acetaminophen / phenylephrine / dextromethorphan / guaifenesin
Tylenol Cold and Flu Severe is an over-the-counter (OTC) combination medication containing acetaminophen (pain killer), dextromethorphan (cough suppressant), guaifenesin (expectorant), and phenylephrine (decongestant). It's used to temporarily relieve multiple cold and flu symptoms, like sore throat, cough, congestion, fever, and minor aches, for people 12 years and older. Tylenol Cold and Flu Severe is typically taken by mouth every 4 hours as needed. This medication doesn't commonly cause side effects, but watch out for nausea, belly discomfort, and headache.
What is Tylenol Cold and Flu Severe?
What is Tylenol Cold and Flu Severe used for?
Short-term relief of common cold and flu symptoms, including:
- Stuffy nose
- Sinus congestion and pressure
- Chest congestion
- Cough
- Sore throat
- Minor aches and pains
- Headache
- Fever
How Tylenol Cold and Flu Severe works
Tylenol Cold and Flu Severe is a combination of four medications.
- Acetaminophen is an analgesic. It relieves pain and lowers fever by stopping the production of certain inflammatory chemicals in the brain.
- Dextromethorphan is a cough suppressant that works in the part of your brain that makes you cough. It calms down this part of the brain and tells your body to cough less.
- Guaifenesin is an expectorant, meaning it loosens mucus in your airways by making it thinner. This makes it easier to cough out mucus and helps clear chest congestion.
- Phenylephrine is a decongestant that works to clear stuffy nose and sinuses by tightening the blood vessels in your nose.
Drug facts
Side effects of Tylenol Cold and Flu Severe
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Side effects aren't common. See Other Side Effects.
Less Common Side Effects
Possible acetaminophen side effects:
- Nausea
- Headache
Possible dextromethorphan side effects:
- Belly discomfort
- Vomiting
- Drowsiness
Possible guaifenesin side effects:
- Diarrhea
- Dizziness
Possible phenylephrine side effects:
- Anxiety or nervousness
- Headache
- Trouble sleeping
- Fast heartbeat
Tylenol Cold and Flu Severe serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Liver damage: nausea, vomiting, loss of appetite, severe stomach pain, yellowing of the skin or whites of the eyes
- Serotonin syndrome: fast heart rate, sweating, muscle stiffness or spasms, high fever, confusion
- Severe skin reaction: skin reddening, blisters, rash
The following Tylenol Cold and Flu Severe 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
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Tylenol Cold and Flu Severe
Pros
- Conveniently combines four medications into one product to treat many cold and flu symptoms
- Available over the counter without a prescription
- Available as a tablet and liquid
Cons
- Might need to take multiple times a day for optimal relief
- Might raise blood pressure
- Not safe for use in young children
Pharmacist tips for Tylenol Cold and Flu Severe
- For Tylenol Cold and Flu Severe liquid: Be sure to use the medication dose cup, spoon, or oral syringe that comes in the packaging to measure out the dose. Ask your pharmacy if you need extras. Don't use household spoons because they might not be accurate; you might take the wrong amount of medication if you use them.
- Tylenol Cold and Flu Severe liquid contains sodium. Avoid taking the liquid form of the medication if you're following a low-sodium diet.
- It's best to limit how much alcohol you drink while you're taking Tylenol Cold and Flu Severe to help lower the risk for liver problems. This medication contains acetaminophen. Too much alcohol (3 drinks or more daily) and acetaminophen can seriously harm the liver.
- Tell your primary care provider if you have a long-lasting cough that's caused by cigarette smoke or bronchitis, a cough that's related to a breathing problem (e.g., asthma, emphysema), or a cough with a lot of mucus. Tylenol Cold and Flu Severe might not be appropriate for these types of coughs.
- Talk with your primary care provider if your cough gets worse, comes back after clearing up, or lasts more than a week. Also let them know if you also have a rash or headache with your cough. These might be signs of a more serious medical condition that requires other treatment.
- Stop taking Tylenol Cold and Flu Severe and call your primary care provider if your body aches or stuffy nose gets worse or lasts longer than 7 days. Also stop and contact your primary care provider if your fever gets worse or lasts for more than 3 days. You might need to get examined to see whether you need other treatment.
- Stop taking Tylenol Cold and Flu Severe and let your primary care provider know if you notice any mood changes, trouble sleeping, redness, swelling, or new symptoms.
- Stop taking Tylenol Cold and Flu Severe if you have a severe sore throat, if it lasts for more than 2 days, or if it happens along with fever, headache, rash, nausea, or vomiting. These can be symptoms of a more serious medical condition that requires medical attention.
- Many other medications contain acetaminophen, dextromethorphan, guaifenesin, and phenylephrine, the same ingredients in Tylenol Cold and Flu Severe. Read package labels carefully and don't use multiple products with the same ingredients. This helps lower the risk of accidentally taking too much and serious side effects, like hallucinations, slow breathing, seizure, and liver damage (e.g., yellowing of eyes or skin). Get medical help right away if you have these side effects.
- Keep Tylenol Cold and Flu Severe up and away and out of children's reach and sight. Always put medication away every time you use it. This prevents children from accidentally swallowing any medication that's left out. Call a Poison Center at 1-800-222-1222 right away if a child might’ve accidentally swallowed the medication, even if you aren't completely sure.
Common questions about Tylenol Cold and Flu Severe
Though uncommon, it's possible for Tylenol Cold and Flu Severe to make you drowsy. Avoid drinking alcohol while you're taking Tylenol Cold and Flu Severe because it can make you feel even drowsier, which can lead to accidental injuries. Don't drive a car or operate machinery until you know how this medication affects you.
You can take Tylenol Cold and Flu Severe during the day or at night. Keep in mind that this medication contains dextromethorphan (which can make some people drowsy or dizzy) and phenylephrine (which can make some people have trouble sleeping). Be aware of how Tylenol Cold and Flu Severe affects your wakefulness and sleep to decide whether taking the medication at night is right for you. Talk to your care team if you need help figuring out what the best time is to take Tylenol Cold and Flu Severe for symptom relief.
In general, you can take Tylenol Cold and Flu Severe by mouth every 4 hours as needed for cold and flu symptoms. Keep in mind that this medication only helps to relieve symptoms and isn't meant for long-term use. Make sure to contact your primary care provider if your sore throat lasts more than 2 days, fever lasts more than 3 days, or other symptoms last more than 7 days. It's also important to talk with your primary care provider if your symptoms get worse. These could be signs of a more serious condition that can't be treated with Tylenol Cold and Flu Severe.
There isn't enough information available to know whether Tylenol Cold and Flu Severe is safe to take during pregnancy. Tylenol Cold and Flu Severe contains four different medications (acetaminophen, dextromethorphan, guaifenesin, and phenylephrine). In general, acetaminophen and dextromethorphan are considered safe medications during pregnancy. But there aren't many studies on the use of guaifenesin in pregnant mothers. In addition, information about the safety of phenylephrine during pregnancy is mixed. Talk with your obstetrician, primary care provider, or pharmacist about the best options to relieve your cold and flu symptoms if you're currently pregnant.
Speak with your primary care provider or pharmacist about the risks and benefits of taking Tylenol Cold and Flu Severe if you're breastfeeding. Tylenol Cold and Flu Severe contains four medications. Three of these medications (acetaminophen, dextromethorphan, and guaifenesin) are generally considered safe to take while nursing. But the medication phenylephrine might affect your milk supply and cause your baby to be irritable. In addition, certain liquid forms with the same ingredients contain alcohol, which can be harmful to your infant. Read the package instructions closely and ask a healthcare professional before taking any over-the-counter medications while you're breastfeeding.
Retail stores in most states require you to be at least 18 years old to purchase products containing dextromethorphan, such as Tylenol Cold and Flu Severe. This is because teenagers are at highest risk of misusing dextromethorphan. Dextromethorphan misuse can lead to dangerous side effects like hallucinations, trouble breathing, and heart problems, especially if the medication is taken at high doses. This age requirement helps lessen the risk for misuse in teenagers. Keep in mind that you might need to show a valid form of photo identification when you purchase Tylenol Cold and Flu Severe to check your age.
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Risks and warnings for Tylenol Cold and Flu Severe
Tylenol Cold and Flu Severe 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 3 or more alcoholic beverages a day | Taking with other acetaminophen-containing medications | History of liver problems
Tylenol Cold and Flu Severe contains acetaminophen. Taking too much acetaminophen can cause severe and sometimes life-threatening liver damage. For healthy adults, the maximum amount of acetaminophen is typically 4 grams in a 24-hour period, though it could be lower depending on your liver health and your primary care provider's instructions. Be sure to keep track of how much acetaminophen you're taking throughout the day to lessen the risk for liver damage.
Talk to your primary care provider before starting Tylenol Cold and Flu Severe if you have a history of liver problems, since this medication might further damage your liver. Also avoid drinking alcohol while you're taking Tylenol Cold and Flu Severe because taking this medication with alcohol can put you at higher risk for liver damage.
Get medical attention right away if you notice any signs of liver problems, including feeling tired, upset stomach, stomach pain, dark urine, or yellowing of skin or whites of the eyes.
Risk of taking too much medication
There are many over-the-counter medications that contain the same or similar ingredients in Tylenol Cold and Flu Severe (acetaminophen, phenylephrine, dextromethorphan, and guaifenesin). In addition, some prescription pain medications have acetaminophen in them.
Taking more than one product containing similar ingredients raises the risk that you might accidentally take too much medication. This can cause serious and sometimes life-threatening side effects. For example, taking too much acetaminophen can raise your risk for severe liver damage. Also, taking too much dextromethorphan can lead to hallucinations and trouble breathing.
Talk to your care team before you start Tylenol Cold and Flu Severe if you're not sure whether you're already taking a product with similar medications in it. To prevent an accidental overdose, carefully follow the product instructions on the package. Call your Poison Control Center at 1-800-222-1222 right away if you or anyone else might’ve accidentally taken too much Tylenol Cold and Flu Severe, even if you aren't completely sure.
Interaction with monoamine oxidase inhibitors (MAOIs)
- Risk factor: Currently take or have taken an MAOI in the last 14 days
Talk to your primary care provider first before using Tylenol Cold and Flu Severe if you're taking or have recently taken medications for Parkinson's disease or depression known as monoamine oxidase inhibitors (MAOIs).
MAOIs can interact with the dextromethorphan that's in Tylenol Cold and Flu Severe. This drug interaction can cause dangerously high blood pressure. It can also lead to a rare, but serious side effect called serotonin syndrome. Ask your primary care provider about other options to relieve your cold and flu symptoms if you've taken an MAOI in the past two weeks.
Serious skin reaction
In some rare cases, acetaminophen in Tylenol Cold and Flu Severe can cause serious skin reactions. Stop using Tylenol Cold and Flu Severe and get medical attention right away if you notice a rash, blisters, or skin reddening after you take the medication.
Worsening of certain medical conditions
- Risk factors: Liver problems | Heart problems | High blood pressure | Thyroid problems | Diabetes | Trouble urinating | Long-term cough | Cough with too much mucus
Speak to your primary care provider or pharmacist first before using Tylenol Cold and Flu Severe if you have other medical conditions to make sure this medication is safe and appropriate for you. You might need other treatment if you have a cough with a lot of mucus or long-term coughing caused by conditions like asthma, emphysema, smoking, and bronchitis. In addition, it's possible for this medication to worsen certain medical conditions, such as liver problems, heart problems, high blood pressure, thyroid problems, diabetes, or trouble urinating.
Tylenol Cold and Flu Severe dosage
Bottle of liquid| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 177ml of 650mg/10mg/20mg/400mg/20ml | 1 bottle | $5.50 | $5.50 |
Bottle of oral solution| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 355ml of 325mg/5mg/10mg/200mg/15ml | 1 bottle | $7.06 | $7.06 |
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 325mg/5mg/10mg/200mg | 30 tablets | $5.72 | $0.19 |
Typical dosage for Tylenol Cold and Flu Severe
Note: Several manufacturers make this medication under different brand names, in different forms, and in different strengths. Follow the specific product instructions on the package or talk with your primary care provider or pharmacist about how to take this medication.
Tylenol Cold and Flu Severe liquid
- Each 30 mL of liquid contains 650 mg of acetaminophen, 20 mg of dextromethorphan, 400 mg of guaifenesin, and 10 mg of phenylephrine.
- Adults and children 12 years and older: The typical dose is 30 mL by mouth every 4 hours as needed for cold and flu symptoms. Don't take more than 5 doses (or 150 mL) in a 24-hour period.
- Children under age 12: Don't use. Ask your child's pediatrician for other options.
Tylenol Cold and Flu Severe tablets
- Each tablet contains 325 mg of acetaminophen, 10 mg of dextromethorphan, 200 mg of guaifenesin, and 5 mg of phenylephrine.
- Adults and children 12 years and older: The typical dose is 2 tablets by mouth every 4 hours as needed for cold and flu symptoms. Don't take more than 10 tablets in a 24-hour period.
- Children under age 12: Don't use. Ask your child's pediatrician for other options.
How much does Tylenol Cold and Flu Severe cost?
$5.50
Tylenol Cold and Flu Severe contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Tylenol Cold and Flu Severe will not be safe for you to take.
- Taking acetaminophen or products that contain acetaminophen
- Currently taking or have taken an MAOI in the last 14 days
What are alternatives to Tylenol Cold and Flu Severe?
Short-term relief of common cold and flu symptoms, including:
News about Tylenol Cold and Flu Severe
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