage and directions. Be sure to check the medication label or ask your pharmacist for directions specific to your product. Below are a few dosing instructions by product formulation and name.
Alka-Seltzer Plus Maximum Strength Cold and Cough PowerMax Gel capsules
Each capsule contains 325 mg of acetaminophen, 2 mg of chlorpheniramine, 10 mg of dextromethorphan, and 5 mg of phenylephrine.
Ages 12 years or older: The typical dose is 2 capsules by mouth every 4 hours while you're having symptoms. Don't use more than 10 capsules (5 doses) in a 24-hour period unless instructed by a healthcare professional.
Ages under 12 years: Ask your child's pediatrician.
Alka-Seltzer Plus Severe Cold and Flu PowerFast Fizz effervescent tablets
Each effervescent tablet contains 250 mg of acetaminophen, 2 mg of chlorpheniramine, 10 mg of dextromethorphan, and 5 mg of phenylephrine.
Ages 12 years or older: The typical dose is 2 tablets, fully dissolved in one-half cup of water, by mouth every 4 hours while you're having symptoms. Don't use more than 8 tablets (4 doses) in a 24-hour period unless instructed by a healthcare professional.
Ages under 12 years: Ask your child's pediatrician.
Dr. Kids Children's Multi-Symptom Cold and Flu liquid
Each 10 mL vial contains 320 mg of acetaminophen, 2 mg of chlorpheniramine, 10 mg of dextromethorphan, and 5 mg of phenylephrine.
Ages 12 years and older: Don't use. This brand name is for young children only.
Ages 6 to under 12 years: The typical dose is one 10 mL vial by mouth every 4 hours while your child has symptoms. Don't use more than 5 doses in a 24-hour period.
Ages under 6 years: Ask your child's pediatrician.
How much does Alka-Seltzer Plus Severe Cold and Flu cost?
Alka-Seltzer Plus Severe Cold and Flu contraindications
Take any other medication containing acetaminophen
Currently take or have taken a monoamine oxidase inhibitor (MAOI) in the last 2 weeks
What are alternatives to Alka-Seltzer Plus Severe Cold and Flu?
Short-term relief of symptoms from the common cold or flu:
Minor aches and pains
Headache
Nasal congestion
Sinus pressure and congestion
Cough
Sore throat
Runny nose
Sneezing
Fever
Stuffy nose (nasal congestion)
Runny nose
Sneezing
Sore throat
Itchy or watery eyes
Itching of the nose or throat
Sinus congestion and pressure
Minor aches, pains, or headache
Fever
Short-term relief of symptoms from the common cold and flu:
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References
Best studies we foundBayer HealthCare LLC. (2023). Alka-Seltzer Plus Maximum Strength Cold and Cough Power Max Gels- acetaminophen, chlorpheniramine malaeate, dextromethorphan hydrobromide, phenylephrine hydrochloride capsule, liquid filled [package insert]. DailyMed.
Bayer HealthCare LLC. (2023). Alka-Seltzer Plus Severe Cold and Flu Powerfast Fizz- chlorpheniramine maleate, acetaminophen, phenylephrine hydrochloride, dextromethorphan hydrobromide tablet, effervescent [package insert]. DailyMed.
Calmco. (2024). DrKids Children Multi Symptom Cold and Flu- acetaminophen 320mg, chlorpheniramine maleate 2mg, dextromethorphan hbr 10mg, phenylephrine hcl 5mg solution [package insert]. DailyMed.
Francescangeli, J., et al. (2019). The serotonin syndrome: From molecular mechanisms to clinical practice. International Journal of Molecular Science.
Gelotte, C. K., et al. (2015). Pharmacokinetics, safety, and cardiovascular tolerability of phenylephrine HCl 10, 20 and 30 mg after a single oral administration in healthy volunteers. Clinical Drug Investigation.
Oh, S., et al. (2023). Dextromethorphan. StatPearls.
Pagel, J. F. (2009). Excessive daytime sleepiness. American Family Physician.
Simons, F. E. R. (2003). H1-antihistamines. The Journal of Allergy and Clinical Immunology.
Twycross, R., et al. (2013). Acetaminophen (paracetamol). Journal of Pain and Symptom Management.
U.S. Food and Drug Administration. (2016). FDA Drug Safety Communication: FDA warns of rare but serious skin reactions with the pain reliever/fever reducer acetaminophen.
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