Please wait while the formulary information is being retrieved.
DAYTIME COLD RELIEF (dextromethorphan HBr/phenylephrine HCl/acetaminophen)
- Cold symptoms
- Cough
- Fever
- Flu-like symptoms
- Headache disorder
- Nasal congestion
- Rhinorrhea
- Tylenol Cold Multi-symptom Day Tablet
- Tylenol Cold Max Day Tablet
- Theraflu Expressmax Cold-cough Day Tablet
- Sudafed Pe Pressure+pain+cough Tablet
- Mapap Cold Formula Tablet
- Daytime Cold Tablet
- Cold Multi-symptom Tablet
- Cold Head Congestion Daytime Tablet
Tylenol Cold Multi-Symptom Day 5 mg-10 mg-325 mg tablet
- Dosage information is not available
Day 5 mg-10 mg-325 mg tablet
- Dosage information is not available
Theraflu ExpressMax Cold-Cough Day 5 mg-10 mg-325 mg tablet
- Dosage information is not available
Sudafed PE Pressure-Pain-Cough 5 mg-10 mg-325 mg tablet
- Dosage information is not available
5 mg-10 mg-325 mg tablet
- Dosage information is not available
5 mg-10 mg-325 mg tablet
- Dosage information is not available
Daytime Cold 5 mg-10 mg-325 mg tablet
- Dosage information is not available
5 mg-10 mg-325 mg tablet
- Dosage information is not available
Cold Multi-Symptom 5 mg-10 mg-325 mg tablet
- Dosage information is not available
Cold Head Congestion Daytime 5 mg-10 mg-325 mg tablet
- Dosage information is not available
Daytime 5 mg-10 mg-325 mg tablet
- Dosage information is not available
- Azilect
- Eldepryl
- isocarboxazid
- linezolid
- Marplan
- Matulane
- methylene blue (antidote)
- Nardil
- Parnate
- phenelzine
- procarbazine
- rasagiline
- selegiline HCl
- tranylcypromine
- Zelapar
- Zyvox
Contraindicated
- bromocriptine
- cabergoline
- Cafergot
- Compound 347
- Cycloset
- D.h.e.45
- dihydroergotamine
- enflurane
- ergoloid
- Ergomar
- ergotamine tartrate
- ergotamine-caffeine
- Forane
- isoflurane
- methylergonovine
- Migergot
- Migranal
- Parlodel
- sevoflurane
- Sojourn
- Terrell
- Ultane
Severe
Moderate
- Coumadin
- isoniazid
- isoniazid-rifamp-pyrazinamide
- Jantoven
- methyldopa
- methyldopa-hydrochlorothiazide
- methyldopate
- reserpine
- Rifamate
- rifampin-isoniazid
- Rifater
- warfarin
- Acetaminophen overdose
- Acute hepatic failure
- Acute hepatitis C
- Acute myocardial infarction
- Arterial thrombosis
- Severe uncontrolled hypertension
- Ventricular tachycardia
Contraindicated
- Acute hepatitis
- Acute pancreatitis
- Benign prostatic hyperplasia
- Bradycardia
- Coronary artery disease
- Disease of liver
- Hypertension
- Hyperthyroidism
- Incomplete AV heart block
- Protein-calorie malnutrition
- Severe arteriosclerotic vascular disease
- Severe renal impairment
- Shock
- Systemic mastocytosis
Severe
Moderate
- Acidosis
- Chronic heart failure
- Hypoxia
DAYTIME COLD RELIEF (dextromethorphan HBr/phenylephrine HCl/acetaminophen)
- Cold symptoms
- Cough
- Fever
- Flu-like symptoms
- Headache disorder
- Nasal congestion
- Rhinorrhea
- None
- None
More Frequent
Severe
Less Severe
- Abnormal hepatic function tests
- None
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Acute generalized exanthematous pustulosis
- Acute hepatic failure
- Agranulocytosis
- Allergic dermatitis
- Angioedema
- Cardiac arrhythmia
- Dizziness
- Drug-induced hepatitis
- Headache disorder
- Hyperhidrosis
- Insomnia
- Laryngeal edema
- Leukopenia
- Maculopapular rash
- Nervousness
- Neutropenic disorder
- Pallor
- Stevens-johnson syndrome
- Tachycardia
- Thrombocytopenic disorder
- Toxic epidermal necrolysis
- Tremor
- Vomiting
Less Severe
- Abdominal pain with cramps
- Dizziness
- Drowsy
- Erythema
- Medication overuse headache
- Nausea
- Skin rash
- Urticaria
Contraindicated
Dextromethorphan (OTC)
Do not use in pediatrics <6 years of age unless clinician consultation.
Risk of CNS excitation. Do not use age <6 years without clinician consult.
- 1 Day – 6 Years
- 1 Do not use in pediatrics <6 years of age unless clinician consultation.
Phenylephrine (Oral,Rectal)
Do not use in pediatrics <6 years of age unless clinician consultation.
Risk of CNS excitation. Do not use age <6 years without clinician consult.
- 1 Day – 6 Years
- 1 Risk of CNS excitation. Do not use age <6 years without clinician consult.
Severe Precaution
None
Management or Monitoring Precaution
Acetaminophen (oral,rectal)
Use weight based dosing in children less than 12 years.
- 1 Day – 12 Years
- Use weight based dosing in children less than 12 years.
Acetaminophen
- Severity Level:
2
- Additional Notes: Available data suggest no known risk; otc product, no fda pregnancy warnings
Dextromethorphan
- Severity Level:
C
- Additional Notes:
Phenylephrine
- Severity Level:
2
- Additional Notes: Insufficient human data available.
Contraindicated
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Precaution Exists
Dextromethorphan
Insufficient data available; molecular wt low enough for possible excretion
Oral bioavailability low; infant exposure may be minimal
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Unknown | Not known; no or inclusive data | Insufficient data available; molecular wt low enough for possible excretion |
Phenylephrine
Insufficient data available; molecular wt low enough for possible excretion
Oral bioavailability low; infant exposure may be minimal
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Excreted | Not known; no or inclusive data | Oral bioavailability low; infant exposure may be minimal |
No Known Risk
Acetaminophen
Low levels excreted with low risk for adverse effects in infant
| General | Excretion Potential | Effect on Infant | Notes |
| No known risks; does not adversely affect lactation | Excreted | No adverse effect | Low levels excreted with low risk for adverse effects in infant |
Contraindicated
None
Precaution Exists
None
No Known Risk
None
- None
| Cold symptoms | |
| J00 | Acute nasopharyngitis [common cold] |
| Cough | |
| R05 | Cough |
| Fever | |
| R50 | Fever of other and unknown origin |
| R50.2 | Drug induced fever |
| R50.8 | Other specified fever |
| R50.81 | Fever presenting with conditions classified elsewhere |
| R50.82 | Postprocedural fever |
| R50.83 | Postvaccination fever |
| R50.84 | Febrile nonhemolytic transfusion reaction |
| R50.9 | Fever, unspecified |
| Flu-like symptoms | |
| J02.9 | Acute pharyngitis, unspecified |
| R05 | Cough |
| R09.81 | Nasal congestion |
| R50.9 | Fever, unspecified |
| R53.1 | Weakness |
| R53.81 | Other malaise |
| R53.83 | Other fatigue |
| R68.83 | Chills (without fever) |
| Headache disorder | |
| G43 | Migraine |
| G43.0 | Migraine without aura |
| G43.00 | Migraine without aura, not intractable |
| G43.009 | Migraine without aura, not intractable, without status migrainosus |
| G43.01 | Migraine without aura, intractable |
| G43.019 | Migraine without aura, intractable, without status migrainosus |
| G43.1 | Migraine with aura |
| G43.10 | Migraine with aura, not intractable |
| G43.109 | Migraine with aura, not intractable, without status migrainosus |
| G43.11 | Migraine with aura, intractable |
| G43.119 | Migraine with aura, intractable, without status migrainosus |
| G43.4 | Hemiplegic migraine |
| G43.40 | Hemiplegic migraine, not intractable |
| G43.409 | Hemiplegic migraine, not intractable, without status migrainosus |
| G43.41 | Hemiplegic migraine, intractable |
| G43.419 | Hemiplegic migraine, intractable, without status migrainosus |
| G43.5 | Persistent migraine aura without cerebral infarction |
| G43.50 | Persistent migraine aura without cerebral infarction, not intractable |
| G43.509 | Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus |
| G43.51 | Persistent migraine aura without cerebral infarction, intractable |
| G43.519 | Persistent migraine aura without cerebral infarction, intractable, without status migrainosus |
| G43.6 | Persistent migraine aura with cerebral infarction |
| G43.60 | Persistent migraine aura with cerebral infarction, not intractable |
| G43.609 | Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus |
| G43.61 | Persistent migraine aura with cerebral infarction, intractable |
| G43.619 | Persistent migraine aura with cerebral infarction, intractable, without status migrainosus |
| G43.7 | Chronic migraine without aura |
| G43.70 | Chronic migraine without aura, not intractable |
| G43.709 | Chronic migraine without aura, not intractable, without status migrainosus |
| G43.71 | Chronic migraine without aura, intractable |
| G43.719 | Chronic migraine without aura, intractable, without status migrainosus |
| G43.8 | Other migraine |
| G43.80 | Other migraine, not intractable |
| G43.809 | Other migraine, not intractable, without status migrainosus |
| G43.81 | Other migraine, intractable |
| G43.819 | Other migraine, intractable, without status migrainosus |
| G43.82 | Menstrual migraine, not intractable |
| G43.829 | Menstrual migraine, not intractable, without status migrainosus |
| G43.83 | Menstrual migraine, intractable |
| G43.839 | Menstrual migraine, intractable, without status migrainosus |
| G43.9 | Migraine, unspecified |
| G43.90 | Migraine, unspecified, not intractable |
| G43.909 | Migraine, unspecified, not intractable, without status migrainosus |
| G43.91 | Migraine, unspecified, intractable |
| G43.919 | Migraine, unspecified, intractable, without status migrainosus |
| G43.B | Ophthalmoplegic migraine |
| G43.B0 | Ophthalmoplegic migraine, not intractable |
| G43.B1 | Ophthalmoplegic migraine, intractable |
| G43.C | Periodic headache syndromes in child or adult |
| G43.C0 | Periodic headache syndromes in child or adult, not intractable |
| G43.C1 | Periodic headache syndromes in child or adult, intractable |
| G43.D | Abdominal migraine |
| G43.D0 | Abdominal migraine, not intractable |
| G43.D1 | Abdominal migraine, intractable |
| G44 | Other headache syndromes |
| G44.0 | Cluster headaches and other trigeminal autonomic cephalgias (TAc) |
| G44.00 | Cluster headache syndrome, unspecified |
| G44.001 | Cluster headache syndrome, unspecified, intractable |
| G44.009 | Cluster headache syndrome, unspecified, not intractable |
| G44.01 | Episodic cluster headache |
| G44.011 | Episodic cluster headache, intractable |
| G44.019 | Episodic cluster headache, not intractable |
| G44.02 | Chronic cluster headache |
| G44.021 | Chronic cluster headache, intractable |
| G44.029 | Chronic cluster headache, not intractable |
| G44.03 | Episodic paroxysmal hemicrania |
| G44.031 | Episodic paroxysmal hemicrania, intractable |
| G44.039 | Episodic paroxysmal hemicrania, not intractable |
| G44.04 | Chronic paroxysmal hemicrania |
| G44.041 | Chronic paroxysmal hemicrania, intractable |
| G44.049 | Chronic paroxysmal hemicrania, not intractable |
| G44.05 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCt) |
| G44.051 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCt), intractable |
| G44.059 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCt), not intractable |
| G44.09 | Other trigeminal autonomic cephalgias (TAc) |
| G44.091 | Other trigeminal autonomic cephalgias (TAc), intractable |
| G44.099 | Other trigeminal autonomic cephalgias (TAc), not intractable |
| G44.1 | Vascular headache, not elsewhere classified |
| G44.2 | Tension-type headache |
| G44.20 | Tension-type headache, unspecified |
| G44.201 | Tension-type headache, unspecified, intractable |
| G44.209 | Tension-type headache, unspecified, not intractable |
| G44.21 | Episodic tension-type headache |
| G44.211 | Episodic tension-type headache, intractable |
| G44.219 | Episodic tension-type headache, not intractable |
| G44.22 | Chronic tension-type headache |
| G44.221 | Chronic tension-type headache, intractable |
| G44.229 | Chronic tension-type headache, not intractable |
| G44.3 | Post-traumatic headache |
| G44.30 | Post-traumatic headache, unspecified |
| G44.301 | Post-traumatic headache, unspecified, intractable |
| G44.309 | Post-traumatic headache, unspecified, not intractable |
| G44.31 | Acute post-traumatic headache |
| G44.311 | Acute post-traumatic headache, intractable |
| G44.319 | Acute post-traumatic headache, not intractable |
| G44.32 | Chronic post-traumatic headache |
| G44.321 | Chronic post-traumatic headache, intractable |
| G44.329 | Chronic post-traumatic headache, not intractable |
| G44.4 | Drug-induced headache, not elsewhere classified |
| G44.40 | Drug-induced headache, not elsewhere classified, not intractable |
| G44.41 | Drug-induced headache, not elsewhere classified, intractable |
| G44.5 | Complicated headache syndromes |
| G44.51 | Hemicrania continua |
| G44.52 | New daily persistent headache (NDPh) |
| G44.53 | Primary thunderclap headache |
| G44.59 | Other complicated headache syndrome |
| G44.8 | Other specified headache syndromes |
| G44.81 | Hypnic headache |
| G44.82 | Headache associated with sexual activity |
| G44.83 | Primary cough headache |
| G44.84 | Primary exertional headache |
| G44.85 | Primary stabbing headache |
| G44.89 | Other headache syndrome |
| R51 | Headache |
| Nasal congestion | |
| R09.81 | Nasal congestion |
| Rhinorrhea | |
| R09.82 | Postnasal drip |
| 0-9 | A-Z |
|---|---|
| G43 | Migraine |
| G43.0 | Migraine without aura |
| G43.00 | Migraine without aura, not intractable |
| G43.009 | Migraine without aura, not intractable, without status migrainosus |
| G43.01 | Migraine without aura, intractable |
| G43.019 | Migraine without aura, intractable, without status migrainosus |
| G43.1 | Migraine with aura |
| G43.10 | Migraine with aura, not intractable |
| G43.109 | Migraine with aura, not intractable, without status migrainosus |
| G43.11 | Migraine with aura, intractable |
| G43.119 | Migraine with aura, intractable, without status migrainosus |
| G43.4 | Hemiplegic migraine |
| G43.40 | Hemiplegic migraine, not intractable |
| G43.409 | Hemiplegic migraine, not intractable, without status migrainosus |
| G43.41 | Hemiplegic migraine, intractable |
| G43.419 | Hemiplegic migraine, intractable, without status migrainosus |
| G43.5 | Persistent migraine aura without cerebral infarction |
| G43.50 | Persistent migraine aura without cerebral infarction, not intractable |
| G43.509 | Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus |
| G43.51 | Persistent migraine aura without cerebral infarction, intractable |
| G43.519 | Persistent migraine aura without cerebral infarction, intractable, without status migrainosus |
| G43.6 | Persistent migraine aura with cerebral infarction |
| G43.60 | Persistent migraine aura with cerebral infarction, not intractable |
| G43.609 | Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus |
| G43.61 | Persistent migraine aura with cerebral infarction, intractable |
| G43.619 | Persistent migraine aura with cerebral infarction, intractable, without status migrainosus |
| G43.7 | Chronic migraine without aura |
| G43.70 | Chronic migraine without aura, not intractable |
| G43.709 | Chronic migraine without aura, not intractable, without status migrainosus |
| G43.71 | Chronic migraine without aura, intractable |
| G43.719 | Chronic migraine without aura, intractable, without status migrainosus |
| G43.8 | Other migraine |
| G43.80 | Other migraine, not intractable |
| G43.809 | Other migraine, not intractable, without status migrainosus |
| G43.81 | Other migraine, intractable |
| G43.819 | Other migraine, intractable, without status migrainosus |
| G43.82 | Menstrual migraine, not intractable |
| G43.829 | Menstrual migraine, not intractable, without status migrainosus |
| G43.83 | Menstrual migraine, intractable |
| G43.839 | Menstrual migraine, intractable, without status migrainosus |
| G43.9 | Migraine, unspecified |
| G43.90 | Migraine, unspecified, not intractable |
| G43.909 | Migraine, unspecified, not intractable, without status migrainosus |
| G43.91 | Migraine, unspecified, intractable |
| G43.919 | Migraine, unspecified, intractable, without status migrainosus |
| G43.B | Ophthalmoplegic migraine |
| G43.B0 | Ophthalmoplegic migraine, not intractable |
| G43.B1 | Ophthalmoplegic migraine, intractable |
| G43.C | Periodic headache syndromes in child or adult |
| G43.C0 | Periodic headache syndromes in child or adult, not intractable |
| G43.C1 | Periodic headache syndromes in child or adult, intractable |
| G43.D | Abdominal migraine |
| G43.D0 | Abdominal migraine, not intractable |
| G43.D1 | Abdominal migraine, intractable |
| G44 | Other headache syndromes |
| G44.0 | Cluster headaches and other trigeminal autonomic cephalgias (TAc) |
| G44.00 | Cluster headache syndrome, unspecified |
| G44.001 | Cluster headache syndrome, unspecified, intractable |
| G44.009 | Cluster headache syndrome, unspecified, not intractable |
| G44.01 | Episodic cluster headache |
| G44.011 | Episodic cluster headache, intractable |
| G44.019 | Episodic cluster headache, not intractable |
| G44.02 | Chronic cluster headache |
| G44.021 | Chronic cluster headache, intractable |
| G44.029 | Chronic cluster headache, not intractable |
| G44.03 | Episodic paroxysmal hemicrania |
| G44.031 | Episodic paroxysmal hemicrania, intractable |
| G44.039 | Episodic paroxysmal hemicrania, not intractable |
| G44.04 | Chronic paroxysmal hemicrania |
| G44.041 | Chronic paroxysmal hemicrania, intractable |
| G44.049 | Chronic paroxysmal hemicrania, not intractable |
| G44.05 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCt) |
| G44.051 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCt), intractable |
| G44.059 | Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCt), not intractable |
| G44.09 | Other trigeminal autonomic cephalgias (TAc) |
| G44.091 | Other trigeminal autonomic cephalgias (TAc), intractable |
| G44.099 | Other trigeminal autonomic cephalgias (TAc), not intractable |
| G44.1 | Vascular headache, not elsewhere classified |
| G44.2 | Tension-type headache |
| G44.20 | Tension-type headache, unspecified |
| G44.201 | Tension-type headache, unspecified, intractable |
| G44.209 | Tension-type headache, unspecified, not intractable |
| G44.21 | Episodic tension-type headache |
| G44.211 | Episodic tension-type headache, intractable |
| G44.219 | Episodic tension-type headache, not intractable |
| G44.22 | Chronic tension-type headache |
| G44.221 | Chronic tension-type headache, intractable |
| G44.229 | Chronic tension-type headache, not intractable |
| G44.3 | Post-traumatic headache |
| G44.30 | Post-traumatic headache, unspecified |
| G44.301 | Post-traumatic headache, unspecified, intractable |
| G44.309 | Post-traumatic headache, unspecified, not intractable |
| G44.31 | Acute post-traumatic headache |
| G44.311 | Acute post-traumatic headache, intractable |
| G44.319 | Acute post-traumatic headache, not intractable |
| G44.32 | Chronic post-traumatic headache |
| G44.321 | Chronic post-traumatic headache, intractable |
| G44.329 | Chronic post-traumatic headache, not intractable |
| G44.4 | Drug-induced headache, not elsewhere classified |
| G44.40 | Drug-induced headache, not elsewhere classified, not intractable |
| G44.41 | Drug-induced headache, not elsewhere classified, intractable |
| G44.5 | Complicated headache syndromes |
| G44.51 | Hemicrania continua |
| G44.52 | New daily persistent headache (NDPh) |
| G44.53 | Primary thunderclap headache |
| G44.59 | Other complicated headache syndrome |
| G44.8 | Other specified headache syndromes |
| G44.81 | Hypnic headache |
| G44.82 | Headache associated with sexual activity |
| G44.83 | Primary cough headache |
| G44.84 | Primary exertional headache |
| G44.85 | Primary stabbing headache |
| G44.89 | Other headache syndrome |
| J00 | Acute nasopharyngitis [common cold] |
| J02.9 | Acute pharyngitis, unspecified |
| R05 | Cough |
| R05 | Cough |
| R09.81 | Nasal congestion |
| R09.81 | Nasal congestion |
| R09.82 | Postnasal drip |
| R50 | Fever of other and unknown origin |
| R50.2 | Drug induced fever |
| R50.8 | Other specified fever |
| R50.81 | Fever presenting with conditions classified elsewhere |
| R50.82 | Postprocedural fever |
| R50.83 | Postvaccination fever |
| R50.84 | Febrile nonhemolytic transfusion reaction |
| R50.9 | Fever, unspecified |
| R50.9 | Fever, unspecified |
| R51 | Headache |
| R53.1 | Weakness |
| R53.81 | Other malaise |
| R53.83 | Other fatigue |
| R68.83 | Chills (without fever) |
Formulary Reference Tool