Version May 2024
Expectorant/decongestant: Dosing may vary by product; consult specific product labeling.
Liquid: Oral:
Guaifenesin 50 mg/phenylephrine 2.5 mg per 5 mL: 20 mL every 4 hour; maximum: 120 mL per 24 hours.
Guaifenesin 100 mg/phenylephrine 5 mg per 5 mL: 10 mL every 4 hours; maximum: 60 mL per 24 hours.
Tablet: Oral:
Guaifenesin 385 mg/phenylephrine 10 mg per tablet: One tablet every 4 hours; maximum: 6 tablets per 24 hours.
Guaifenesin 400 mg/phenylephrine 10 mg per tablet: One tablet every 4 hours; maximum: 6 tablets per 24 hours.
Refer to adult dosing.
(For additional information see "Guaifenesin and phenylephrine: Pediatric drug information")
Note: Safety and efficacy for the use of cough and cold products in infants and young children are limited; the AAP warns against the use of these products for respiratory illnesses in infants and young children; the FDA does not recommend OTC use in infants and children <2 years of age due to the risk of serious and life-threatening adverse effects (including death) and recommends using with caution in pediatric patients ≥2 years of age (Ref).
Cold, allergy symptoms: Note: Multiple formulations of tablet strength and oral liquid concentrations exist; pay close attention to the concentration/strength when ordering or administering.
Liquid:
Guaifenesin 50 mg and phenylephrine 2.5 mg per 5 mL (eg, Maxi-Tuss PE Jr):
Children 6 to <12 years: Oral: 10 mL every 4 hours as needed; maximum daily dose: 60 mL per 24 hours.
Children ≥12 years and Adolescents: Oral: 20 mL every 4 hours as needed; maximum daily dose: 120 mL per 24 hours.
Guaifenesin 100 mg and phenylephrine 2.5 mg per 5 mL (eg, Mucinex Children's Stuffy Nose and Chest Congestion):
Children 4 to <6 years: Oral: 5 mL every 4 hours as needed; maximum daily dose: 30 mL per 24 hours.
Children 6 to <12 years: Oral: 10 mL every 4 hours as needed; maximum daily dose: 60 mL per 24 hours.
Guaifenesin 100 mg and phenylephrine 5 mg per 5 mL (eg, Ed Bron GP, Maxi-Tuss PE Max):
Children 6 to <12 years: Oral: 5 mL every 4 hours as needed; maximum daily dose: 30 mL per 24 hours.
Children ≥12 years and Adolescents: Oral: 10 mL every 4 hours as needed; maximum daily dose: 60 mL per 24 hours.
Tablet:
Guaifenesin 385 mg and phenylephrine 10 mg per tablet (eg, Deconex IR):
Children 6 to <12 years: Oral: 1/2 tablet every 4 hours as needed; maximum daily dose: 3 tablets per 24 hours.
Children ≥12 years and Adolescents: Oral: 1 tablet every 4 hours as needed; maximum daily dose: 6 tablets per 24 hours.
Guaifenesin 400 mg and phenylephrine 10 mg per tablet (eg, Chest Congestion Relief PE):
Children 6 years to <12 years: Oral: 1/2 tablet every 4 hours as needed; maximum daily dose: 3 tablets per 24 hours.
Children ≥12 years and Adolescents: Oral: 1 tablet every 4 hours as needed; maximum daily dose: 6 tablets per 24 hours.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
See individual agents.
Concurrent administration with or within 2 weeks of discontinuing an MAO inhibitor.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (including hypertension and ischemic heart disease); contraindicated with severe disease.
• Diabetes: Use with caution in patients with diabetes mellitus.
• Increased intraocular pressure/glaucoma: Use with caution in patients with increased intraocular pressure or glaucoma.
• Prostatic hyperplasia/urinary obstruction: Use with caution in patients with prostatic hyperplasia and/or GU obstruction.
• Thyroid dysfunction: Use with caution in patients with thyroid dysfunction.
Special populations:
• Older adult: Use with caution in the elderly; may be more sensitive to adverse effects.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggest that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP ["Inactive" 1997]; Zar 2007).
Other warnings/precautions:
• Cough: Appropriate use: Underlying cause of cough should be determined prior to prescribing.
• Self-medication (OTC use): When used for self-medication (OTC), do not exceed recommended doses; discontinue use and contact health care provider if symptoms do not improve within 7 days or are accompanied by fever, rash, persistent headache, or excessive mucus; if nervousness, dizziness, or sleeplessness occur; or if new symptoms occur.
Safety and efficacy for the use of cough and cold products in pediatric patients <4 years of age is limited; the AAP warns against the use of these products for respiratory illnesses in young children. Serious adverse effects including death have been reported (in some cases, high blood concentrations of pseudoephedrine were found). Many of these products contain multiple active ingredients, increasing the risk of accidental overdose when used with other products. The FDA does not recommend OTC uses for these products in pediatric patients <2 years of age, and recommends to use with caution in pediatric patients ≥2 years of age. Health care providers are reminded to ask caregivers about the use of OTC cough and cold products in order to avoid exposure to multiple medications containing the same ingredient (AAP 2018; CDC 2007; FDA 2017; FDA 2018). Multiple concentrations of oral liquid formulations exist; close attention must be paid to the concentration when ordering or administering.
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Liquid, Oral:
ED Bron GP: Guaifenesin 100 mg and phenylephrine hydrochloride 5 mg per 5 mL (473 mL) [alcohol free, dye free, sugar free; contains methylparaben, propylene glycol, propylparaben]
Maxi-Tuss PE Jr: Guaifenesin 50 mg and phenylephrine hydrochloride 2.5 mg per 5 mL (473 mL) [alcohol free, dye free, sugar free; contains methylparaben, propylene glycol, propylparaben]
Maxi-Tuss PE Max: Guaifenesin 100 mg and phenylephrine hydrochloride 5 mg per 5 mL (473 mL) [alcohol free, dye free, sugar free; contains methylparaben, propylene glycol, propylparaben]
Mucinex Stuffy Nose & Chest: Guaifenesin 100 mg and phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL) [contains edetate (edta) disodium, fd&c red #40 (allura red ac dye), glycerin (soy), propylene glycol, sodium benzoate]
Mucinex Stuffy Nose/Cold Child: Guaifenesin 100 mg and phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL [DSC]) [contains edetate (edta) disodium, fd&c red #40 (allura red ac dye), propylene glycol, sodium benzoate]
Triaminic Chest/Nasal Congest: Guaifenesin 50 mg and phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL) [contains benzoic acid, fd&c yellow #6 (sunset yellow), propylene glycol, quinoline yellow (d&c yellow #10)]
Tablet, Oral:
Chest Congestion Relief PE: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg [dye free]
Deconex IR: Guaifenesin 385 mg and phenylephrine hydrochloride 10 mg [scored; contains fd&c blue #1 (brilliant blue), fd&c yellow #5 (tartrazine)]
Fenesin PE IR: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg [DSC]
FT Chest Congestion Relief PE: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg [scored; dye free]
Gcon IR: Guaifenesin 385 mg and phenylephrine hydrochloride 10 mg [scored; contains fd&c blue #1 (brilliant blue), fd&c yellow #5 (tartrazine)]
MucusRelief Sinus: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg [DSC] [pseudoephedrine free]
Pharbinex-PE: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg
Refenesen PE: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg [scored; dye free, pseudoephedrine free]
Yes
Liquid (Mucinex Stuffy Nose & Chest Oral)
2.5-100 mg/5 mL (per mL): $0.09
Liquid (Supress-PE Pediatric Oral)
2.5-50 mg/mL (per mL): $0.45
Liquid (Triaminic Chest/Nasal Congest Oral)
2.5-50 mg/5 mL (per mL): $0.04
Liquid (Tusnel Pediatric Oral)
1.25-25 mg/mL (per mL): $0.30
Liquid (Tussi-Pres PE Pediatric Oral)
2.5-100 mg/5 mL (per mL): $0.07
Tablets (Deconex IR Oral)
10-385 mg (per each): $0.76
Tablets (Giltuss Sinus & Congestion Oral)
10-388 mg (per each): $0.45
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral:
Liquid: Administer liquid formulations with an accurate measuring device; do not use a household teaspoon (overdosage may occur).
Expectorant/decongestant: Temporary relief of nasal congestion, sneezing, nasal/throat irritation, and itchy/watery eyes associated with common cold, hay fever, or other respiratory allergies; loosens mucus and thins bronchial secretions making coughs more productive; reduces swelling of nasal passages
Entex may be confused with Tenex
Entex LA brand name represents a different product in the US than it does in Canada. Formerly available in the US, Entex LA contains guaifenesin and phenylephrine, while in Canada the product bearing this brand name contains guaifenesin and pseudoephedrine.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: May increase the serum concentration of Phenylephrine (Systemic). Risk C: Monitor therapy
Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1-Agonists may antagonize Alpha1-Blocker vasodilation. Risk C: Monitor therapy
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Atropine (Systemic): May enhance the hypertensive effect of Alpha1-Agonists. Risk C: Monitor therapy
Benzylpenicilloyl Polylysine: Alpha1-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider delaying skin testing until alpha1-agonists are no longer required, or use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Risk D: Consider therapy modification
Bromocriptine: May enhance the hypertensive effect of Alpha1-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider therapy modification
Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Chloroprocaine (Systemic): May enhance the hypotensive effect of Phenylephrine (Systemic). Risk C: Monitor therapy
CloZAPine: May diminish the therapeutic effect of Phenylephrine (Systemic). Risk C: Monitor therapy
Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification
Disulfiram: May enhance the adverse/toxic effect of Products Containing Ethanol. Management: Do not use disulfiram with dosage forms that contain ethanol. Risk X: Avoid combination
Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May enhance the vasoconstricting effect of Alpha1-Agonists. Risk X: Avoid combination
FentaNYL: Decongestants may decrease the serum concentration of FentaNYL. Risk C: Monitor therapy
Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Hyaluronidase: May enhance the vasoconstricting effect of Phenylephrine (Systemic). Management: Do not use hyaluronidase to enhance the dispersion or absorption of phenylephrine. Use of hyaluronidase for other purposes in patients receiving phenylephrine may be considered as clinically indicated. Risk D: Consider therapy modification
Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may diminish the therapeutic effect of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Risk X: Avoid combination
Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination
Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider therapy modification
Lisuride: May enhance the hypertensive effect of Alpha1-Agonists. Risk X: Avoid combination
Methotrimeprazine: Products Containing Ethanol may enhance the adverse/toxic effect of Methotrimeprazine. Specifically, a disulfiram-like reaction may occur and CNS depressant effects may be increased. Management: Avoid products containing alcohol in patients treated with methotrimeprazine. Risk X: Avoid combination
Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Risk X: Avoid combination
Ornidazole: May enhance the adverse/toxic effect of Products Containing Ethanol. Specifically, a disulfiram-like reaction may occur. Risk X: Avoid combination
Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Pergolide: May enhance the hypertensive effect of Alpha1-Agonists. Risk C: Monitor therapy
Propacetamol: May increase the serum concentration of Phenylephrine (Systemic). Management: Monitor patients closely for increased side effects of phenylephrine if propacetamol is used concomitantly. Patients with underlying blood pressure issues or arrhythmias may need closer monitoring and may warrant consideration of alternative therapies. Risk C: Monitor therapy
Secnidazole: Products Containing Ethanol may enhance the adverse/toxic effect of Secnidazole. Risk X: Avoid combination
Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Tricyclic Antidepressants: May enhance the therapeutic effect of Alpha1-Agonists. Tricyclic Antidepressants may diminish the therapeutic effect of Alpha1-Agonists. Risk C: Monitor therapy
Refer to individual monographs.
Refer to individual monographs.
May be taken with or without food. Taking with food, water or milk may help decrease gastric irritation. Some products may contain sodium.
See individual agents.
See individual agents.
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