Interactions between Bayer Select Sinus Pain Formula and Toripalimab
1 drug interaction and 17 additional warnings found for the following 2 drugs:
- Bayer Select Sinus Pain Formula (acetaminophen/pseudoephedrine)
- toripalimab
Drug interactions
Moderate drug interactions
Moderate:
acetaminophen toripalimab
Applies to: Bayer Select Sinus Pain Formula (acetaminophen / pseudoephedrine) and toripalimab
Monitor
Acetaminophen may reduce the efficacy of immune checkpoint inhibitors (ICIs) such as anti-cytotoxic T-lymphocyte-associated protein (CTLA)-4 monoclonal antibodies and/or inhibitors of programmed cell death-1 (PD-1)/programmed death ligand-1 (PD-L1). The mechanism of this interaction has not been fully elucidated, but may involve the ability of acetaminophen to impair proliferation of immune cells and T-cell mediated antitumor immunity, which has been observed in some studies. In the CheckMate 025 trial, patients with advanced renal cell carcinoma (n=297) and detectable serum levels of acetaminophen or its metabolite acetaminophen glucuronide were observed to have significantly poorer overall survival (OS) than patients without detectable acetaminophen levels at treatment onset. Similarly, it was noted during an analysis of plasma samples from patients (n=34) in a separate study who were treated with anti-PD-L1 therapies, with or without anti-CTLA-4 antibodies, that those with a detectable serum acetaminophen level had a significantly lower objective response rate than those without a detectable acetaminophen level (0% vs. 29.4%, respectively). Although OS was numerically shorter for patients with detectable acetaminophen levels compared to those without, this difference was not statistically significant in this study. Likewise, an analysis of plasma samples from patients enrolled in the PREMIS study (n=297) treated with anti-PD-L1 therapies, with or without anti-CTLA-4 antibodies, found that the presence of detectable acetaminophen levels was associated with significantly worse progression-free survival (PFS, median 2.63 months vs. 50.3 months) and OS (median 8.43 months vs. 14.93 months) when compared to those without detectable acetaminophen levels. Similarly, a retrospective single-center study in patients (n=225) with stage IV non-small cell lung cancer (NSCLC) who underwent first-line therapy with pembrolizumab (alone or in combination with platinum-based chemotherapy) or second-line therapy with pembrolizumab, nivolumab, or atezolizumab noted that patients who were exposed to high intensity acetaminophen (defined as therapeutic intake lasting >24 hours or a total intake >60 doses of 1000 mg) between 30 days before to 90 days after the first ICI infusion had an increased risk of treatment failure and a shorter duration of median PFS and OS. Multivariate analyses confirmed that high exposure to acetaminophen was independently associated with a reduction in both PFS and OS. Data are not available for every ICI in combination with acetaminophen in every clinical situation.
Management
Until more information is available, caution and clinical monitoring for reduced efficacy of immune checkpoint inhibitors (ICIs) may be advisable if they are administered with acetaminophen. One study suggests that only a pronounced and/or prolonged intake of acetaminophen is able to reduce the immune response to anti-PD-1/PD-L1 agents in patients with advanced NSCLC and suggests a more restrained and discontinuous intake of acetaminophen (<4 doses of 1000 mg/week) may help avoid worsening patient outcomes in this patient population.
References (3)
- Bessede A, Marabelle A, Guegan JP, et al. (2022) "Impact of acetaminophen on the efficacy of immunotherapy in cancer patients." Ann Oncol, 33, p. 909-15
- Nelli F, Virtuoso A, giannarelli d, et al. (2023) "Effects of acetaminophen exposure on outcomes of patients receiving immune checkpoint inhibitors for advanced non-small-cell lung cancer: a propensity score-matched analysis." Curr Oncol, 30, p. 8117-33
- Najeebullah, ali ma, Naveed R, Khatri G, Priya, hasan mm (2022) "Acetaminophen: a hazard to immunotherapy." Ann Med Surg (Lond), 80, p. 104272
Food/lifestyle interactions
Major food/lifestyle interactions
Major:
acetaminophen Food/Lifestyle
Applies to: Bayer Select Sinus Pain Formula (acetaminophen / pseudoephedrine)
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.
References (1)
- (2022) "Product Information. Acetaminophen (acetaminophen)." Camber Pharmaceuticals, Inc
Moderate food/lifestyle interactions
Moderate:
pseudoephedrine Caffeine
Applies to: Bayer Select Sinus Pain Formula (acetaminophen / pseudoephedrine)
Monitor
Coadministration of two or more sympathomimetic or noradrenergic agents may increase the risk of nervousness, irritability, tachycardia, and/or increased blood pressure. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic and/or noradrenergic agents, including norepinephrine transporter inhibitors. 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 or noradrenergic agents are coadministered. Pulse and blood pressure should be closely monitored. Consultation with individual product labeling, as well as relevant institutional protocols, may be advisable for further guidance.
References (20)
- Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
- Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
- (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
- (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
- (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
- (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
- (2024) "Product Information. Ephedrine (ephedrine)." Hameln Pharma Ltd
- (2023) "Product Information. Ephedrine Hydrochloride (ephedrine)." Wockhardt UK Ltd
- (2026) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
- (2025) "Product Information. Atomoxetine (atomoxetine)." Zentiva Pharma UK Ltd
- (2026) "Product Information. Atomoxetine (Apo) (atomoxetine)." Arrotex Pharmaceuticals Pty Ltd
- Angita Pharma, Inc (2026) AG-ATOMOXETINE Product Monograph (Health Canada) https://pdf.hres.ca/dpd_pm/00059014.PDF
- (2026) "Product Information. Boots Decongestant (Pseudoephedrine) (pseudoephedrine)." The Boots Company Plc
- (2023) "Product Information. Sinus and Nasal Decongestant (Trust) (pseudoephedrine)." Noumed Pharmaceuticals Pty Ltd
- (2019) "Product Information. Ephedrine (ephedrine)." Pfizer Australia Pty Ltd
- (2024) "Product Information. EPHEDrine Sulfate (ePHEDrine)." Amneal Pharmaceuticals LLC
- (2024) "Product Information. Lemsip Cough Max for Mucus Cough and Cold (guaifenesin/paracetamol/phenylephrine)." Reckitt Benckiser Healthcare (UK) Ltd
- emc (2026) Product information: sudafed plus blocked nose 1mg/50mg/ml nasal spray. https://www.medicines.org.uk/emc/product/14256/smpc?utm_source=chatgpt.com
- (2023) "Product Information. EPHEDrine Sulfate (ePHEDrine)." Baxter Corporation
- Neo Health (OTC) Pty Ltd (2026) Product information: pseudoephedrine hydrochloride-paracetamol capsules. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2024-PI-02603-1&d=20260804172310101&d=20260827172310101
Disease interactions
15 potential interactions Applies to: 14 conditions, including Benign Prostatic Hyperplasia, Hyperthyroidism, Diabetes Mellitus, Liver Disease, and Dehydration.
Alcoholism
Major:
Bayer Select Sinus Pain Formula
The acetaminophen in Bayer Select Sinus Pain Formula has a major potential interaction with Alcoholism.
Chronic alcohol abusers may be at increased risk of hepatotoxicity during treatment with acetaminophen (APAP). Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously, if at all, in patients who consume three or more alcoholic drinks a day. In general, patients should avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure. They should also be advised to seek medical attention if they experience signs and symptoms of liver injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.
Benign Prostatic Hyperplasia
Moderate:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a moderate potential interaction with Benign Prostatic Hyperplasia.
Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.
Cardiovascular Conditions and Disorders
Major:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a major potential interaction with Cardiovascular Conditions and Disorders.
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
Cerebrovascular Insufficiency
Major:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a major potential interaction with Cerebrovascular Insufficiency.
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
Dehydration
Major:
Bayer Select Sinus Pain Formula
The acetaminophen in Bayer Select Sinus Pain Formula has a major potential interaction with Dehydration.
Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.
Diabetes Mellitus
Moderate:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a moderate potential interaction with Diabetes Mellitus.
Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.
Gastrointestinal Obstruction
Moderate:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a moderate potential interaction with Gastrointestinal Obstruction.
The extended-release formulation of pseudoephedrine (Sudafed 24 Hour) contains a non-deformable material. There have been rare reports of obstructive symptoms in patients with known strictures following the ingestion of similar sustained-release products. Therapy with the extended-release formulation of pseudoephedrine should be administered cautiously in patients with preexisting severe gastrointestinal narrowing or obstruction, whether pathologic or iatrogenic.
Glaucoma/Intraocular Hypertension
Moderate:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a moderate potential interaction with Glaucoma/Intraocular Hypertension.
Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.
Hyperthyroidism
Major:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a major potential interaction with Hyperthyroidism.
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
Liver Disease
Major:
Bayer Select Sinus Pain Formula
The acetaminophen in Bayer Select Sinus Pain Formula has a major potential interaction with Liver Disease.
Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.
Malnourishment
Major:
Bayer Select Sinus Pain Formula
The acetaminophen in Bayer Select Sinus Pain Formula has a major potential interaction with Malnourishment.
Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.
Phenylketonuria
Moderate:
Bayer Select Sinus Pain Formula
The acetaminophen in Bayer Select Sinus Pain Formula has a moderate potential interaction with Phenylketonuria.
Several oral acetaminophen and acetaminophen-combination products, particularly flavored chewable tablets, contain the artificial sweetener, aspartame (NutraSweet). Aspartame is converted to phenylalanine in the gastrointestinal tract following ingestion. Chewable and effervescent formulations of acetaminophen products may also contain phenylalanine. The aspartame/phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).
Moderate:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a moderate potential interaction with Phenylketonuria.
Chewable products frequently may contain aspartame, which is metabolized in the gastrointestinal tract to phenylalanine. Sudafed (brand of pseudoephedrine) chewable 15 mg tablets provide the equivalent of 0.78 mg of phenylalanine per each tablet. The aspartame/phenylalanine content should be considered when this and similar products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).
Pheochromocytoma
Major:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a major potential interaction with Pheochromocytoma.
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
Prostate Tumor, Benign
Moderate:
Bayer Select Sinus Pain Formula
The pseudoephedrine in Bayer Select Sinus Pain Formula has a moderate potential interaction with Prostate Tumor, Benign.
Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.
More resources
Bayer Select Sinus Pain Formula
A total of 747 drugs are known to interact with Bayer Select Sinus Pain Formula.
- Bayer select sinus pain formula is in the drug class upper respiratory combinations.
- Bayer select sinus pain formula is used to treat Sinus Symptoms.
toripalimab
A total of 628 drugs are known to interact with toripalimab.
- Toripalimab is in the drug class Immune checkpoint inhibitors (PD-1 and PD-L1 inhibitors).
- Toripalimab is used to treat Nasopharyngeal Carcinoma.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.