ALKA-SELTZER PLUS ALLERG-COUGH (DEXTROMETHORPHAN HBR/PHENYLEPHRINE/ACETAMINOPHEN/DOXYLAMINE)

Moderate

• Coumadin

• isoniazid

• isoniazid-rifamp-pyrazinamide

• Jantoven

• methyldopa

• methyldopa-hydrochlorothiazide

• methyldopate

• reserpine

• Rifamate

• rifampin-isoniazid

• Rifater

• warfarin

Moderate

• Acidosis

• Chronic heart failure

• Hypertension

• Hyperthyroidism

• Hypoxia

• Ocular hypertension

Acetaminophen

• Severity Level:

  2

• Additional Notes: Available data suggest no known risk; otc product, no fda pregnancy warnings

Dextromethorphan

• Severity Level:

  C

• Additional Notes:

Doxylamine

• Severity Level:

  2

• Additional Notes: Compatible per briggs;overwhelming human and animal data suggests compatibility

Phenylephrine

• Severity Level:

  2

• Additional Notes: Insufficient human data available.

Contraindicated

None

Precaution Exists

Dextromethorphan

Insufficient data available; molecular wt low enough for possible excretion

Low molec wt. possible excretion; not recom; may cause paradoxical excitation

Oral bioavailability low; infant exposure may be minimal

Doxylamine

Insufficient data available; molecular wt low enough for possible excretion

Low molec wt. possible excretion; not recom; may cause paradoxical excitation

Oral bioavailability low; infant exposure may be minimal

Phenylephrine

Insufficient data available; molecular wt low enough for possible excretion

Low molec wt. possible excretion; not recom; may cause paradoxical excitation

Oral bioavailability low; infant exposure may be minimal

No Known Risk

Acetaminophen

Low levels excreted with low risk for adverse effects in infant

Contraindicated

None

Precaution Exists

Acetaminophen (oral,rectal)

Hepatic-Elderly may be more susceptible to hepatotoxicity. Strict adherence to a maximum daily dose is recommended, and the maximum dose recommendation varies between 3000-3800 mg depending on strength used and source of the recommendation.

Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating antihistamine preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.

Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.

BEERS: N     HEDIS: N     STOPP: N

Doxylamine

Hepatic-Elderly may be more susceptible to hepatotoxicity. Strict adherence to a maximum daily dose is recommended, and the maximum dose recommendation varies between 3000-3800 mg depending on strength used and source of the recommendation.

Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating antihistamine preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.

Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.

BEERS: Y     HEDIS: Y     STOPP: Y

Phenylephrine

Hepatic-Elderly may be more susceptible to hepatotoxicity. Strict adherence to a maximum daily dose is recommended, and the maximum dose recommendation varies between 3000-3800 mg depending on strength used and source of the recommendation.

Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Non-sedating antihistamine preferred. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.

Cardiovascular-Elderly are more sensitive to tachycardia and hypertensive effects. May exacerbate symptomatic coronary insufficiency. Genitourinary-May cause urinary retention. Neuro/Psych-May worsen cognitive impairment in some elderly with dementia. Insomnia risk.

BEERS: N     HEDIS: N     STOPP: N

No Known Risk

None