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Drug Interactions between Alka-Seltzer Plus Multi-Symptom Cold & Flu Day & Night Liquid Gels (Night Formula) and Liqui-Char with Sorbitol

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

acetaminophen charcoal

Applies to: Alka-Seltzer Plus Multi-Symptom Cold & Flu Day & Night Liquid Gels (Night Formula) (acetaminophen / dextromethorphan / doxylamine / phenylephrine) and Liqui-Char with Sorbitol (charcoal / sorbitol)

GENERALLY AVOID: Charcoal may reduce the absorption of many drugs and can absorb enterohepatically circulated drugs. Clinical utility may be the reduction either of the effects or of the toxicity of many drugs. Activated charcoal may adsorb any therapeutic agents administered while it is in the gastrointestinal tract.

MANAGEMENT: The regular ingestion of charcoal should be avoided by patients requiring maintenance medications. If concomitant use is necessary, the dosage or route of administration may need to be altered.

References

  1. Decker WJ, Shpall RA, Corby DG "Inhibition of aspirin absorption by activated charcoal and apomorphine." Clin Pharmacol Ther 10 (1969): 710-3
  2. Knadler MP, Bergstrom RF, Callaghan JT, Obermeyer BD, Rubin A "Absorption studies of the H2-blocker nizatidine." Clin Pharmacol Ther 42 (1987): 514-20
  3. Wing LM, Miners JO, Birkett DJ, et al. "Lidocaine disposition: sex differences and effects of cimetidine." Clin Pharmacol Ther 35 (1984): 695-701
  4. Scheufler E, Bos I "Influence of peroral charcoal on pharmacokinetics and intestinal toxicity of intravenously given methotrexate." Arch Int Pharmacodyn Ther 261 (1983): 180-5
  5. Gadgil SD, Damle SR, Advani SH, Vaidya AB "Effect of activated charcoal on the pharmacokinetics of high-dose methotrexate." Cancer Treat Rep 66 (1982): 1169-71
  6. Park GD, Spector R, Goldberg MJ, Johnson GF "Expanded role of charcoal therapy in the poisoned and overdosed patient." Arch Intern Med 146 (1986): 969-73
  7. Watson WA "Factors influencing the clinical efficacy of activated charcoal." Drug Intell Clin Pharm 21 (1987): 160-6
  8. Kivisto KT, Neuvonen PJ "The effect of cholestyramine and activated charcoal on glipizide absorption." Br J Clin Pharmacol 30 (1990): 733-6
  9. Dolgin JG, Nix DE, Sanchez J, Watson WA "Pharmacokinetic simulation of the effect of multiple-dose activated charcoal in phenytoin poisoning: report of two pediatric cases." DICP 25 (1991): 646-9
  10. Rowden AM, Spoor JE, Bertino JS, Jr "The effect of activated charcoal on phenytoin pharmacokinetics." Ann Emerg Med 19 (1990): 1144-7
  11. Farrar HC, Herold DA, Reed MD "Acute valproic acid intoxication: enhanced drug clearance with oral-activated charcoal." Crit Care Med 21 (1993): 299-301
  12. Howard CE, Roberts RS, Ely DS, Moye RA "Use of multiple-dose activated charcoal in phenytoin toxicity." Ann Pharmacother 28 (1994): 201-3
  13. Chernish SM, Wolen RL, Rodda BE "Adsorption of propoxyphene hydrochloride by activated charcoal." Clin Toxicol 5 (1972): 317-29
  14. Glab WN, Corby DG, Decker WJ, Coldiron VR "Decreased absorption of propoxyphene by activated charcoal." J Toxicol Clin Toxicol 19 (1982): 129-38
  15. Karkkainen S, Neuvonen PJ "Effect of oral charcoal and urine pH on dextropropoxyphene pharmacokinetics." Int J Clin Pharmacol Ther Toxicol 23 (1985): 219-25
  16. Wakabayashi Y, Maruyama S, Hachimura K, Ohwada T "Activated charcoal interrupts enteroenteric circulation of phenobarbital." J Toxicol Clin Toxicol 32 (1994): 419-24
  17. Reed MD "Oral activated charcoal therapy." Am J Emerg Med 6 (1988): 318
  18. Neuvonen PJ "Clinical pharmacokinetics of oral activated charcoal in acute intoxications." Clin Pharmacokinet 7 (1982): 465-89
  19. Naveau S, Bonhomme L, Preaux N, Chaput JC "A pure charcoal suspension for colonoscopic tattoo." Gastrointest Endosc 37 (1991): 624-5
  20. Ilkhanipour K, Yealy DM, Krenzelok EP "Activated charcoal surface area and its role in multiple-dose charcoal therapy." Am J Emerg Med 11 (1993): 583-5
  21. Saetta JP "Gastric decontaminating procedures: is it time to call a stop?" J R Soc Med 86 (1993): 396-9
  22. Orisakwe OE "Activated charcoal: is failure to use it negligence or ignorance?" South Med J 87 (1994): 165-8
  23. Herrington AM, Clifton GD "Toxicology and management of acute drug ingestions in adults." Pharmacotherapy 15 (1995): 182-200
  24. Bonuccelli U, Piccini P, Del Dotto P, Pavese N, D'Antonio P, Muratorio A "Apomorphine test in de novo Parkinson's disease." Funct Neurol 7 (1992): 295-8
  25. "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals PROD (2001):
View all 25 references

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Moderate

dextromethorphan doxylamine

Applies to: Alka-Seltzer Plus Multi-Symptom Cold & Flu Day & Night Liquid Gels (Night Formula) (acetaminophen / dextromethorphan / doxylamine / phenylephrine) and Alka-Seltzer Plus Multi-Symptom Cold & Flu Day & Night Liquid Gels (Night Formula) (acetaminophen / dextromethorphan / doxylamine / phenylephrine)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. Sedation and impairment of attention, judgment, thinking, and psychomotor skills may increase.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Hamilton MJ, Bush M, Smith P, Peck AW "The effects of bupropion, a new antidepressant drug, and diazepam, and their interaction in man." Br J Clin Pharmacol 14 (1982): 791-7
  2. Stambaugh JE, Lane C "Analgesic efficacy and pharmacokinetic evaluation of meperidine and hydroxyzine, alone and in combination." Cancer Invest 1 (1983): 111-7
  3. Sotaniemi EA, Anttila M, Rautio A, et al. "Propranolol and sotalol metabolism after a drinking party." Clin Pharmacol Ther 29 (1981): 705-10
  4. Grabowski BS, Cady WJ, Young WW, Emery JF "Effects of acute alcohol administration on propranolol absorption." Int J Clin Pharmacol Ther Toxicol 18 (1980): 317-9
  5. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF "The effect of fluoxetine on the pharmacokinetics and psychomotor responses of diazepam." Clin Pharmacol Ther 43 (1988): 412-9
  6. MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM "Diazepam actions and plasma concentrations following ethanol ingestion." Eur J Clin Pharmacol 11 (1977): 345-9
  7. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
  8. Naylor GJ, McHarg A "Profound hypothermia on combined lithium carbonate and diazepam treatment." Br Med J 2 (1977): 22
  9. Stovner J, Endresen R "Intravenous anaesthesia with diazepam." Acta Anaesthesiol Scand 24 (1965): 223-7
  10. Driessen JJ, Vree TB, Booij LH, van der Pol FM, Crul JF "Effect of some benzodiazepines on peripheral neuromuscular function in the rat in-vitro hemidiaphragm preparation." J Pharm Pharmacol 36 (1984): 244-7
  11. Feldman SA, Crawley BE "Interaction of diazepam with the muscle-relaxant drugs." Br Med J 1 (1970): 336-8
  12. Ochs HR, Greenblatt DJ, Verburg-Ochs B "Propranolol interactions with diazepam, lorazepam and alprazolam." Clin Pharmacol Ther 36 (1984): 451-5
  13. Desager JP, Hulhoven R, Harvengt C, Hermann P, Guillet P, Thiercelin JF "Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic." Psychopharmacology (Berl) 96 (1988): 63-6
  14. Tverskoy M, Fleyshman G, Ezry J, Bradley EL, Jr Kissin I "Midazolam-morphine sedative interaction in patients." Anesth Analg 68 (1989): 282-5
  15. "Product Information. Iopidine (apraclonidine ophthalmic)." Alcon Laboratories Inc PROD
  16. Greiff JMC, Rowbotham D "Pharmacokinetic drug interactions with gastrointestinal motility modifying agents." Clin Pharmacokinet 27 (1994): 447-61
  17. Greb WH, Buscher G, Dierdorf HD, Koster FE, Wolf D, Mellows G "The effect of liver enzyme inhibition by cimetidine and enzyme induction by phenobarbitone on the pharmacokinetics of paroxetine." Acta Psychiatr Scand 80 Suppl (1989): 95-8
  18. Markowitz JS, Wells BG, Carson WH "Interactions between antipsychotic and antihypertensive drugs." Ann Pharmacother 29 (1995): 603-9
  19. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical PROD (2001):
  20. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories PROD (2001):
  21. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) PROD (2001):
  22. "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals PROD (2001):
  23. "Product Information. Meridia (sibutramine)." Knoll Pharmaceutical Company PROD (2001):
  24. "Product Information. Tasmar (tolcapone)." Valeant Pharmaceuticals PROD (2001):
  25. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  26. "Product Information. Precedex (dexmedetomidine)." Abbott Pharmaceutical PROD (2001):
  27. "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals PROD (2001):
  28. Ferslew KE, Hagardorn AN, McCormick WF "A fatal interaction of methocarbamol and ethanol in an accidental poisoning." J Forensic Sci 35 (1990): 477-82
  29. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35
  30. "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc (2002):
  31. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals (2002):
  32. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  33. Cerner Multum, Inc. "Australian Product Information." O 0
  34. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  35. "Product Information. Belsomra (suvorexant)." Merck & Co., Inc (2014):
  36. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 36 references

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Drug and food interactions

Major

acetaminophen food

Applies to: Alka-Seltzer Plus Multi-Symptom Cold & Flu Day & Night Liquid Gels (Night Formula) (acetaminophen / dextromethorphan / doxylamine / phenylephrine)

GENERALLY AVOID: Chronic, excessive consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity, which has included rare cases of fatal hepatitis and frank hepatic failure requiring liver transplantation. The proposed mechanism is induction of hepatic microsomal enzymes during chronic alcohol use, which may result in accelerated metabolism of acetaminophen and increased production of potentially hepatotoxic metabolites.

MANAGEMENT: In general, chronic alcoholics should avoid regular or excessive use of acetaminophen. Alternative analgesic/antipyretic therapy may be appropriate in patients who consume three or more alcoholic drinks per day. However, if acetaminophen is used, these patients should be cautioned not to exceed the recommended dosage (maximum 4 g/day in adults and children 12 years of age or older).

References

  1. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med 145 (1985): 2019-23
  2. O'Dell JR, Zetterman RK, Burnett DA "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA 255 (1986): 2636-7
  3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med 104 (1986): 399-404
  4. Thummel KE, Slattery JT, Nelson SD "Mechanism by which ethanol diminishes the hepatotoxicity of acetaminophen." J Pharmacol Exp Ther 245 (1988): 129-36
  5. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA 244 (1980): 251-3
  6. Kartsonis A, Reddy KR, Schiff ER "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med 105 (1986): 138-9
  7. Prescott LF, Critchley JA "Drug interactions affecting analgesic toxicity." Am J Med 75 (1983): 113-6
  8. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
  9. Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50
  10. Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  11. Nelson EB, Temple AR "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  12. Zimmerman HJ, Maddrey WC "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology 22 (1995): 767-73
View all 12 references

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Moderate

dextromethorphan food

Applies to: Alka-Seltzer Plus Multi-Symptom Cold & Flu Day & Night Liquid Gels (Night Formula) (acetaminophen / dextromethorphan / doxylamine / phenylephrine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Moderate

doxylamine food

Applies to: Alka-Seltzer Plus Multi-Symptom Cold & Flu Day & Night Liquid Gels (Night Formula) (acetaminophen / dextromethorphan / doxylamine / phenylephrine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Moderate

phenylephrine food

Applies to: Alka-Seltzer Plus Multi-Symptom Cold & Flu Day & Night Liquid Gels (Night Formula) (acetaminophen / dextromethorphan / doxylamine / phenylephrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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