Multi-Symptom Cold and Flu Medications

Multi-symptom cold medicines contain different drug combinations that relieve congestion, coughing, headaches, fever, and other cold and flu symptoms.

These all-in-one remedies are convenient but may contain more medication than you need. Some active ingredients come with side effects, warnings, and risks.

People who have high blood pressure, are pregnant, or take other over-the-counter (OTC) or prescription medicine should be cautious when selecting a combination cold med.

This article discusses multi-symptom cold medicine. It lists the active ingredients in different OTC cold meds to help you decide which one is right for your symptoms.

Common Cold Medicine Ingredients

Different brands and formulas contain different combinations of:

• Analgesics (pain/fever reducer): acetaminophen, aspirin, ibuprofen, and naproxen
• Antihistamines: chlorpheniramine, doxylamine succinate, and diphenhydramine
• Cough suppressants: dextromethorphan
• Decongestants: phenylephrine and pseudoephedrine
• Expectorants: guaifenesin

These ingredients have various side effects and risks. Look for medicines that treat only the symptoms you have to avoid taking ones you don't need.

Be careful about mixing cold medicine with other OTC medications to avoid an accidental overdose.

Analgesics

Analgesics reduce fever and relieve headaches, body aches, and sore throats. OTC drugs in this class include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) aspirin, ibuprofen, and naproxen.

NSAIDs can cause stomach bleeding and ulcers if overused. Taking them with alcohol increases the risk. Avoid taking more than one NSAID at a time.

Acetaminophen is not an NSAID but can also cause gastric side effects. Avoid taking more than one acetaminophen product at a time, which could cause liver damage. The risk increases if alcohol is consumed.

Cold medicines that contain acetaminophen include Coricidin, Dayquil, Nyquil, Mucinex, Robitussin, Theraflu, and Tylenol. 

Cold medicines without acetaminophen include Advil Multi-Symptom Cold and Flu, Aleve-D Sinus and Cold, and Alka-Selzer Plus.

Antihistaminines

Antihistamines help to relieve a runny nose, sneezing, and itchy, watery eyes. Some, like doxylamine succinate and diphenhydramine, are used in nighttime cold medicine because they make you drowsy.

Antihistamines can also cause dizziness, dry mouth, and blurry vision. Taking multiple antihistamines at once can increase these side effects.

If you take a daily antihistamine to treat allergies, do not take a cold medicine that contains antihistamines. Cold medicines without antihistamines include Aleve Sinus and Cold, Alka-Seltzer Plus Day, DayQuil, Mucinex, and Robitussin.

Cough Medicines

OTC cough medicines come in two forms. Dextromethorphan is a cough suppressant. Guaifenesin is an expectorant, which thins mucus and phlegm so you can cough it up.

Dextromethorphan side effects include dizziness, drowsiness, nausea, nervousness, and restlessness.  Avoid taking dextromethorphan with grapefruit juice, which can increase side effects.

Guaifenesin side effects include headache, nausea, and vomiting. It should not be given to children under age 4 and should be used with caution in children 4 to 11.

Decongestants

Decongestants phenylephrine and pseudoephedrine are used to relieve congestion from colds and flu. They work by narrowing blood vessels in the sinus cavity to reduce swelling, making it easier to breathe.

Decongestants should not be given to children under 6. These medications have side effects, including dizziness, insomnia, nausea, nervousness, and restlessness.

Decongestants should be used with caution in people with high blood pressure, glaucoma, diabetes, difficulty urinating, thyroid disease, or heart disease.

Advil Multi-Symptom Cold & Flu

Advil Multi-Symptom Cold & Flu treats headaches, stuffy nose, sneezing, and itchy eyes. One dose (one tablet) contains:

• Chlorpheniramine 4 mg (antihistamine)
• Ibuprofen 200 mg (pain/fever reducer)
• Phenylephrine 10 mg (decongestant)

Phenylephrine is considered a safer decongestant because it has a low potential for misuse. Chlorpheniramine is an H1 antihistamine that is less likely to cause drowsiness than some other antihistamines.

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.

Do not take it with other products containing NSAIDs, such as aspirin, ibuprofen, or naproxen.

Aleve-D Sinus & Cold

Aleve-D Sinus & Cold treats headaches, stuffy nose, congestion, and fever. One dose (one tablet) contains:

• Naproxen 200 mg (pain/fever reducer)
• Pseudoephedrine 120 mg, extended-release (decongestant)
  

Because pseudoephedrine is used in the manufacture of methamphetamine, you are required to show your ID for the purchase of any OTC product containing the drug.

Aleve-D Sinus & Cold is for use in adults and children over 12. Children under 12 should not take this product. The recommended dose is one tablet every 12 hours.

Do not take it with other products containing NSAIDs, such as aspirin, ibuprofen, or naproxen.

Alka-Seltzer Plus Severe Cold & Flu Powerfast Fizz 

Alka-Seltzer Plus Severe Cold & Flu Powerfast Fizz is an effervescent cold medicine that treats cough, congestion, fever, and headache. It comes in formulas for day and night.

One daytime dose (two tablets) contains:

• Aspirin 650 mg (pain/fever reducer)
• Dextromethorphan 20 mg (cough suppressant)
• Phenylephrine 15.6 mg (decongestant)

One nighttime dose (two tablets) contains:

• Aspirin 650 mg (pain/fever reducer)
• Chlorpheniramine 4 mg (antihistamine)
• Dextromethorphan 20 mg (cough suppressant)
• Phenylephrine 15.6 mg (decongestant)

Dissolve a single-dose packet of Alka-Seltzer Plus (two tablets) in 8 ounces of water and take every four to six hours. It is intended for use in adults and children over 12 and should not be given to younger children.

Do not take it with other products containing NSAIDs, such as aspirin, ibuprofen, or naproxen.

Coricidin HBP Cold & Flu

Coricidin HBP Cold & Flu is a decongestant-free cold medicine approved for use in people with high blood pressure and children over age 6. It treats fever, runny nose, sneezing, body aches, headache and sore throat.

One adult dose (two tablets) contains:

• Acetaminophen 650 mg (pain/fever reducer)
• Chlorpheniramine 4 mg (antihistamine)

Children age 6 to 11 can take one tablet every four to six hours for no more than five tablets in 24 hours. Adults and children 12 and over should take two tablets every four to six hours for no more than 12 tablets in 24 hours.

Do not take it with other products containing acetaminophen, such as Tylenol.

DayQuil Cold & Flu

DayQuil Cold & Flu is a liquid multi-symptom cold medication that can be used in people ages 6 and up. This non-drowsy formula treats congestion, coughing, fever, headache, body aches, and sore throat.

One adult dose (30 mL) contains:

• Acetaminophen 650 mg (pain/fever reducer) 
• Dextromethorphan 20 mg (cough suppressant)
• Phenylephrine 10 mg (decongestant)

The dose for children ages 6 to 11 is 15 mL, and for people over the age of 12 is 30 mL every four hours, with a maximum of four doses per day. This medicine also comes as a capsule sold as DayQuil LiquiCap. Children 6 to 11 can take one capsule, and adults can take two.

Another version, DayQuil Severe Cold & Flu, also includes an expectorant guaifenesin, which helps to thin and expel mucus. Do not take it with other products containing acetaminophen, such as Tylenol.

Mucinex Fast-Max Cold & Flu

Mucinex Fast-Max Cold & Flu treats congestion, cough, fever, headache, body aches, and sore throat. It also helps to break up chest congestion, helping you to cough up phlegm. 

One dose (two capsules) contains: 

• Acetaminophen 650 mg (pain/fever reducer)
• Dextromethorphan 20 mg (cough suppressant) 
• Guaifenesin 400 mg (expectorant) 
• Phenylephrine 10 mg (decongestant)

Adults and children 12 and over can take two liquid gels every four hours. Do not take more than 12 liquid gels in a 24-hour period. It should not be given to children under 12.

Do not take it with other products containing acetaminophen, such as Tylenol.

NyQuil Cold & Flu

NyQuil Cold & Flu is a popular nighttime cough and cough medicine that relieves cold and flu symptoms and helps promote sleep. One 30 mL dose contains: 

• Acetaminophen 650 mg (pain/fever reducer)
• Dextromethorphan 30 mg (cough suppressant) 
• Doxylamine succinate 12.5 mg (antihistamine)

Dextromethorphan and doxylamine succinate both cause drowsiness, which is why NyQuil is for nighttime use.

Other NyQuil products include:

• NyQuil extended-relief tablets
• NyQuil Cough Suppressant (acetaminophen-free)
• NyQuil Severe Cold & Flu Nighttime Relief (also contains phenylephrine, a decongestant)
• Children's NyQuil (dextromethorphan and chlorpheniramine)

Adults and children 12 and over can take 30 mL of NyQuil every six hours. Do not exceed four doses in 24 hours. Do not take it with other products containing acetaminophen, such as Tylenol.

Robitussin Multi-Symptom Cough, Cold + Flu

Robitussin Multi-Symptom Cough, Cold + Flu helps to treat congestion, coughing, fever, sore throat, headache, and body aches. It also helps to loosen phlegm, making it easier to cough up. 

One 20 mL dose contains: 

• Acetaminophen 650 mg (pain/fever reducer)
• Dextromethorphan 20 mg (cough suppressant) 
• Guaifenesin 400 mg (expectorant) 
• Phenylephrine 10 mg (decongestant)

Adults and children 12 and over can take 20 mL every four hours. Do not take more than six doses in 24 hours. Do not give to children under 12 years old. 

Theraflu Nighttime Severe Cold & Cough

Theraflu Nighttime Severe Cold & Cough helps to treat congestion, runny nose, itchy eyes, fever, sore throat, headache, and body aches. It also helps you sleep. Unlike other cold medicines on this list, it comes as a powder that is dissolved in hot water and sipped like tea.  

One dose contains: 

• Acetaminophen 650 mg (pain/fever reducer)
• Diphenhydramine 25 mg (antihistamine)
• Phenylephrine 10 mg (decongestant)

Theraflu Nighttime Severe Cold and Cough is approved for use in adults and children over 12. To take, mix one packet in 8 ounces of hot water, let it dissolve, and sip over 10 to 15 minutes. You can take one packet every four hours.

Do not exceed five doses in 24 hours or give to children under 12. Do not take it with other products containing acetaminophen, such as Tylenol.

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

Tylenol Cold + Flu Severe

Tylenol Cold + Flu Severe treats congestion, cough, fever, headache, body aches, and sore throat. It also helps to thin mucus, helping you to cough up phlegm. It comes in two formulas for day and night relief.

One daytime dose (two caplets) contains: 

• Acetaminophen 650 mg (pain/fever reducer)
• Dextromethorphan 20 mg (cough suppressant) 
• Guaifenesin 400 mg (expectorant) 
• Phenylephrine 10 mg (decongestant)

The nighttime dose (two caplets) contains:

• Acetaminophen 650 mg (pain/fever reducer)
• Chlorpheniramine 4 mg (antihistamine)
• Dextromethorphan 20 mg (cough suppressant) 
• Phenylephrine 10 mg (decongestant)

The difference between the two formulas is the day version contains a cough expectorant, and the night version contains an antihistamine that should make you drowsy and help you sleep.

Adults and children 12 and over can take two caplets every four hours. Do not exceed 10 caplets in 24 hours. Do not give to children under 12.

Do not take it with other products containing acetaminophen.