Can I take Mucinex Fast-Max with ibuprofen?

Which Fast-Max box do you have?

Fast-Max is a family of products, not one formula. DailyMed lists more than 40 Fast-Max labels, and the same box name can come in more than one version, so read the Active ingredients line on the box you have. Here is what the labels list:

• Fast-Max Cold & Flu (liquid gels): many versions list acetaminophen 325 mg, dextromethorphan 10 mg (cough), guaifenesin 200 mg (mucus) and phenylephrine 5 mg (decongestant) per gel, 2 gels per dose. Some newer Cold & Flu capsules and caplets list only acetaminophen and dextromethorphan.
• Fast-Max Severe Cold, Kickstart Severe Cold and Flu, Cold, Flu and Sore Throat, and Congestion and Headache: all contain acetaminophen. Most versions also contain dextromethorphan and phenylephrine.
• Fast-Max Night Cold & Flu gels (in Day/Night kits): acetaminophen, dextromethorphan, phenylephrine and the sedating antihistamine doxylamine. The Nighttime, Recharge Nighttime and Nightshift liquids contain acetaminophen, dextromethorphan and the antihistamine triprolidine.
• Fast-Max Severe Congestion & Cough: dextromethorphan and guaifenesin, plus phenylephrine in some versions. No acetaminophen.
• Fast-Max DM Max: dextromethorphan and guaifenesin only. No acetaminophen and no decongestant.
• Kits: some kits pair DM Max or Severe Congestion & Cough with a Nighttime or Nightshift bottle. The night bottle contains acetaminophen even though the day bottle does not.

Is it OK to add ibuprofen to Fast-Max Cold & Flu?

Fast-Max Cold & Flu has acetaminophen but no ibuprofen, so adding Advil or Motrin does not double up an ingredient. The NHS says adults can take paracetamol (the UK name for acetaminophen) at the same time as ibuprofen if needed, and suggests trying each on its own first to see if it helps.

Sources differ on how cautious to be. MedlinePlus, from the US National Library of Medicine, advises not to take nonprescription ibuprofen with any other pain medicine unless your doctor tells you to. The Advil label says to ask a doctor or pharmacist before use if you take any other drug. So check with a pharmacist before you combine them, especially if you have any health conditions. If you have no pain or fever, you may not need the ibuprofen at all: Cold & Flu already treats aches, headache and fever with its acetaminophen.

Count the acetaminophen. The Fast-Max Cold & Flu liquid gel label caps you at 12 gels in 24 hours, and warns that severe liver damage may occur if you take more, take other acetaminophen products, or have 3 or more alcoholic drinks a day while using it.

What about the boxes with no pain reliever?

Fast-Max Severe Congestion & Cough and Fast-Max DM Max on their own contain no acetaminophen and no NSAID. Ibuprofen is the only pain and fever medicine in that pairing. Follow the ibuprofen label: for Advil 200 mg tablets, adults and children 12 and over take 1 tablet every 4 to 6 hours, 2 if 1 doesn't work, and no more than 6 tablets in 24 hours unless a doctor tells you otherwise.

If your Severe Congestion & Cough box lists phenylephrine, the blood pressure and heart questions below apply to it too. DM Max has no decongestant. If your box came in a kit with a night bottle, see the note on kits above.

What should you never add on top?

Most problems come from a second box that repeats an ingredient you are already taking. With any acetaminophen-containing Fast-Max, the label says do not use it with any other drug containing acetaminophen, prescription or not. If you're not sure whether a medicine contains acetaminophen, the label says to ask a doctor or pharmacist.

• No Tylenol or other acetaminophen product on top of an acetaminophen Fast-Max. Many other multi-symptom cold and flu medicines contain it too, so check their labels.
• No Advil Dual Action with an acetaminophen Fast-Max. It contains both ibuprofen and acetaminophen.
• No second NSAID. The NHS says not to take ibuprofen at the same time as other NSAIDs such as naproxen (Aleve) or aspirin. If you take daily aspirin for your heart, ask a doctor or pharmacist first, because the Advil label says ibuprofen may reduce this benefit of aspirin.
• No second decongestant. Advil Cold & Sinus adds pseudoephedrine, and many Fast-Max formulas already contain phenylephrine. Plain ibuprofen is the version to pair.
• No second cough medicine with dextromethorphan, such as Robitussin DM products. Most Fast-Max formulas already contain dextromethorphan; Fast-Max Chest Congestion (guaifenesin only) is one that does not.

Who should ask before combining them?

Both products carry warnings that overlap, so some people should check with a doctor or pharmacist before taking either one, let alone both.

• High blood pressure or heart disease: the Fast-Max labels with phenylephrine and the Advil label both say ask a doctor first. Ibuprofen also carries a heart attack and stroke warning.
• MAOI medicines: do not use Fast-Max (dextromethorphan, and phenylephrine where present) if you take a prescription MAOI for depression, psychiatric or emotional conditions or Parkinson's disease, or for 2 weeks after stopping one.
• Stomach bleeding risk: age 60 or older, past ulcers or bleeding, blood thinners or steroids, other NSAIDs, or 3 or more drinks a day.
• Warfarin: the Fast-Max Cold & Flu label says ask a doctor or pharmacist first, and the Advil label lists blood thinners as a stomach bleeding risk.
• Kidney disease, liver disease, asthma, diabetes, thyroid disease or trouble urinating from an enlarged prostate.
• Pregnancy or breastfeeding: both labels say ask a health professional first. The NHS says avoid ibuprofen in pregnancy unless a doctor or pharmacist advises it, and the Advil label says it is especially important not to use it at 20 weeks or later unless a doctor directs you to.
• Under 12: Fast-Max is not for children under 12. The NHS advice on taking both together is for adults, so teens 12 to 17 should check with a pharmacist.

Does the Night version change anything?

Fast-Max Night Cold & Flu contains acetaminophen plus doxylamine, an antihistamine, and the label warns marked drowsiness may occur. Ibuprofen does not repeat any of its ingredients, but don't add Benadryl, ZzzQuil or another antihistamine on top. Avoid alcohol, and ask a doctor or pharmacist first if you take sedatives or tranquilizers, or ask a doctor if you have glaucoma.

In a Day/Night kit, both the Day and Night gels contain 325 mg of acetaminophen each, and the kit label sets one limit of 12 liquid gels in 24 hours. Count them together.