aspirin / chlorpheniramine / phenylephrine
Alka-Seltzer Plus Cold is an over-the-counter combination medication containing three ingredients: aspirin (an NSAID), chlorpheniramine (an antihistamine), and phenylephrine (a decongestant). It's used to temporarily relieve cold symptoms and lower fever. It can be used for people 12 years of age or older. Alka-Seltzer Plus Cold effervescent tablets are dissolved in water and taken by mouth every 4 hours. Side effects can include sleepiness, dizziness, and dry mouth.
What is Alka-Seltzer Plus Cold?
What is Alka-Seltzer Plus Cold used for?
Short-term relief of fever and symptoms of common cold:
Nasal congestion
Sinus pressure and congestion
Sore throat
Runny nose
Sneezing
Minor aches and pains
Headache
How Alka-Seltzer Plus Cold works
Alka-Seltzer Plus Cold is a combination of three medications that work together to relieve symptoms of the common cold and fever.
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID). It blocks proteins in your body that typically cause inflammation, pain, and fever. This helps relieve inflammation, pain, and fever.
Chlorpheniramine is an antihistamine. It blocks a natural substance in your body called histamine. This helps with runny or itchy nose, sneezing, and watery eyes.
Phenylephrine is a decongestant. It clears your sinuses by tightening the blood vessels in your nose.
Drug Facts
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What are the side effects of Alka-Seltzer Plus Cold?
Common Side Effects
- Sleepiness
- Dizziness
- Dry mouth
Other Side Effects
- Headache
- Blurry vision
- Trouble urinating
Serious Side Effects
- Allergic reactions: rash; hives; difficulty breathing; swelling of face, lips, tongue, or throat
- Stomach bleed: feeling faint or dizzy, long-lasting stomach pain, coughing up or vomiting blood, bloody or dark-colored stools
- Excessive sleepiness or dizziness
- Ringing in the ears or loss of hearing
- Taking too much (signs of an overdose): flushed skin, skin that's warm to the touch, vision changes, heart rhythm problems, fast breathing, ringing in the ears, confusion, seizures
Source: DailyMed
Pros and cons of Alka-Seltzer Plus Cold
Pros
Combination of three medications in a single pill that helps with various cold symptoms at the same time
Dissolved in water so it's easier to take
Available over the counter
Cons
Might have to take up to every 4 hours when you have symptoms
Shouldn't use long term without asking your provider
Not for children under 12 years of age
Pharmacist tips for Alka-Seltzer Plus Cold
Double check your medication label to make sure you have the right Alka-Seltzer Plus Cold product because there are several medications with the Alka-Seltzer brand name. They can contain different active ingredients and different directions.
You can take Alka-Seltzer Plus Cold with or without food. If it upsets your stomach, try taking the medication with food.
Alka-Seltzer Plus Cold can make you sleepy or dizzy, which can affect your ability to focus, think, or react. Don't drive until you know how the medication affects you. To prevent daytime sleepiness, it might help to take the least amount of medication possible for your symptoms. Also, avoid alcohol because it can worsen sleepiness and dizziness.
While Alka-Seltzer Plus Cold might make adults sleepy, it's possible for children who use this medication to become overly excited or energetic. Speak to your child's provider if this happens.
Since Alka-Seltzer Plus Cold contains aspirin, you're at risk for stomach bleeds. Stop using the medication and get medical help right away if you feel faint, vomit blood, have bloody or black stools, or have stomach pain that doesn't get better. These might be symptoms of a stomach bleed.
Tell your provider if you notice a ringing in the ears or loss of hearing after you start using Alka-Seltzer Plus Cold. These are possible side effects of aspirin. You'll probably need to stop taking Alka-Seltzer Plus Cold. The ringing sound should go away and your hearing should return after you stop taking this medication.
Tell your provider and pharmacist about all the medications you're taking, especially if you're taking other NSAIDs, antihistamines, sleep medications, blood thinners, corticosteroids, or monoamine oxidase inhibitors (MAOIs). Some medications can raise your risk for side effects when they're taken with Alka-Seltzer Plus Cold. Your providers can make sure all your medications are safe to take together.
Don't start any new medications while you're taking Alka-Seltzer Plus Cold, particularly other medications containing similar ingredients (e.g., NSAID, antihistamine, decongestant), without talking to your provider or pharmacist first. Doing so can raise your risk of overdose and severe side effects.
Each Alka-Seltzer Plus Cold tablet contains 467 mg of sodium (salt). Ask your provider whether Alka-Seltzer Plus Cold is right for you if you have heart problems (e.g., heart failure) or kidney problems. Typically, people with heart or kidney problems need to follow a low-sodium diet to prevent their conditions from getting worse.
Stop using Alka-Seltzer Plus Cold and contact your provider if you have pain or nasal congestion that gets worse or lasts more than 1 week, or a fever that gets worse or lasts more than 3 days. You should also stop and call your provider if you have any redness, swelling, or any new symptoms that appear while you're taking the medication. These might be signs of a different or more serious medical condition that Alka-Seltzer Plus Cold might not be able to treat.
Talk to your provider if your sore throat is severe; lasts for more than 2 days; or happens with a fever, headache, rash, nausea, or vomiting.
Frequently asked questions about Alka-Seltzer Plus Cold
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What are the risks and warnings for Alka-Seltzer Plus Cold?
Alka-Seltzer Plus Cold 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.
Stomach bleeding and ulcers
Risk factors: Age 60 years or older | History of stomach bleeding or ulcers | Taking other NSAIDs, blood thinners, or corticosteroids while also taking Alka-Seltzer Plus Cold | Drinking 3 or more alcoholic beverages per day | Taking Alka-Seltzer Plus Cold for a long time | Taking more Alka-Seltzer Plus Cold than instructed
Alka-Seltzer Plus Cold contains aspirin, which can irritate your stomach. This irritation can feel like stomach pain or heartburn. It can also lead to serious stomach problems, including bleeding and ulcers in this area. Stop using Alka-Seltzer Plus Cold and get medical attention right away if you have stomach pain that doesn't get better; vomit or cough up blood or bits that look like coffee grounds; or have bloody or black, tarry stools. These can be signs of stomach bleeding or a stomach ulcer that your provider can help manage and treat.
Kidney problems
Risk factors: History of kidney or liver problems | History of heart failure | Taking Alka-Seltzer Plus Cold for a long time | Taking certain blood pressure medications (water pills, ACE inhibitors, or ARBs) | Low fluids in the body | Age 65 years and older
Alka-Seltzer Plus Cold contains aspirin, which can sometimes cause kidney damage at higher doses. This damage can happen at any time while you're taking the medication, especially if you have any of the risk factors listed above. Tell your provider if you're taking certain blood pressure medications that can harm your kidneys, such as ACE inhibitors (e.g., lisinopril (Zestril)) and ARBs (e.g., losartan (Cozaar)). Stop taking Alka-Seltzer Plus Cold and let your provider know if you're not urinating as often as usual or if you have muscle weakness, numbness in your arms or legs, or a fast heartbeat. These can be signs of kidney damage.
Reye's syndrome in children
Risk factors: Children 18 years or younger recovering from chickenpox or flu-like symptoms
Aspirin use in children is linked to a rare, but serious and life-threatening condition called Reye's syndrome. It typically occurs when children who are recovering from flu-like symptoms or other viruses take medications containing aspirin. Early symptoms of Reye's syndrome include vomiting, headache, confusion, and distress. But if left untreated, it can lead to seizures and loss of consciousness. Get medical help as soon as possible if any of these symptoms happen.
To lower the risk for Reye's syndrome, don't give Alka-Seltzer Plus Cold to a child who has a fever due to the flu or who is recovering from chickenpox. Ask a provider for medication recommendations for children who are sick.
Accidentally taking too much (overdose)
Alka-Seltzer Plus Cold contains an NSAID (aspirin), antihistamine (chlorpheniramine), and a decongestant (phenylephrine), which are medications that can be found in other over-the-counter products. Using more than one medication containing an NSAID, chlorpheniramine (or other antihistamine), or a decongestant can lead to an accidental overdose and serious side effects. These serious side effects can potentially include kidney failure, seizures, hallucinations (seeing things that aren't real), or even death.
To prevent an accidental overdose, read package labels carefully. Ask your pharmacist if you're not sure whether a product has any similar ingredients. Get medical help as soon as possible or contact a poison control center at 1-800-222-1222 if you or your loved one has an accidental overdose.
Allergic reactions
Risk factors: NSAID allergy
Severe allergic reactions to Alka-Seltzer Plus Cold are possible, including anaphylaxis (closing of the throat). Let your provider know if you have an allergy to aspirin or other NSAIDs before you start taking Alka-Seltzer Plus Cold. Call 911 if you have hives; trouble breathing; or swelling of your face, lips, or tongue.
Worsening of certain medical conditions
Risk factors: History of stomach bleeding or stomach problems (e.g, heartburn) | Liver or kidney problems | Heart disease or high blood pressure | Thyroid disease | High blood sugar (diabetes) | Glaucoma | Breathing problems (e.g., asthma, emphysema, long-term bronchitis) | Urinary conditions
Ask your provider whether it's safe for you to take Alka-Seltzer Plus Cold if you have any of the risk factors listed above. Taking Alka-Seltzer Plus Cold can potentially worsen your condition(s) and cause serious side effects. Make sure your provider knows about all medical conditions you have or have had in the past before you start taking Alka-Seltzer Plus Cold.
Caution use in people with phenylketonuria (PKU)
Alka-Seltzer Plus Cold contains phenylalanine, a component of the artificial sweetener aspartame. If you have a genetic condition called phenylketonuria (PKU), taking this medication can be dangerous for you. Let your providers know if you have PKU so they can recommend a different formulation or medication that might be safer for you.
Alka-Seltzer Plus Cold dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 20 tablets of 325mg/2mg/7.8mg | 1 carton | $5.47 | $5.47 |
Typical dosing for Alka-Seltzer Plus Cold
Each effervescent tablet contains 325 mg of aspirin, 2 mg of chlorpheniramine, and 7.8 mg of phenylephrine.
Ages 12 years and older: Dissolve 2 tablets in 4 ounces (one-half cup) of water, and drink the mixture. Repeat every 4 hours. Don't use more than 8 tablets in a 24-hour period or as instructed by your provider.
Ages under 12 years old: Ask your child's provider.
How much does Alka-Seltzer Plus Cold cost?
Alka-Seltzer Plus Cold contraindications
What are alternatives to Alka-Seltzer Plus Cold?
Short-term relief of fever and symptoms of common cold:
Nasal congestion
Sinus pressure and congestion
Sore throat
Runny nose
Sneezing
Minor aches and pains
Headache
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 allergies and the common cold: runny nose, itchy or watery eyes, itchy nose or throat, sneezing, nasal congestion, sinus pressure, headache, minor aches and pains, fever
Lowers swelling in the sinuses around the nose
Restores breathing through the nose
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References
Best studies we foundArif, H., et al. (2023). Salicylic acid (aspirin). StatPearls.
Aronoff, D. M., et al. (2001). Antipyretics: mechanisms of action and clinical use in fever suppression. The American Journal of Medicine.
Bayer, Inc. (n.d.). Facts and FAQ.
Bayer, Inc. (n.d.). Find the Alka-Seltzer® product that’s right for you.
Bayer, Inc. (n.d.). Frequently asked questions.
Borowy, C. S., et al. (2023). Antihistamine toxicity. StatPearls.
Chapman, J., et al. (2023). Reye syndrome. StatPearls.
Drugs and Lactation Database (LactMed®). (2021). Aspirin. National Institute of Child Health and Human Development.
Johnson, D. A., et al. (1993). The pharmacology of alpha-adrenergic decongestants. Pharmacotherapy.
Källén, B. A. J., et al. (2006). Use of oral decongestants during pregnancy and delivery outcome. American Journal of Obstetrics and Gynecology.
Lil' Drug Store Products, Inc. (2022). Alka-Seltzer Plus- aspirin, chlorpheniramine maleate, and phenylephrine bitartrate tablet, effervescent [package insert]. DailyMed.
National Human Genome Research Institute. (2014). About phenylketonuria.
National Kidney Foundation. (n.d.). Pain medicines (analgesics).
Richards, E., et al. (2023). Phenylephrine. StatPearls.
U.S. Food and Drug Administration. (2020). Nonsteroidal anti-inflammatory drugs (NSAIDs): Drug Safety Communication - Avoid use of NSAIDs in pregnancy at 20 weeks or later.
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