PAIN RELIEF COLD & COUGH

Acetaminophen 500mg/15mL, Dextromethorphan Hydrobromide 15mg/15mL, Oral solution

Tobacco

· Severity: Moderate

· Notes for Consumers: If you are a tobacco smoker, use of Acetaminophen can increase the risk of liver side effects. Immediately tell your doctor if you get severe abdominal pain, nausea, vomiting, or yellowing of the skin. Do not exceed 4 g acetaminophen/day in adults. Tell your doctor if Acetaminophen does not help your headache or other pain. Tobacco smoke may reduce the effectiveness of Acetaminophen.

· Notes for Professionals: Tobacco smoking induces the cytochrome P450 isoenzyme CYP1A2 and may potentially increase the risk for acetaminophen-induced hepatotoxicity during overdose via enhanced generation of acetaminophen's hepatotoxic metabolite, NAPQI. In one study, current tobacco smoking was found to be very frequent in patients admitted with acetaminophen poisoning. Tobacco smoking appears to be an independent risk factor of severe hepatotoxicity, acute liver failure and death following acetaminophen overdose.

Acetaminophen 500mg/15mL, Dextromethorphan Hydrobromide 15mg/15mL, Oral solution

Grapefruit juice

· Severity: Mild

· Notes for Consumers: Grapefruit juice may increase the actions of Dextromethorphan, which may make some people feel drowsiness or other side effects (dizziness, nervousness or restlessness, nausea, vomiting, stomach upset) of Dextromethorphan that do not usually occur with prescribed or nonprescription product doses. It may be best to limit intake of grapefruit juice while you are taking Dextromethorphan-containing products.

· Notes for Professionals: Intake of grapefruit juice or seville orange juice increased dextromethorphan bioavailability in one study. Patients with increased concentrations of dextromethorphan may experience drowsiness or serotonergic side effects (dizziness, nervousness or restlessness, nausea, vomiting, stomach upset) not usually noted with prescribed or nonprescription product doses. Grapefruit juice and seville orange juice contain compounds that can inhibit P-glycoprotein in the intestinal wall, and dextromethorphan absorption may be affected by P-glycoprotein activity. Dextromethorphan is largely metabolized by CYP2D6, so this particular interaction with grapefruit juice may be more relevant in patients who are poor CYP2D6 metabolizers.

Acetaminophen 500mg/15mL, Dextromethorphan Hydrobromide 15mg/15mL, Oral solution

Alcohol

· Severity: Major

· Notes for Consumers: Patients who drink more than 3 alcoholic drinks a day and take Acetaminophen are at increased risk of developing liver side effects. Limit alcohol intake while taking Acetaminophen. Avoid alcoholic drinks if you are taking Acetaminophen on a regular basis.

· Notes for Professionals: The risk of developing hepatotoxicity from acetaminophen appears to be increased in patients who regularly consume ethanol. Patients who drink more than 3 alcoholic drinks a day and take acetaminophen are at increased risk of developing hepatotoxicity. Acute or chronic ethanol use increases acetaminophen-induced hepatotoxicity by inducing cytochrome P450 CYP 2E1 leading to increased formation of the hepatotoxic metabolite of acetaminophen. Also, chronic alcohol use can deplete liver glutathione stores. Administration of acetaminophen should be limited or avoided altogether in patients with alcoholism or patients who consume ethanol regularly.

<b>DISCLAIMER:</b><em> This drug information content is provided for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Patients should always consult their physician with any questions regarding a medical condition and to obtain medical advice and treatment. Drug information is sourced from GSDD (Gold Standard Drug Database ) provided by Elsevier.</em>