Table of ContentsView AllTable of ContentsPain RelieversCough RemediesDecongestants
Table of ContentsView All
View All
Table of Contents
Pain Relievers
Cough Remedies
Decongestants
While doubling up oncold and flumedicines like Sudafed and Dayquil may seem like a good idea—hitting symptoms hard for faster relief—doing so poses certain harms if you are not careful. This includes overdosing on medications used in both medicines, which not only increases the risk of side effects but might also end up injuring your liver and other organs.
As a general rule, mostmulti-symptom cold & flu medicinesshould not be taken with other multi-symptom cold and flu medicines. If taking a single-symptom medication (like aspirin), you need to be sure that you don’t take it with a drug of the same class (like Advil). Speak with your pharmacist or healthcare provider if you are not sure.
This article lists 12 different over-the-counter (OTC) drugs commonly used to treat cold and flu symptoms and explains which can be taken together and which cannot.
Verywell / Theresa Chiechi
Pain Relievers/Fever Reducers
There are two types of drugs people commonly reach to treat headaches and fevers. One isTylenol (acetaminophen)and the other is a class of medication callednonsteroidal anti-inflammatory drugs (NSAIDs)that include aspirin, ibuprofen, and naproxen.
Tylenol and NSAIDs are similar but not exactly alike. Tylenol is bothanalgesic(pain-relieving) andantipyretic(fever-reducing). So are NSAIDs but they are also anti-inflammatory due to a different mechanism of action.
Can You Take Tylenol With an NSAID?Tylenol is generally safe to take with an NSAID, even in children.On the other hand, an NSAID should never be taken with another NSAID. Doing so increases the risk of stomach ulcers and bleeding.
Can You Take Tylenol With an NSAID?
Tylenol is generally safe to take with an NSAID, even in children.On the other hand, an NSAID should never be taken with another NSAID. Doing so increases the risk of stomach ulcers and bleeding.
Tylenol (Acetaminophen)
Acetaminophenis one of the most popular OTC pain relievers and fever reducers, sold under the brand name Tylenol. It is also available as a generic.
Tylenol can be taken on its own, but there are many multi-symptom cold & flu remedies that also contain acetaminophen as an active ingredient. These include:
If you are takingTylenol or generic acetaminophen,you should not take any of these acetaminophen-containing medicines. Doing so can lead toacetaminophen toxicity, a condition in which the liver is poisoned and, in some cases, permanently damaged.
This risk of this is easier than one might expect.
In adults, the maximum daily dose of acetaminophen in any form is 4000 milligrams (mg).Toxicity can occur with doses as little as 7,500 mg per day—something that can easily occur if you take two different forms of acetaminophen at once.Add alcohol to the mix, and the risk of liver injury is further increased.
While Tylenol can be combined with NSAIDs—and is even co-formulated in products like Excedrin (acetaminophen/aspirin/caffeine)—some healthcare providers recommend alternating doses every four to six hours rather than taking both drugs every four to six hours. This is especially true for children.
How Much Tylenol Extra Strength Is Safe to Take?
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs are a class of OTC and prescription medications that provide short-term relief ofinflammationand pain.
The three NSAIDs available over the counter are:
All three are also available as generics.
There are several multi-symptom cold & flu medications that contain NSAIDs, including:
If you are taking aspirin, ibuprofen, or naproxen,you should not take any of these NSAID-containing medicines. This is because of the unique action of NSAIDs on the body.
At the same time, prostaglandins are involved withblood clottingand the regulation of stomach acids. By blocking prostaglandins, NSAIDs can increase the risk of stomach irritation, gastrointestinal bleeding, andpeptic ulcers, particularly when overused.
Combining an NSAID with NSAID-containing medications increases the likelihood of these potentially serious side effects.
Warning to ParentsChildren and teens with fever and flu-like symptoms. should never be given aspirin. Aspirin is linked to a rare disorder calledReye’s syndromethat can cause serious liver and brain damage and, in severe cases, lead to permanent brain injury or death.
Warning to Parents
Children and teens with fever and flu-like symptoms. should never be given aspirin. Aspirin is linked to a rare disorder calledReye’s syndromethat can cause serious liver and brain damage and, in severe cases, lead to permanent brain injury or death.
Why Kids Shouldn’t Take Aspirin
Cold and Cough Relievers
There are two types of OTC cough medicines: antitussives and expectorants. The only OTC antitussive isdextromethorphanand the only OTC expectorant isguaifenesin.
Dextromethorphan and guaifenesin can be taken together and are even co-formulated in products like Vicks Formula 44 (guaifenesin/dextromethorphan).
Dextromethorphan
Dextromethorphan is an antitussive sold under the brand names Delsym, Robitussin, and others. It acts directly on the brain to ease the cough reflex and is available as a syrup, tablet, lozenge, and spray.
Dextromethorphan is found in many multi-symptom cold & flu medicines, including:
Dextromethorphan is anopioid-like substance similar to the prescription drugcodeine. When overused, it can lead to intoxication and symptoms like dizziness, blurred vision, and a loss of coordination. This can make driving or handling heavy machinery dangerous.
Dextromethorphan and Diphenhydramine RiskDiphenhydramineis an OTCantihistaminethat can also cause extreme drowsiness. Avoid mixing dextromethorphan with diphenhydramine-containing multi-symptom medicines like:Benedryl Allergy + CongestionDiabetic Tussin Night Time Cold & FluExcedrin PM HeadacheMucinex Fast-Max Day Time Severe Cold Maximum StrengthMucinex Fast-Max Night Time Cold & Flu Maximum StrengthVicks ZzzQuil
Dextromethorphan and Diphenhydramine Risk
Diphenhydramineis an OTCantihistaminethat can also cause extreme drowsiness. Avoid mixing dextromethorphan with diphenhydramine-containing multi-symptom medicines like:Benedryl Allergy + CongestionDiabetic Tussin Night Time Cold & FluExcedrin PM HeadacheMucinex Fast-Max Day Time Severe Cold Maximum StrengthMucinex Fast-Max Night Time Cold & Flu Maximum StrengthVicks ZzzQuil
Diphenhydramineis an OTCantihistaminethat can also cause extreme drowsiness. Avoid mixing dextromethorphan with diphenhydramine-containing multi-symptom medicines like:
Guaifenesin
Guaifenesin is an expectorant sold under the brand nameMucinex, Bidex, Organidin, Robafen, and others. Guaifenesin reduces the viscosity of mucus so it can be easily coughed up.
Guaifenesin is found in many multi-symptom cold & cough medicines, including:
Check the product label to ensure you don’t double-dose on guaifenesin. While guaifenesin has low toxicity, overdosing can lead to headaches, dizziness, nausea, and vomiting.
Choosing the Best OTC Cough Medication
They come in regular and extended-relief tablets as well as oral solutions. However, oral decongestants containing the active ingredient phenylephrine are not considered effective at clearing up congestion.
To avoid overdosing, be careful not to combine Sudafed or Sudafed PE with other oral medications containing phenylephrine or pseudoephedrine, including:
Sudafed and Sudafed PE should also not be combined withnasal decongestant sprays, These contain a topical decongestant calledoxymetazolinethat can raise the risk for side effects without helping your congestion more.
Examples include:
Decongestants and CaffeinePseudoephedrine and phenylephrine are both stimulants that can cause side effects like edginess, a pounding heartbeat, and insomnia. It is best to avoid combining Sudafed or Sudafed PE with cold & flu medicines containingcaffeinewhich can amplify these effects, including:Alka-Selzer Morning ReliefAnacin Fast Pain ReliefBenylin Cold & Flu Maximum StrengthExcedrin Extra StrengthRobitussin Severe Congestion
Decongestants and Caffeine
Pseudoephedrine and phenylephrine are both stimulants that can cause side effects like edginess, a pounding heartbeat, and insomnia. It is best to avoid combining Sudafed or Sudafed PE with cold & flu medicines containingcaffeinewhich can amplify these effects, including:Alka-Selzer Morning ReliefAnacin Fast Pain ReliefBenylin Cold & Flu Maximum StrengthExcedrin Extra StrengthRobitussin Severe Congestion
Pseudoephedrine and phenylephrine are both stimulants that can cause side effects like edginess, a pounding heartbeat, and insomnia. It is best to avoid combining Sudafed or Sudafed PE with cold & flu medicines containingcaffeinewhich can amplify these effects, including:
A Word From VerywellIt’s important to note the side effects of using oral decongestants, including high blood pressure, palpitations and arrhythmias, and urinary retention in men with BPH. Anyone with diabetes, heart disease, high blood pressure, thyroid disease, difficulty urinating due to an enlarged prostate, or obstruction/narrowing of the bowel should consult with their physician before use.—BRIAN H. WETCHLER, DO, MEDICAL EXPERT BOARD
A Word From Verywell
It’s important to note the side effects of using oral decongestants, including high blood pressure, palpitations and arrhythmias, and urinary retention in men with BPH. Anyone with diabetes, heart disease, high blood pressure, thyroid disease, difficulty urinating due to an enlarged prostate, or obstruction/narrowing of the bowel should consult with their physician before use.—BRIAN H. WETCHLER, DO, MEDICAL EXPERT BOARD
It’s important to note the side effects of using oral decongestants, including high blood pressure, palpitations and arrhythmias, and urinary retention in men with BPH. Anyone with diabetes, heart disease, high blood pressure, thyroid disease, difficulty urinating due to an enlarged prostate, or obstruction/narrowing of the bowel should consult with their physician before use.
—BRIAN H. WETCHLER, DO, MEDICAL EXPERT BOARD
Summary
It is important to read product labels on cold and flu medicines to avoid double dosing. These include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), dextromethorphan, guaifenesin, phenylephrine, and pseudoephedrine used both as single-symptom drugs and in multi-symptom cold & flu remedies.
Taking more than the recommended daily dose can increase the risk (and severity) of side effects and possibly lead to complications such as liver injury or stomach ulcers.
Best Cold Medicine: Over-the-Counter Treatments for Your Symptoms
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Smith C, Goldman RD.Alternating acetaminophen and ibuprofen for pain in children.Can Fam Physician.2012 Jun;58(6):645–7.Victoria Department of Health (Australia).Medications - non-steroidal anti-inflammatory drugs.Ramachandran A, Jaeschke H.Acetaminophen toxicity: novel insights into mechanisms and future perspectives.Gene Expr. 2018;18(1):19–30. doi:10.3727/105221617X15084371374138National Cancer Institute.Table 1: dosing recommendations for acetaminophen and anti-inflammatories.Saljoughian M.Acetaminophen intoxication: a critical-care emergency.US Pharm.2016;41(12):38-41.Ghosh A, Berger I, Remien CH, Mubayi A.The role of alcohol consumption on acetaminophen induced liver injury: Implications from a mathematical model.J Theor Biol.2021 Jun 21;519:110559. doi:10.1016/j.jtbi.2020.110559McEvoy L, Carr DF, Pirmohamed M.Pharmacogenomics of NSAID-induced upper gastrointestinal toxicity.Front Pharmacol.2021;12:684162. doi:10.3389/fphar.2021.684162National Institute of Neurological Disorders and Stroke.Reye’s syndrome.Mount Sinai Medical Center.Dextromethorphan overdose.New Zealand Consumer Medicine Information.Guaifenesin and possible risk of tinnitus added to the medicines monitoring scheme.Centers for Disease Control and Prevention.Relief for common symptom of colds and cough.National Health Service (UK).Decongestants.Food and Drug Administration.FDA clarifies results of recent advisory committee meeting on oral phenylephrine.Consumer Reports.Can I take a decongestant pill and nasal spray at the same time?National Health Service (UK).Common questions about pseudoephedrine.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Smith C, Goldman RD.Alternating acetaminophen and ibuprofen for pain in children.Can Fam Physician.2012 Jun;58(6):645–7.Victoria Department of Health (Australia).Medications - non-steroidal anti-inflammatory drugs.Ramachandran A, Jaeschke H.Acetaminophen toxicity: novel insights into mechanisms and future perspectives.Gene Expr. 2018;18(1):19–30. doi:10.3727/105221617X15084371374138National Cancer Institute.Table 1: dosing recommendations for acetaminophen and anti-inflammatories.Saljoughian M.Acetaminophen intoxication: a critical-care emergency.US Pharm.2016;41(12):38-41.Ghosh A, Berger I, Remien CH, Mubayi A.The role of alcohol consumption on acetaminophen induced liver injury: Implications from a mathematical model.J Theor Biol.2021 Jun 21;519:110559. doi:10.1016/j.jtbi.2020.110559McEvoy L, Carr DF, Pirmohamed M.Pharmacogenomics of NSAID-induced upper gastrointestinal toxicity.Front Pharmacol.2021;12:684162. doi:10.3389/fphar.2021.684162National Institute of Neurological Disorders and Stroke.Reye’s syndrome.Mount Sinai Medical Center.Dextromethorphan overdose.New Zealand Consumer Medicine Information.Guaifenesin and possible risk of tinnitus added to the medicines monitoring scheme.Centers for Disease Control and Prevention.Relief for common symptom of colds and cough.National Health Service (UK).Decongestants.Food and Drug Administration.FDA clarifies results of recent advisory committee meeting on oral phenylephrine.Consumer Reports.Can I take a decongestant pill and nasal spray at the same time?National Health Service (UK).Common questions about pseudoephedrine.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Smith C, Goldman RD.Alternating acetaminophen and ibuprofen for pain in children.Can Fam Physician.2012 Jun;58(6):645–7.Victoria Department of Health (Australia).Medications - non-steroidal anti-inflammatory drugs.Ramachandran A, Jaeschke H.Acetaminophen toxicity: novel insights into mechanisms and future perspectives.Gene Expr. 2018;18(1):19–30. doi:10.3727/105221617X15084371374138National Cancer Institute.Table 1: dosing recommendations for acetaminophen and anti-inflammatories.Saljoughian M.Acetaminophen intoxication: a critical-care emergency.US Pharm.2016;41(12):38-41.Ghosh A, Berger I, Remien CH, Mubayi A.The role of alcohol consumption on acetaminophen induced liver injury: Implications from a mathematical model.J Theor Biol.2021 Jun 21;519:110559. doi:10.1016/j.jtbi.2020.110559McEvoy L, Carr DF, Pirmohamed M.Pharmacogenomics of NSAID-induced upper gastrointestinal toxicity.Front Pharmacol.2021;12:684162. doi:10.3389/fphar.2021.684162National Institute of Neurological Disorders and Stroke.Reye’s syndrome.Mount Sinai Medical Center.Dextromethorphan overdose.New Zealand Consumer Medicine Information.Guaifenesin and possible risk of tinnitus added to the medicines monitoring scheme.Centers for Disease Control and Prevention.Relief for common symptom of colds and cough.National Health Service (UK).Decongestants.Food and Drug Administration.FDA clarifies results of recent advisory committee meeting on oral phenylephrine.Consumer Reports.Can I take a decongestant pill and nasal spray at the same time?National Health Service (UK).Common questions about pseudoephedrine.
Smith C, Goldman RD.Alternating acetaminophen and ibuprofen for pain in children.Can Fam Physician.2012 Jun;58(6):645–7.
Victoria Department of Health (Australia).Medications - non-steroidal anti-inflammatory drugs.
Ramachandran A, Jaeschke H.Acetaminophen toxicity: novel insights into mechanisms and future perspectives.Gene Expr. 2018;18(1):19–30. doi:10.3727/105221617X15084371374138
National Cancer Institute.Table 1: dosing recommendations for acetaminophen and anti-inflammatories.
Saljoughian M.Acetaminophen intoxication: a critical-care emergency.US Pharm.2016;41(12):38-41.
Ghosh A, Berger I, Remien CH, Mubayi A.The role of alcohol consumption on acetaminophen induced liver injury: Implications from a mathematical model.J Theor Biol.2021 Jun 21;519:110559. doi:10.1016/j.jtbi.2020.110559
McEvoy L, Carr DF, Pirmohamed M.Pharmacogenomics of NSAID-induced upper gastrointestinal toxicity.Front Pharmacol.2021;12:684162. doi:10.3389/fphar.2021.684162
National Institute of Neurological Disorders and Stroke.Reye’s syndrome.
Mount Sinai Medical Center.Dextromethorphan overdose.
New Zealand Consumer Medicine Information.Guaifenesin and possible risk of tinnitus added to the medicines monitoring scheme.
Centers for Disease Control and Prevention.Relief for common symptom of colds and cough.
National Health Service (UK).Decongestants.
Food and Drug Administration.FDA clarifies results of recent advisory committee meeting on oral phenylephrine.
Consumer Reports.Can I take a decongestant pill and nasal spray at the same time?
National Health Service (UK).Common questions about pseudoephedrine.
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