Acetaminophen Dextromethorphan Guaifenesin Phenylephrine

Acetaminophen Dextromethorphan Guaifenesin Phenylephrine Brand Names

Alka-Seltzer Plus Day Severe Cold & Flu | Alka-Seltzer Plus Severe Cough Mucus & Congestion | Alka-Seltzer Plus Severe Sinus, Cold & Cough | Delsym Cough + Cold | MooreBrand Severe Cold Relief | Mucinex Children’s Cold, Cough & Sore Throat | Mucinex Cold, Flu & Sore Throat | Mucinex Fast-Max | Mucinex Fast-Max Cold & Flu | Mucinex Fast-Max Severe Congestion & Cold | Mucinex Junior Cold & Flu | Mucinex Multi-Symptom Cold and Fever Children’s | Mucinex Sinus-Max | Mucinex Sinus-Max Pressure, Pain & Cough | Phenflu DM | Phenflu G | Robitussin CF MAX Severe Multi-Symptom Cough Cold + Flu | Robitussin Severe Multi-Symptom Daytime/Nighttime Could Cold + Flu | Sine-Off Cold and Cough | Sudafed Cold and Cough | Sudafed PE Cold and Cough | Sudafed PE Head Congestion + Flu | Sudafed PE Pressure + Pain + Cold | Theraflu ExpressMax Severe Cold & Cough | Tylenol Cold | Tylenol Cold & Flu Severe | Tylenol Cold Multi-Symptom Severe Daytime | Tylenol Cold Severe Head Congestion | Tylenol Warming Cough and Severe Congestion | Vicks DayQuil Cold & Flu

What is Acetaminophen Dextromethorphan Guaifenesin Phenylephrine

Acetaminophen, dextromethorphan, guaifenesin, and phenylephrine are used together to provide temporary relief from common cold, allergies, or flu symptoms such as mild pain, cough, nasal congestion, headache, sore throat, and fever. 

Dextromethorphan is effective in inhibiting dry, nonproductive coughs. It is not intended to treat coughs associated with excessive mucus production such as may occur with smoking, emphysema, or chronic bronchitis.

Guaifenesin loosens and thins sputum and bronchial secretions to ease expectoration.

Guaifenesin is especially useful for dry, non-productive coughs which tend to injure the respiratory mucous membranes.

Phenylephrine is a sympathomimetic amine used as a decongestant to decrease nasal and sinus congestion

Indications/Uses of Acetaminophen Dextromethorphan Guaifenesin Phenylephrine

  1. Allergic rhinitis
  2. common cold
  3. cough
  4. fever
  5. headache
  6. mild pain
  7. nasal congestion
  8. pharyngitis
  9. sinusitis
  10. upper respiratory tract infections

Side Effects of Acetaminophen Dextromethorphan Guaifenesin Phenylephrine

  1. abdominal pain
  2. acute generalized exanthematous pustulosis (AGEP)
  3. agranulocytosis
  4. anaphylactic shock
  5. anaphylactoid reactions
  6. angina
  7. angioedema
  8. anorexia
  9. anxiety
  10. arrhythmia exacerbation
  11. bleeding
  12. bradycardia
  13. colitis
  14. confusion
  15. contact dermatitis
  16. dizziness
  17. drowsiness
  18. dysarthria
  19. dysuria
  20. elevated hepatic enzymes
  21. encephalopathy
  22. erythema
  23. excitability
  24. exfoliative dermatitis
  25. fever
  26. GI bleeding
  27. hallucinations
  28. headache
  29. hemolysis
  30. hemolytic anemia
  31. hepatic necrosis
  32. hypertension
  33. hypoprothrombinemia
  34. insomnia
  35. interstitial nephritis
  36. irritability
  37. jaundice
  38. maculopapular rash
  39. methemoglobinemia
  40. myocardial infarction
  41. myocarditis
  42. nausea
  43. nephrolithiasis
  44. pancytopenia
  45. pruritus
  46. psychological dependence
  47. psychosis
  48. purpura
  49. rash
  50. renal failure (unspecified)
  51. renal papillary necrosis
  52. renal tubular necrosis
  53. restlessness
  54. stroke
  55. thrombocytopenia
  56. thrombocytosis
  57. toxic epidermal necrolysis
  58. urinary retention
  59. urticaria
  60. vomiting
  61. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • acetaminophen hypersensitivity
  • acute myocardial infarction
  • alcoholism
  • aneurysm
  • angina
  • arteriosclerosis
  • asthma
  • atrial fibrillation
  • atrial flutter
  • AV block
  • bladder obstruction
  • bone marrow suppression
  • bradycardia
  • breast-feeding
  • bronchitis
  • bundle-branch block
  • cardiac arrhythmias
  • cardiac disease
  • cardiomyopathy
  • cerebrovascular disease
  • children
  • chronic obstructive pulmonary disease (COPD)
  • closed-angle glaucoma
  • coronary artery disease
  • diabetes mellitus
  • driving or operating machinery
  • emphysema
  • G6PD deficiency
  • geriatric
  • heart failure
  • hepatic disease
  • hepatitis
  • hypertension
  • hyperthyroidism
  • immunosuppression
  • increased intraocular pressure
  • infants
  • infection
  • intracranial bleeding
  • labor
  • MAOI therapy
  • myocardial infarction
  • neonates
  • neutropenia
  • obstetric delivery
  • organic brain syndrome
  • peripheral vascular disease
  • pregnancy
  • prostatic hypertrophy
  • renal disease
  • renal failure
  • renal impairment
  • stroke
  • tachycardia
  • thyrotoxicosis
  • tobacco smoking
  • urinary retention
  • ventricular fibrillation
  • ventricular tachycardia

Interactions

  • Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
  • Abiraterone
  • Acarbose
  • Acebutolol
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Aclidinium; Formoterol
  • Acrivastine; Pseudoephedrine
  • Albiglutide
  • Albuterol
  • Albuterol; Ipratropium
  • Aldesleukin, IL-2
  • Alfentanil
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Alosetron
  • Alpha-blockers
  • Alpha-glucosidase Inhibitors
  • Alprazolam
  • Amantadine
  • Ambenonium Chloride
  • Ambrisentan
  • Amikacin
  • Amiloride
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Aminoglycosides
  • Amiodarone
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amobarbital
  • Amoxapine
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamine; Dextroamphetamine Salts
  • Angiotensin II receptor antagonists
  • Angiotensin-converting enzyme inhibitors
  • Antacids
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  • Apomorphine
  • Apraclonidine
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  • Aripiprazole
  • Artemether; Lumefantrine
  • Articaine; Epinephrine
  • Asenapine
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
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  • Atenolol; Chlorthalidone
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  • Avanafil
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  • Bisoprolol
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  • Boceprevir
  • Bosentan
  • Bretylium
  • Brimonidine; Timolol
  • Bromocriptine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Budesonide
  • Budesonide; Formoterol
  • Bumetanide
  • Bupivacaine
  • Bupivacaine Liposomal
  • Bupivacaine; Lidocaine
  • Buprenorphine
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  • Busulfan
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  • Butorphanol
  • Caffeine
  • Caffeine; Ergotamine
  • Calcium-channel blockers
  • Canagliflozin
  • Canagliflozin; Metformin
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Cannabidiol
  • Capecitabine
  • Capsaicin; Metaxalone
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Pseudoephedrine
  • Cardiac glycosides
  • Cariprazine
  • Carisoprodol
  • Carteolol
  • Carvedilol
  • Celecoxib
  • Cenobamate
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Charcoal
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
  • Chlorothiazide
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Chlorzoxazone
  • Cholestyramine
  • Choline Salicylate; Magnesium Salicylate
  • Ciclesonide
  • Cinacalcet
  • Citalopram
  • Clevidipine
  • Clobazam
  • Clonazepam
  • Clonidine
  • Clorazepate
  • Clozapine
  • Cobicistat
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Colchicine
  • Colchicine; Probenecid
  • COMT inhibitors
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Cyclobenzaprine
  • Dacomitinib
  • Dantrolene
  • Dapagliflozin
  • Dapagliflozin; Metformin
  • Dapagliflozin; Saxagliptin
  • Dapsone
  • Daratumumab; Hyaluronidase
  • Darifenacin
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Deflazacort
  • Delavirdine
  • Desloratadine
  • Desloratadine; Pseudoephedrine
  • Desmopressin
  • Desvenlafaxine
  • Deutetrabenazine
  • Dexamethasone
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmedetomidine
  • Dexmethylphenidate
  • Dextroamphetamine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diazepam
  • Diethylpropion
  • Diflunisal
  • Digitoxin
  • Digoxin
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Dihydroergotamine
  • Diltiazem
  • Dipeptidyl Peptidase-4 Inhibitors
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Disopyramide
  • Donepezil
  • Donepezil; Memantine
  • Dorzolamide; Timolol
  • Doxazosin
  • Doxercalciferol
  • Doxorubicin
  • Dronabinol
  • Dronedarone
  • Droperidol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Dulaglutide
  • Duloxetine
  • Dutasteride; Tamsulosin
  • Dyphylline
  • Dyphylline; Guaifenesin
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elexacaftor; tezacaftor; ivacaftor
  • Eliglustat
  • Eltrombopag
  • Elvitegravir
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enflurane
  • Entacapone
  • Epinephrine
  • Epoprostenol
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Ergoloid Mesylates
  • Ergonovine
  • Ergot alkaloids
  • Ergotamine
  • Ertugliflozin
  • Ertugliflozin; Metformin
  • Ertugliflozin; Sitagliptin
  • Escitalopram
  • Esketamine
  • Esmolol
  • Estazolam
  • Eszopiclone
  • Ethacrynic Acid
  • Ethanol
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etomidate
  • Exenatide
  • Ezogabine
  • Fedratinib
  • Felodipine
  • Fenofibric Acid
  • Fentanyl
  • Fexofenadine; Pseudoephedrine
  • Flibanserin
  • Fludrocortisone
  • Flunisolide
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurazepam
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Formoterol
  • Formoterol; Mometasone
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fospropofol
  • Furosemide
  • Gabapentin
  • Galantamine
  • Gentamicin
  • Ginger, Zingiber officinale
  • Givosiran
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Glipizide; Metformin
  • Glyburide; Metformin
  • Glycopyrrolate; Formoterol
  • grapefruit juice
  • Green Tea
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Pseudoephedrine
  • Guanabenz
  • Halogenated Anesthetics
  • Haloperidol
  • Halothane
  • Heparin
  • Homatropine; Hydrocodone
  • Hyaluronidase
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydantoins
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydrocortisone
  • Hydromorphone
  • Hydroxyprogesterone
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Iloperidone
  • Iloprost
  • Imatinib
  • Incretin Mimetics
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Indapamide
  • Insulin Degludec; Liraglutide
  • Insulin Glargine; Lixisenatide
  • Insulins
  • Iobenguane I 131
  • Ionic Contrast Media
  • Isavuconazonium
  • Isocarboxazid
  • Isoflurane
  • Isoniazid, INH
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isradipine
  • Ivacaftor
  • Kanamycin
  • Ketamine
  • Labetalol
  • Lamivudine, 3TC; Zidovudine, ZDV
  • Lamotrigine
  • Lanthanum Carbonate
  • Lasmiditan
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  • Levalbuterol
  • Levobetaxolol
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  • Levocetirizine
  • Levomethadyl
  • Levomilnacipran
  • Levorphanol
  • Levothyroxine
  • Levothyroxine; Liothyronine (Porcine)
  • Levothyroxine; Liothyronine (Synthetic)
  • Lidocaine
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  • Linagliptin; Metformin
  • Linezolid
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  • Liraglutide
  • Lithium
  • Lixisenatide
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  • Loratadine
  • Loratadine; Pseudoephedrine
  • Lorazepam
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  • Lumateperone
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  • Metaxalone
  • Metformin
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  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methadone
  • Methamphetamine
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methocarbamol
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  • Methylene Blue
  • Methylergonovine
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  • Opiate Agonists
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  • Propoxyphene
  • Propranolol
  • Pseudoephedrine
  • Quazepam
  • Quetiapine
  • Quinidine
  • Quinine
  • Racepinephrine
  • Ramelteon
  • Rasagiline
  • Remifentanil
  • Reserpine
  • Rifabutin
  • Rifampin
  • Riociguat
  • Risperidone
  • Ritonavir
  • Rituximab; Hyaluronidase
  • Rivastigmine
  • Rolapitant
  • Ropinirole
  • Ropivacaine
  • Rosiglitazone
  • Rotigotine
  • Safinamide
  • Salmeterol
  • Salsalate
  • Secobarbital
  • Segesterone Acetate; Ethinyl Estradiol
  • Selegiline
  • Selexipag
  • Semaglutide
  • Serotonin-Receptor Agonists
  • Sertraline
  • Sevoflurane
  • SGLT2 Inhibitors
  • Sibutramine
  • Sildenafil
  • Sincalide
  • Sodium Bicarbonate
  • Sodium Iodide
  • Sodium Oxybate
  • Solifenacin
  • Solriamfetol
  • Sotalol
  • Spironolactone
  • St. John’s Wort, Hypericum perforatum
  • Streptomycin
  • Sufentanil
  • Sulfinpyrazone
  • Sulfonylureas
  • Suvorexant
  • Tacrine
  • Tadalafil
  • Tamsulosin
  • Tapentadol
  • Tasimelteon
  • Tedizolid
  • Telaprevir
  • Telotristat Ethyl
  • Temazepam
  • Terazosin
  • Terbinafine
  • Terbutaline
  • Tetrabenazine
  • Tetracaine
  • Tezacaftor; Ivacaftor
  • Thalidomide
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Thiazolidinediones
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Thyroid hormones
  • Timolol
  • Tizanidine
  • tobacco
  • Tobramycin
  • Tocilizumab
  • Tolcapone
  • Topiramate
  • Torsemide
  • Tramadol
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trastuzumab; Hyaluronidase
  • Trazodone
  • Treprostinil
  • Triamcinolone
  • Triamterene
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimethobenzamide
  • Trimetrexate
  • Trospium
  • Umeclidinium; Vilanterol
  • Vardenafil
  • Vasodilators
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Vigabatrin
  • Vilazodone
  • Vortioxetine
  • Warfarin
  • Yohimbine
  • Zaleplon
  • Ziconotide
  • Zidovudine, ZDV
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem

Mechanism of Action

Mechanism of Action: This analgesic-antitussive-decongestant combination acts synergistically to provide temporary relief from common cold or flu symptoms such as mild pain, cough, nasal congestion, headache, sore throat, and fever.

•Acetaminophen: Acetaminophen is thought to act primarily in the CNS and increase the pain threshold by inhibiting cyclooxygenase, a collection of enzymes involved in prostaglandin (PG) synthesis. Acetaminophen appears to be a potent inhibitor of both isoforms of cyclooxygenase, COX-1 and COX-2, within the CNS. Unlike nonsteroidal anti-inflammatory drugs, acetaminophen does not inhibit cyclooxygenase in peripheral tissues, which is the reason for its lack of peripheral anti-inflammatory effects. Acetaminophen may also inhibit the synthesis or actions of chemical mediators that sensitize the pain receptors to mechanical or chemical stimulation. The antipyretic activity of acetaminophen is exerted by blocking the effects of endogenous pyrogen on the hypothalamic heat-regulating center by inhibiting PG synthesis. Heat is dissipated by vasodilatation, increased peripheral blood flow, and sweating.

•Dextromethorphan: Dextromethorphan is a non-competitive antagonist of N-methyl-D-aspartate (NMDA) receptors in the brain and spinal cord. It is the d-isomer of levorphanol but has none of the analgesic, respiratory depressive, or sedative effects associated with opiate agonists. Dextromethorphan has similar antitussive effects as codeine. Dextromethorphan acts on the cough center in the medulla to raise the threshold for coughing by decreasing the excitability of the cough center. Naloxone, an opiate-antagonist, does not block the antitussive effects of dextromethorphan.

•Guaifenesin: Guaifenesin reduces the adhesiveness and surface tension of respiratory tract secretions, thereby easing their expectoration. The expectorant effect can reduce cough frequency. The increased flow of less viscous secretions promotes ciliary action and changes a dry, nonproductive cough to one that is more productive and less frequent. Guaifenesin loosens and thins phlegm and bronchial secretions to ease expectoration. By reducing the viscosity and adhesiveness of secretions, guaifenesin increases the efficacy of the mucociliary mechanism in removing accumulated secretions from the upper and lower airway. Guaifenesin can also be beneficial for irritating, nonproductive coughs and for conditions in which thick mucous secretions are produced.

•Phenylephrine: Phenylephrine possesses both direct and indirect sympathomimetic effects, primarily as a postsynaptic alpha-adrenergic agonist, producing potent vasoconstriction. An indirect effect due to the release of norepinephrine plays a small role in the overall action of phenylephrine. Phenylephrine does not stimulate beta-2 adrenergic receptors in the bronchi or peripheral blood vessels or beta-1 adrenergic receptors of the heart. Phenylephrine increases resistance and, to a lesser extent, decreases capacitance of blood vessels. Following oral administration, constriction of blood vessels leads to reduced blood flow to the nose, decreased amount of blood in the sinusoid vessels, and decreased mucosal edema, which relieves nasal congestion.

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