Multi-Symptom Cold and Flu Medications

What to Know About Popular Options

When you have a cold or flu, you don't typically have just one symptom. There may be a headache, nasal congestion, sneezing, coughing, muscle aches, fever, chills, and a plethora of other symptoms to deal with. It sometimes makes sense, therefore, to buy a multi-symptom cold and flu remedy that attacks several of these symptoms all at once.

There are pros and cons to these over-the-counter (OTC) preparations. On the one hand, you may be exposed to drugs you don't actually need (such as certain decongestants that can make you drowsy). On the other, taking one all-encompassing remedy rather than several reduces your risk of accidental overdosing (as might occur, for example, if you take Tylenol and NyQuil, both of which contain acetaminophen).

If in doubt about whether a multi-symptom cold and flu remedy is right for you, tell your doctor or pharmacist about the symptoms you are experiencing. They can usually point you in the direction of the OTC remedies most suited to your concerns.

Aleve-D Sinus & Headache

If nasal congestion is your main concern during a bout of cold or flu, there are a number of sinus relief formulations that can open nasal passages and relieve a sinus headache.

Aleve-D Sinus & Headache is one of the more popular OTC options comprised of the nonsteroidal anti-inflammatory drug (NSAID) naproxen and the decongestant pseudoephedrine. Depending on the part of the country you are in, it is sometimes sold as Aleve-D Sinus & Cold, which contains the exact same ingredients.

Naproxen in any form should not be taken during the last three months of pregnancy as it may harm the baby by causing the premature closure of the ductus arteriosus (a vessel near the fetal heart).

Advil Multi-Symptom Cold & Flu

Advil Multi-Symptom Cold & Flu is another tablet formulation meant to treat headaches, stuffy nose, sneezing, and itchy eyes. The OTC product contains the NSAID ibuprofen, the antihistamine chlorpheniramine maleate, and the decongestant phenylephrine.

The phenylephrine used in the Advil product is similar to pseudoephedrine used in Aleve-D but is considered "safer" because it has less potential for misuse. Because pseudoephedrine is used in the manufacture of methamphetamine, some states (including Oregon and Mississippi) keep records or require prescriptions for the purchase of any OTC product containing the drug.

Meanwhile, the use of chlorpheniramine maleate, a drug classified as an H1 antihistamine, means that the drug causes less drowsiness than doxylamine succinate, which is also classified as a sedative/hypnotic.

Advil Multi-Symptom Cold & Flu is intended for use in adults and children over 12. Children under 12 should not take this product. The recommended dose is one tablet every four hours, with no more than six doses every 24 hours.

All NSAIDs, including ibuprofen, naproxen, and aspirin, can cause stomach bleeding and ulcers if overused. Using NSAIDs with alcohol further increases the risk.

NyQuil Cold & Flu

NyQuil Cold & Flu is one of the most popular OTC cold and flu medications in the United States, recognized by its green-colored syrup. It includes the analgesic (painkiller) acetaminophen for pain relief, the cough suppressant dextromethorphan (found in Robittusin), and the antihistamine doxylamine succinate to reduce sneezing and watery, itchy eyes.

Dextromethorphan and doxylamine succinate can both cause dizziness and drowsiness, which is why NyQuil is aptly intended for nighttime use. Other common side effects include blurred vision, dry mouth, nervousness, nausea, and stomach ache.

There are other NyQuil products available, including NyQuil extended-relief tablets, NyQuil Cough Suppressant (which is acetaminophen-free), and NyQuil Severe Cold & Flu Nighttime Relief (which also contains the nasal decongestant phenylephrine).

There is also Children's NyQuil that contains only dextromethorphan and chlorpheniramine maleate (which is similar to, but less sedating than doxylamine succinate).

NyQuil is dosed at 30 milliliters (ml) every four hours, with no more than four doses per 24 hours. Children's NyQuil is dosed at 15 ml (roughly one tablespoon) every four hours, with no more than four doses every 24 hours. Both products are sold with handy measuring caps for accurate dosing.

NyQuil should not be used in children under 12. Children age 6 to 11 can use Children's Nyquil formulated specially for kids. Children 4 to 5 years old should only use Children's NyQuil under the direction of a pediatrician.

DayQuil Cold & Flu

As per its name, DayQuil Cold & Flu is basically the daytime version of Nyquil Severe Cold & Flu Nighttime Relief without the antihistamine doxylamine succinate. It is easily recognized by its orange-colored syrup, which many generic manufacturers replicate in their products.

The omission of doxylamine succinate reduces the drowsiness associated with NyQuil, though not entirely. As such, you should still use caution when taking DayQuil; avoiding driving and the use of heavy machinery whenever possible.

The dosing instructions for DayQuil for adults is the same as NyQuil (30 ml every four hours and no more than four doses per 24 hours). There is no children's version of DayQuil, but kids can be given DayQuil with the same age restrictions and the same doses recommended for Children's NyQuil (15 ml every four hours, limit four doses per 24 hours).

In addition to the syrup formulation, there are also DayQuil LiquiCap capsules that allow for easy dosing if the syrup is unpalatable or inconvenient.

DayQuil Severe Cold & Flu is a version of DayQuil that includes the mucus-releasing expectorant guaifenesin.

Avoid taking any product containing dextromethorphan with grapefruit juice, which can increase concentrations of the drug in the bloodstream and make side effects worse.

Tylenol Cold Max Night

Tylenol Cold Max Night contains the same exact ingredient as NyQuil Severe Cold & Flu Nighttime Relief. The only difference is the drug manufacturer and product name; many people turn to Tylenol because of brand awareness, as it was the original OTC brand name for acetaminophen in the United States.

Tylenol Cold Max Night is not intended for daytime use as it can cause drowsiness. Like NyQuil, it is taken as a syrup in 30-ml doses and carries the same restrictions in children.

Unlike naproxen, ibuprofen, or aspirin, acetaminophen is not an NSAID and is not associated with the risk of gastric bleeding. However, nausea, stomach pain, diarrhea, or constipation are not uncommon.

Overuse of any drug containing acetaminophen can cause liver damage. The risk is further amplified if alcohol is consumed.

Alka-Seltzer Plus Multi-Symptom Cold & Flu

Alka-Seltzer is an effervescent OTC drug commonly used to treat heartburn, indigestion, and stomach upset. The brand also has a multi-symptom cold and flu remedy that contains a different mix of drugs. The four active ingredients are acetaminophen, dextromethorphan, guaifenesin, and phenylephrine.

Similar to DayQuil Severe Cold & Flu, Alka-Seltzer Plus Multi-Symptom Cold & Flu has a higher per-pill dose of acetaminophen (500 milligrams versus 325 milligrams). This places it in line with the per-pill dose of Tylenol Extra Strength, commonly used to treat arthritis pain.

Alka-Seltzer Plus Multi-Symptom Cold & Flu can be taken every four hours by dissolving a single-dose packet in eight ounces of water. It is intended for use in adults and children over 12. It should never be used in children under 12.

Alka-Seltzer effervescent products are ideal for people who don't like pills or syrups. While some drugs are known to be delivered faster and act quicker using effervescent agents, there is no evidence Alka-Seltzer's effervescence makes it any more or less effective than other OTC cold and flu remedies.

Medications containing pseudoephedrine, phenylephrine, or dextromethorphan should not be used with monoamine oxidase inhibitors (MAOI) antidepressants. MAOIs can amplify the side effects of antihistamines or lead to a rare but serious reaction called serotonin syndrome when taken with dextromethorphan.

Theraflu Nighttime Severe Cold & Cough

Many people turn to Theraflu products because they feel comforting and soothing. As opposed to syrups and pills that are clearly medicinal, Theraflu products are mixed with warm water and sipped like tea.

Theraflu Nighttime Severe Cold & Cough contains acetaminophen, dextromethorphan, and phenylephrine and is sold in single-dose packets in powder form. It contains among the highest dose of acetaminophen compared to other OTC remedies (650 milligrams). This is the dose typically reserved for extended-release painkillers like Tylenol 8-Hour.

Theraflu Nighttime Severe Cold and Cough can be used in adults and children over 12. Avoid use in younger children. It can be taken every four hours, with a daily limit of no more than five packets every 24 hours. Simply mix it with eight ounces of warm water, let it dissolve, and sip.

There is also a daytime formula, called Theraflu Daytime Severe Cold and Cough, which contains half the dose of dextromethorphan.

While uncommon, allergies to acetaminophen have been known to occur, including potentially life-threatening anaphylaxis. Call 911 or go to your nearest emergency room if you experience some or all of the following after taking acetaminophen:

  • Rash or hives
  • Difficulty breathing or wheezing
  • Rapid or irregular heartbeats
  • Dizziness or fainting
  • Swelling of the face, neck, or tongue
  • A feeling of impending doom

A Word From Verywell

These are only a few of the multi-symptom cold and flu products found on drugstore and grocery store shelves. To compete with well-known brands, many retailers have created their own versions of these products with the same ingredients (and typically cheaper prices). While these generally work no better or worse than the brand name options, always compare labels to ensure that all of the ingredients are, in fact, the same.

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