Antihistamine/decongestant combination (Oral route)

Brand Names:

Alavert-D 12-Hour
Aldex D
AllanVan-S
Allegra-D
BPM Pseudo
Bromfed-PD
Ceron
Deconamine SR
Pediatex 12D
Pediatex-D
Robitussin DM
Ryneze
Semprex-D
Tannate Pediatric
Tripohist D
Uni-Tann D
ZyrTEC-D
Benylin For Allergies

Dosage Forms:

Solution
Tablet, Extended Release
Syrup
Suspension
Elixir
Tablet
Tablet, Chewable
Tablet, Extended Release, 24 HR

Uses of This Medicine:

In November 2000, the Food and Drug Administration (FDA) issued a public health warning regarding phenylpropanolamine (PPA) due to the risk of hemorrhagic stroke. The FDA, supported by results of a research program, requested that manufacturers voluntarily discontinue marketing products that contain PPA and that consumers work with their healthcare providers to select alternative products.

Antihistamine and decongestant combinations are used to treat the nasal congestion (stuffy nose), sneezing, and runny nose caused by colds and hay fever.

Antihistamines work by preventing the effects of a substance called histamine, which is produced by the body. Histamine can cause itching, sneezing, runny nose, and watery eyes. Antihistamines contained in these combinations are:

acrivastine, azatadine, brompheniramine, carbinoxamine, chlorpheniramine, clemastine, dexbrompheniramine, diphenhydramine, loratadine, pheniramine, phenyltoloxamine, promethazine, pyrilamine, and triprolidine.

The decongestants, such as phenylephrine, and pseudoephedrine, produce a narrowing of blood vessels. This leads to clearing of nasal congestion, but it may also cause an increase in blood pressure in patients who have high blood pressure.

Some of these combinations are available only with your doctor's prescription. Others are available without a prescription; however, your doctor may have special instructions on the proper dose of the medicine for your medical condition.

Do not give any over-the-counter (OTC) cough and cold medicine to a baby or child under 2 years of age. Using these medicines in very young children might cause serious or possibly life-threatening side effects .

Before Using This Medicine:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Very young children are usually more sensitive to the effects of this medicine. Increases in blood pressure, nightmares or unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in children. Before giving any of these combination medicines to a child, check the package label very carefully. Some of these medicines are too strong for use in children. If you are not certain whether a specific product can be given to a child, or if you have any questions about the amount to give, check with your health care professional.

Older adults—

Confusion, difficult and painful urination, dizziness, drowsiness, dryness of mouth, or convulsions (seizures) may be more likely to occur in the elderly, who are usually more sensitive to the effects of this medicine. Also, nightmares or unusual excitement, nervousness, restlessness, or irritability may be more likely to occur in elderly patients.

Pregnancy—

The occasional use of antihistamine and decongestant combinations is not likely to cause problems in the fetus or in the newborn baby. However, when these medicines are used at higher doses and/or for a long time, the chance that problems might occur may increase. For the individual ingredients of these combinations, the following apply:

Alcohol—Some of these combination medicines contain alcohol. Too much use of alcohol during pregnancy may cause birth defects.
Phenylephrine—Studies on birth defects have not been done in either humans or animals with phenylephrine.
Promethazine—Phenothiazines, such as promethazine (contained in some of these combination medicines [e.g., Phenergan-D]), have been shown to cause jaundice and muscle tremors in a few newborn infants whose mothers received phenothiazines during pregnancy. Also, the newborn baby may have blood clotting problems if promethazine is taken by the mother within 2 weeks before delivery.
Pseudoephedrine—Studies on birth defects with pseudoephedrine have not been done in humans. In animal studies pseudoephedrine did not cause birth defects but did cause a decrease in average weight, length, and rate of bone formation in the animal fetus when administered in high doses.

Breast-feeding—

Small amounts of antihistamines and decongestants pass into the breast milk. Use is not recommended since the chances are greater for this medicine to cause side effects, such as unusual excitement or irritability, in the nursing baby. Also, since antihistamines tend to decrease the secretions of the body, it is possible that the flow of breast milk may be reduced in some patients. It is not known yet whether loratadine causes these same side effects.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

Alfuzosin
Amiodarone
Amisulpride
Amitriptyline
Amprenavir
Anagrelide
Apomorphine
Aripiprazole
Aripiprazole Lauroxil
Arsenic Trioxide
Artemether
Asenapine
Astemizole
Atazanavir
Azithromycin
Bedaquiline
Bepridil
Buprenorphine
Buserelin
Ceritinib
Chloroquine
Chlorpromazine
Ciprofloxacin
Cisapride
Citalopram
Clarithromycin
Clofazimine
Clomipramine
Clorgyline
Clothiapine
Clozapine
Crizotinib
Cyclobenzaprine
Dabrafenib
Darunavir
Dasatinib
Degarelix
Delamanid
Delavirdine
Desipramine
Deslorelin
Deutetrabenazine
Dexmedetomidine
Dihydroergotamine
Disopyramide
Dofetilide
Dolasetron
Domperidone
Donepezil
Doxepin
Dronedarone
Droperidol
Ebastine
Efavirenz
Encorafenib
Entrectinib
Eribulin
Erythromycin
Escitalopram
Famotidine
Felbamate
Fexinidazole
Fingolimod
Flecainide
Fluoxetine
Fluvoxamine
Formoterol
Foscarnet
Fosphenytoin
Fostemsavir
Furazolidone
Galantamine
Gatifloxacin
Gemifloxacin
Gepirone
Glasdegib
Gonadorelin
Goserelin
Granisetron
Halofantrine
Haloperidol
Histrelin
Hydroquinidine
Hydroxychloroquine
Hydroxyzine
Ibutilide
Iloperidone
Imipramine
Indinavir
Inotuzumab Ozogamicin
Iproniazid
Isocarboxazid
Itraconazole
Ivabradine
Ivosidenib
Ketoconazole
Lapatinib
Lenvatinib
Leuprolide
Levofloxacin
Levoketoconazole
Levomethadyl
Linezolid
Lofexidine
Lumefantrine
Macimorelin
Mefloquine
Mesoridazine
Methadone
Methotrimeprazine
Methylene Blue
Metronidazole
Mifepristone
Mirtazapine
Mizolastine
Mobocertinib
Moclobemide
Moricizine
Moxifloxacin
Nafarelin
Nefazodone
Nelfinavir
Nialamide
Nilotinib
Norfloxacin
Octreotide
Ofloxacin
Olanzapine
Ondansetron
Osilodrostat
Osimertinib
Oxaliplatin
Ozanimod
Pacritinib
Paliperidone
Panobinostat
Papaverine
Pargyline
Paroxetine
Pasireotide
Pazopanib
Pentamidine
Perphenazine
Phenelzine
Pimavanserin
Pimozide
Pipamperone
Piperaquine
Pitolisant
Ponesimod
Posaconazole
Potassium Citrate
Probucol
Procainamide
Procarbazine
Prochlorperazine
Promethazine
Propafenone
Protriptyline
Quetiapine
Quinidine
Quinine
Ranolazine
Rasagiline
Relugolix
Ribociclib
Risperidone
Ritonavir
Safinamide
Saquinavir
Selegiline
Selpercatinib
Sertindole
Sertraline
Sevoflurane
Sibutramine
Sodium Phosphate
Sodium Phosphate, Dibasic
Sodium Phosphate, Monobasic
Solifenacin
Sorafenib
Sotalol
Sparfloxacin
Sulpiride
Sultopride
Sunitinib
Tacrolimus
Tamoxifen
Telaprevir
Telavancin
Telithromycin
Tetrabenazine
Thioridazine
Tipranavir
Toloxatone
Tolterodine
Toremifene
Tranylcypromine
Trazodone
Triclabendazole
Trimipramine
Triptorelin
Vandetanib
Vardenafil
Vemurafenib
Venlafaxine
Vilanterol
Vinflunine
Voclosporin
Voriconazole
Vorinostat
Ziprasidone
Zolmitriptan
Zotepine

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Adagrasib
Alefacept
Alfentanil
Almotriptan
Amantadine
Amifampridine
Amineptine
Amiodarone
Amitriptyline
Amitriptylinoxide
Amoxapine
Amphetamine
Anagrelide
Benzhydrocodone
Benzphetamine
Bromocriptine
Brompheniramine
Buprenorphine
Bupropion
Buspirone
Butorphanol
Carbamazepine
Chlorpheniramine
Citalopram
Clomipramine
Clozapine
Cocaine
Codeine
Cyclobenzaprine
Desipramine
Desvenlafaxine
Dextroamphetamine
Dextromethorphan
Dibenzepin
Difenoxin
Dihydrocodeine
Diphenoxylate
Dolasetron
Donepezil
Doxepin
Duloxetine
Eletriptan
Epinephrine
Ergonovine
Escitalopram
Ethylmorphine
Fedratinib
Fenfluramine
Fentanyl
Fluconazole
Fluoxetine
Fluvoxamine
Fosphenytoin
Frovatriptan
Furazolidone
Gepirone
Givosiran
Glucagon
Glycopyrrolate
Glycopyrronium Tosylate
Granisetron
Guanethidine
Hydrocodone
Hydromorphone
Hydroxyamphetamine
Hydroxytryptophan
Imipramine
Iobenguane I 123
Iobenguane I 131
Ketobemidone
Lasmiditan
Lefamulin
Levomilnacipran
Levorphanol
Linezolid
Lisdexamfetamine
Lithium
Lofepramine
Lorcaserin
Loxapine
Mavacamten
Melitracen
Memantine
Meperidine
Metaxalone
Methacholine
Methadone
Methamphetamine
Methyldopa
Methylene Blue
Methylergonovine
Midodrine
Milnacipran
Mirtazapine
Morphine
Morphine Sulfate Liposome
Nalbuphine
Naratriptan
Nefazodone
Nicomorphine
Nortriptyline
Ondansetron
Opipramol
Opium
Opium Alkaloids
Oxycodone
Oxymorphone
Ozanimod
Palonosetron
Panobinostat
Papaveretum
Paregoric
Paroxetine
Pentazocine
Phenobarbital
Phenytoin
Piritramide
Pitolisant
Primidone
Protriptyline
Quetiapine
Quizartinib
Remifentanil
Revefenacin
Ritlecitinib
Rizatriptan
Rolapitant
Scopolamine
Secretin Human
Sertraline
Sibutramine
Siponimod
St John's Wort
Sufentanil
Sumatriptan
Tapentadol
Tianeptine
Tilidine
Tiotropium
Tocilizumab
Tramadol
Trazodone
Trimipramine
Tryptophan
Venlafaxine
Vilazodone
Vortioxetine
Zavegepant
Ziprasidone

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Using medicines in this class with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use your medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Grapefruit Juice

Other medical problems—

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

Type 2 diabetes mellitus—The decongestant in this medicine may put diabetic patients at a greater risk of having heart or blood vessel disease

Enlarged prostate or
Urinary tract blockage or difficult urination—Some of the effects of antihistamines may make urinary problems worse.

Glaucoma—A slight increase in inner eye pressure may occur.

Heart or blood vessel disease or
High blood pressure—The decongestant in this medicine may cause the blood pressure to increase and may also speed up the heart rate

Kidney disease—Higher blood levels of loratadine may result, which may increase the chance of side effects. The dosage of loratadine-containing combination may need to be reduced

Liver disease—Higher blood levels of loratadine may result, which may increase the chance of side effects

Overactive thyroid—If the overactive thyroid has caused a fast heart rate, the decongestant in this medicine may cause the heart rate to speed up further

Urinary retention—Condition may be worsened with use of pseudoephedrine

Proper Use of This Medicine:

Take this medicine only as directed. Do not take more of it and do not take it more often than recommended on the label, unless otherwise directed by your doctor. To do so may increase the chance of side effects.

If this medicine irritates your stomach, you may take it with food or a glass of water or milk, to lessen the irritation.

For patients taking the extended-release capsule or tablet form of this medicine:

Swallow it whole.
Do not crush, break, or chew before swallowing.
If the capsule is too large to swallow, you may mix the contents of the capsule with applesauce, jelly, honey, or syrup and swallow without chewing.

Dosing—

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

There is a large variety of antihistamine and decongestant combination products on the market. Some products are for use in adults only, while others may be used in children. If you have any questions about this, check with your health care professional.

Follow your doctor's orders if this medicine was prescribed. Or, follow the directions on the box if you are buying this medicine without a prescription

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using This Medicine:

Before you have any skin tests for allergies, tell the doctor in charge that you are taking this medicine. The results of the test may be affected by the antihistamine in this medicine.

When taking antihistamines (contained in this combination medicine) on a regular basis, make sure your doctor knows if you are taking large amounts of aspirin at the same time (as for arthritis or rheumatism). Effects of too much aspirin, such as ringing in the ears, may be covered up by the antihistamine.

The antihistamine in this medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are other antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are taking this medicine.

The antihistamine in this medicine may cause some people to become drowsy, dizzy, or less alert than they are normally. Some antihistamines are more likely to cause drowsiness than others (loratadine , for example, rarely produces this effect). Make sure you know how you react before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.

The decongestant in this medicine may add to the central nervous system (CNS) stimulant and other effects of diet aids. Do not use medicines for diet or appetite control while taking this medicine unless you have checked with your doctor

The decongestant in this medicine may cause some people to be nervous or restless or to have trouble in sleeping. If you have trouble in sleeping, take the last dose of this medicine for each day a few hours before bedtime. If you have any questions about this, check with your doctor.

Antihistamines may cause dryness of the mouth, nose, and throat. Some antihistamines are more likely to cause dryness of the mouth than others (loratadine , for example, rarely produces this effect). For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

For patients using promethazine-containing medicine:

This medicine controls nausea and vomiting. For this reason, it may cover up the signs of overdose caused by other medicines or the symptoms of intestinal blockage. This will make it difficult for your doctor to diagnose these conditions. Make sure your doctor knows that you are taking this medicine if you have other symptoms such as stomach or lower abdominal pain, cramping, or soreness. Also, if you think you may have taken an overdose of any medicine, tell your doctor that you are taking this medicine.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Although serious side effects occur rarely when this medicine is taken as recommended, they may be more likely to occur if: too much medicine is taken, it is taken in large doses, or it is taken for a long period of time.

Clumsiness or unsteadiness; convulsions (seizures); drowsiness (severe); dryness of mouth, nose, or throat (severe); hallucinations (seeing, hearing, or feeling things that are not there; headache (continuing); shortness of breath or troubled breathing; slow, fast, or irregular heartbeat; trouble in sleeping

Check with your doctor as soon as possible if any of the following side effects occur:

Rare: Back, leg or stomach pain; black, sticky stools; bleeding gums; blood, cloudy or dark urine, or sudden decrease in amount of urine; blood pressure increased; blurred vision; chest pain; confusion; diarrhea; dizziness; faintness, or lightheadedness when getting up from a lying or sitting position; fever or chills; light-colored stools; mood or mental changes; nosebleeds; sore throat and fever; skin rash or hives; stillbirth; swollen mouth, throat, face, fingers, feet, glands or lower legs; sweating suddenly; tightness in chest; troubled breathing; twitching, twisting, or uncontrolled repetitive movements of face; unusual bleeding or bruising; unusual tiredness or weakness; vomiting of blood; weight gain suddenly; yellow or pale eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common: Drowsiness; thickening of the bronchial secretions

Less common: Blurred vision; confusion; difficult or painful urination; dizziness; dryness of mouth, nose, or throat; headache; loss of appetite; nightmares; pounding heartbeat; ringing or buzzing in ears; skin rash; stomach upset or pain (more common with pyrilamine); unusual excitement, nervousness, restlessness, or irritability; unusual sleepiness, weakness or drowsiness, extreme tiredness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Last Updated: 11/16/2023

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.