Can I Take This Cold Medication With That One?

While doubling up on cold and flu medicines like Sudafed and Dayquil may seem like a good idea—hitting symptoms hard for faster relief—doing so poses certain harms if you are not careful. This includes overdosing on medications used in both medicines, which not only increases the risk of side effects but might also end up injuring your liver and other organs.

As a general rule, most multi-symptom cold & flu medicines should not be taken with other multi-symptom cold and flu medicines. If taking a single-symptom medication (like aspirin), you need to be sure that you don't take it with a drug of the same class (like Advil). Speak with your pharmacist or healthcare provider if you are not sure.

This article lists 12 different over-the-counter (OTC) drugs commonly used to treat cold and flu symptoms and explains which can be taken together and which cannot.

Verywell / Theresa Chiechi

Pain Relievers/Fever Reducers

There are two types of drugs people commonly reach to treat headaches and fevers. One is Tylenol (acetaminophen) and the other is a class of medication called nonsteroidal anti-inflammatory drugs (NSAIDs) that include aspirin, ibuprofen, and naproxen.

Tylenol and NSAIDs are similar but not exactly alike. Tylenol is both analgesic (pain-relieving) and antipyretic (fever-reducing). So are NSAIDs but they are also anti-inflammatory due to a different mechanism of action.

Can You Take Tylenol With an NSAID?

Tylenol is generally safe to take with an NSAID, even in children. On the other hand, an NSAID should never be taken with another NSAID. Doing so increases the risk of stomach ulcers and bleeding.

Tylenol (Acetaminophen)

Acetaminophen is one of the most popular OTC pain relievers and fever reducers, sold under the brand name Tylenol. It is also available as a generic.

Tylenol can be taken on its own, but there are many multi-symptom cold & flu remedies that also contain acetaminophen as an active ingredient. These include:

Alka-Seltzer Plus Cold & Flu
Contac Cold + Flu
Coricidin HBP Cold & Flu
Equate Cold & Flu Multi-Symptom Relief
Mucines Cold & Flu
Robitussin Multi-Symptom Cough Cold + Flu
Theraflu Severe Cold & Cough
Vicks DayQuil Cold & Flu
Vicks NyQuil

If you are taking Tylenol or generic acetaminophen, you should not take any of these acetaminophen-containing medicines. Doing so can lead to acetaminophen toxicity, a condition in which the liver is poisoned and, in some cases, permanently damaged.

This risk of this is easier than one might expect.

In adults, the maximum daily dose of acetaminophen in any form is 4000 milligrams (mg). Toxicity can occur with doses as little as 7,500 mg per day—something that can easily occur if you take two different forms of acetaminophen at once. Add alcohol to the mix, and the risk of liver injury is further increased.

While Tylenol can be combined with NSAIDs—and is even co-formulated in products like Excedrin (acetaminophen/aspirin/caffeine)—some healthcare providers recommend alternating doses every four to six hours rather than taking both drugs every four to six hours. This is especially true for children.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs are a class of OTC and prescription medications that provide short-term relief of inflammation and pain.

The three NSAIDs available over the counter are:

Aspirin: Marketed under the brand names Bayer, Ecotrin, Lortab, Vanquish, and others
Ibuprofen: Marketed under the brand names Advil, Motrin, Brufen, Nurofen, and others
Naproxen: Marketed under the brand names Aleve, Naprosyn, Treximet, Vimovo, and others

All three are also available as generics.

There are several multi-symptom cold & flu medications that contain NSAIDs, including:

Advil Allergy & Congestion Relief (ibuprofen)
Advil Multi-Symptom Cold and Flu Medicine (ibuprofen)
Alka-Selzer Plus Severe Cold Formula (aspirin)
Aleve-D Sinus and Cold (naproxen)
Sudafed Head Congestion + Pain (naproxen)
Sudafed Sinus Pain and Pressure (naproxen)

If you are taking aspirin, ibuprofen, or naproxen, you should not take any of these NSAID-containing medicines. This is because of the unique action of NSAIDs on the body.

NSAIDs work by blocking the production of compounds called prostaglandins that are involved with inflammation. By doing so, NSAIDs can quickly reduce pain, fever, and swelling.

At the same time, prostaglandins are involved with blood clotting and the regulation of stomach acids. By blocking prostaglandins, NSAIDs can increase the risk of stomach irritation, gastrointestinal bleeding, and peptic ulcers, particularly when overused.

Combining an NSAID with NSAID-containing medications increases the likelihood of these potentially serious side effects.

Warning to Parents

Children and teens with fever and flu-like symptoms. should never be given aspirin. Aspirin is linked to a rare disorder called Reye's syndrome that can cause serious liver and brain damage and, in severe cases, lead to permanent brain injury or death.

Cold and Cough Relievers

There are two types of OTC cough medicines: antitussives and expectorants. The only OTC antitussive is dextromethorphan and the only OTC expectorant is guaifenesin.

Dextromethorphan and guaifenesin can be taken together and are even co-formulated in products like Vicks Formula 44 (guaifenesin/dextromethorphan).

Dextromethorphan

Dextromethorphan is an antitussive sold under the brand names Delsym, Robitussin, and others. It acts directly on the brain to ease the cough reflex and is available as a syrup, tablet, lozenge, and spray.

Dextromethorphan is found in many multi-symptom cold & flu medicines, including:

Alka-Seltzer Plus Cold and Cough Formula
Children's Dimetapp Cold & Cough
Mucinex DM
Pediacare Children's Cough & Congestion
Sudafed PE Cold + Cough
Theraflu Cold & Cough
Triaminic Cold and Cough
Tylenol Cold + Cough
Vicks DayQuil Cough
Vicks NyQuil Cough

Check the product label to ensure you don't accidentally double-dose on dextromethorphan by combining, for example, Robitussin with Mucinex DM (dextromethorphan/guaifenesin).

Dextromethorphan is an opioid-like substance similar to the prescription drug codeine. When overused, it can lead to intoxication and symptoms like dizziness, blurred vision, and a loss of coordination. This can make driving or handling heavy machinery dangerous.

Dextromethorphan and Diphenhydramine Risk

Diphenhydramine is an OTC antihistamine that can also cause extreme drowsiness. Avoid mixing dextromethorphan with diphenhydramine-containing multi-symptom medicines like:

Benedryl Allergy + Congestion
Diabetic Tussin Night Time Cold & Flu
Excedrin PM Headache
Mucinex Fast-Max Day Time Severe Cold Maximum Strength
Mucinex Fast-Max Night Time Cold & Flu Maximum Strength
Vicks ZzzQuil

Guaifenesin

Guaifenesin is an expectorant sold under the brand name Mucinex, Bidex, Organidin, Robafen, and others. Guaifenesin reduces the viscosity of mucus so it can be easily coughed up.

Guaifenesin is found in many multi-symptom cold & cough medicines, including:

Coricidin HBP Day & Night Multi-Symptom Cold
Robitussin DM
Tussin DM
Tylenol Cold and Flu Severe Day & Night
Vicks DayQuil
Zicam Cold Remedy

Check the product label to ensure you don't double-dose on guaifenesin. While guaifenesin has low toxicity, overdosing can lead to headaches, dizziness, nausea, and vomiting.

Warning to Parents

The Centers for Disease Control and Prevention (CDC) warns that OTC cough & cold medicines should not be given to children under 4 years unless directed by their healthcare provider. Doing so can lead to serious and potentially life-threatening side effects due to the child's smaller body size.

Decongestants

There are decongestants called pseudoephedrine (used in the brand name drug Sudafed) and phenylephrine (used in the brand name drug Sudafed PE) that ease nasal stuffiness by shrinking blood vessels in your nasal passages.

They come in regular and extended-relief tablets as well as oral solutions. However, oral decongestants containing the active ingredient phenylephrine are not considered effective at clearing up congestion.

To avoid overdosing, be careful not to combine Sudafed or Sudafed PE with other oral medications containing phenylephrine or pseudoephedrine, including:

Alka-Seltzer Plus
Comtrex Acute Head Cold
Contac 12-Hour
Mucinex Fast-Max
Robitussin Multi-Symptom
Sinutab Ex-Strength
Theraflu Flu & Cough
Tylenol Cold Multi-Symptom
Vicks DayQuil Severe Cold & Flu
Vicks NyQuil Severe Cold & Flu

Sudafed and Sudafed PE should also not be combined with nasal decongestant sprays, These contain a topical decongestant called oxymetazoline that can raise the risk for side effects without helping your congestion more.

Examples include:

Afrin
Dristan Cold Maximum Strength
Sinex Severe
Zicam Severe Congestion

Decongestants and Caffeine

Pseudoephedrine and phenylephrine are both stimulants that can cause side effects like edginess, a pounding heartbeat, and insomnia. It is best to avoid combining Sudafed or Sudafed PE with cold & flu medicines containing caffeine which can amplify these effects, including:

Alka-Selzer Morning Relief
Anacin Fast Pain Relief
Benylin Cold & Flu Maximum Strength
Excedrin Extra Strength
Robitussin Severe Congestion

Summary

It is important to read product labels on cold and flu medicines to avoid double dosing. These include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), dextromethorphan, guaifenesin, phenylephrine, and pseudoephedrine used both as single-symptom drugs and in multi-symptom cold & flu remedies.

Taking more than the recommended daily dose can increase the risk (and severity) of side effects and possibly lead to complications such as liver injury or stomach ulcers.

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