Pyrilamine maleate

What it is

Pyrilamine maleate is the maleate salt of pyrilamine (called mepyramine outside the United States), a first-generation ethylenediamine antihistamine that blocks the histamine H1 receptor. In the United States it is almost never sold alone: it appears as a 15 mg antihistamine component of over-the-counter menstrual-relief caplets alongside acetaminophen and either caffeine or pamabrom, and in some prescription cough-and-cold syrups. Laboratory work shows it also blocks voltage-gated sodium channels at concentrations found in poisoned patients, so its effects are not purely antihistaminic.

What the research says

The honest summary is that almost no modern outcome evidence exists for pyrilamine itself. It is an H1-receptor blocker that crosses into the brain and causes drowsiness, and it is marketed inside combination products for menstrual symptoms and for cough and cold. The one randomised trial that tested a pyrilamine-containing combination had no placebo arm, so it cannot show that pyrilamine adds anything; and Cochrane reviews of antihistamines for acute cough repeatedly found them no better than placebo. The harms that are documented belong mostly to its drug class: sedation, anticholinergic effects, and, with long cumulative use of strong anticholinergics, an observed association with dementia.

Evidence grade: Limited evidence.

How it works

Drug class: First-generation ethylenediamine H1-receptor antagonist (sedating antihistamine)

Pyrilamine blocks the histamine H1 receptor, which is how it is described on the label of the products that contain it. Laboratory work on mepyramine (the same molecule) shows it also directly inhibits voltage-gated sodium channels, including the Nav1.7, Nav1.8 and Nav1.9 channels of pain-sensing nerves, at concentrations in the range measured in poisoned people. Because it enters the brain it also produces drowsiness. (Source 1)

What it is used for

• This is the main surviving use in the United States, and it rests on the over-the-counter monograph rather than on placebo-controlled trials of pyrilamine. The one randomised double-blind trial we found compared a paracetamol-pyrilamine-pamabrom combination with a naproxen-paracetamol-pamabrom combination in 189 women and found no difference between them, but it had no placebo arm, so it cannot show that pyrilamine contributes anything. Evidence: limited. (Source 2)
• Cochrane reviews of over-the-counter cough preparations found that antihistamines were no more effective than placebo for cough in adults and in children, and that antihistamine-containing combinations for the common cold give an effect on individual symptoms that is probably too small to matter, with no evidence of benefit in young children. Evidence: not-supported. (Source 3)
• Laboratory and animal work shows mepyramine blocks nociceptor sodium channels and relieves pain in animal pain models when applied locally. This is pre-clinical only; we found no human trial of pyrilamine as an analgesic, so it must not be read as a human finding. Evidence: unknown. (Source 1)
• In strips of human uterus in an organ bath, paracetamol and pyrilamine together relaxed the muscle more than would be expected from adding their separate effects. This is an in-vitro experiment on tissue, not a clinical outcome. Evidence: unknown. (Source 4)

Interactions

• Alcohol (label): Alcohol adds to the drowsiness pyrilamine causes. The product label tells people to avoid alcoholic drinks while taking it. (Source 5)
• Sedatives and tranquillisers (label): Taking pyrilamine with sedatives or tranquillisers increases sedation; the label directs people taking them to ask a doctor or pharmacist first. (Source 6)
• Caffeine from medicines, foods and drinks (label): The menstrual-relief caplets that contain pyrilamine usually also contain 60 mg of caffeine, so caffeine from coffee, tea, energy drinks and other medicines adds up. The label warns about nervousness, irritability, sleeplessness and rapid heartbeat. (Source 5)
• Warfarin (label): The label of the pyrilamine-containing menstrual caplet tells people taking warfarin to ask a doctor or pharmacist first. This warning attaches to the acetaminophen in the product rather than to pyrilamine itself. (Source 6)
• Other anticholinergic medicines (cumulative anticholinergic burden) (case reports): Pyrilamine is a sedating antihistamine, a class counted in anticholinergic burden. In a cohort of older adults, higher cumulative use of strong anticholinergics was associated with a higher rate of dementia. The association is observational and was measured across the whole class, not for pyrilamine alone. (Source 7)

Stopping it

• We found no deprescribing trial, no withdrawal syndrome and no taper schedule for pyrilamine in the literature we searched. The products that contain it are labelled for short, as-needed use, and the label itself sets stopping rules based on symptoms rather than on any dependence risk. (Source 5)
• Because the labelled use is intermittent and limited to 6 caplets a day, stopping is simply not taking the next dose; the label states the maximum and does not describe any tapering. (Source 5)

What goes wrong

The same Cochrane review reported more adverse effects in people given preparations containing antihistamines or dextromethorphan. (Source 3)

• Systematic review, Low certainty.
• Size: 21 of the 29 included studies reported adverse effects.
• Who: children and adults with acute cough.
• How long: trials of a few days.
• Result: a wide range of adverse-effect rates across studies, with higher numbers in participants taking antihistamine- or dextromethorphan-containing preparations; the review does not give a pooled rate.
• Funding: independent.

There was a wide range across studies, with higher numbers of adverse effects in participants taking preparations containing antihistamines and dextromethorphan.

In Cochrane's pooled analysis, antihistamine-decongestant combinations caused adverse effects in about a third of recipients against about an eighth on placebo or other control. (Source 8)

• Systematic review, Moderate certainty.
• Size: 842 participants with adverse-effect data in the antihistamine-decongestant comparison.
• Who: children and adults with the common cold.
• How long: 3 to 10 days.
• Result: 128/419 (31%) on antihistamine-decongestant suffered one or more adverse effects versus 100/423 (13%) in the control group; odds ratio 1.58, 95% CI 0.78 to 3.21, moderate certainty.
• Funding: independent.

Limit of this finding: The review reports a confidence interval for this odds ratio that crosses 1 while describing the group as experiencing more adverse effects; the raw proportions and the interval do not sit comfortably together, and we report both rather than choosing one. The review's own arithmetic does not hold in two places and we have kept its wording rather than correct it. It prints the control-arm adverse-effect rate as '100/423 (13%)' when 100 of 423 is 23.6 per cent, so the percentage understates the fraction printed beside it. Its two numbers needed to treat also do not follow from its own response rates and read as though they had been swapped: 70 against 55 per cent is a 15-point difference, which gives about 7, not the 3.9 printed, while 70 against 43 per cent gives about 4, not the 6.67 printed. Read the fractions and the percentage-point differences, not the derived figures.

the antihistamine-decongestant group experienced more adverse effects than the control group: 128/419 (31%) versus 100/423 (13%) participants suffered one or more adverse effects (OR 1.58, 95%CI 0.78 to 3.21; moderate certainty of evidence)

Higher cumulative use of strong anticholinergic medicines, of which first-generation antihistamines were one of the three most commonly used classes, was associated with a higher rate of dementia in a prospective cohort. (Source 7)

• Cohort study, Moderate certainty.
• Size: 3434 people aged 65 or older with no dementia at entry.
• Who: members of an integrated health system in Seattle, Washington, followed every 2 years.
• How long: mean follow-up 7.3 years, exposure measured over 10 years.
• Result: 797 participants (23.2%) developed dementia; adjusted hazard ratios versus non-use were 0.92 (95% CI 0.74-1.16) for 1 to 90 total standardised daily doses, 1.19 (95% CI 0.94-1.51) for 91 to 365, 1.23 (95% CI 0.94-1.62) for 366 to 1095 and 1.54 (95% CI 1.21-1.96) above 1095; test for trend P < .001.
• Funding: independent, with several authors declaring industry-funded biostatistician support and other disclosures.

Limit of this finding: This is an observational association across a whole drug class, measured from pharmacy dispensing records. It does not show that pyrilamine causes dementia, and pyrilamine was not studied separately.

The most common anticholinergic classes used were tricyclic antidepressants, first-generation antihistamines, and bladder antimuscarinics.

Serious adverse effects of mepyramine, especially in overdose, were frequently reported when it was widely prescribed, including drowsiness, impaired thinking, convulsion and coma. (Source 1)

• Expert review, not systematic, Very low certainty.
• Size: not stated; the statement is a background claim in a laboratory paper.
• Who: patients historically prescribed mepyramine for allergic reactions and urticaria.
• How long: not applicable.
• Result: no rates given; the paper reports that the laboratory sodium-channel IC50 values it measured fell within the range of drug concentrations detected in poisoned patients.
• Funding: not stated.

Limit of this finding: This is an uncited background assertion in the introduction of a basic-science paper, not a pharmacovigilance analysis. The sodium-channel work itself is in-vitro and animal.

Serious adverse effects, especially in case of overdose, were frequently reported, including drowsiness, impaired thinking, convulsion, and coma.

The over-the-counter label of a pyrilamine-containing menstrual product warns of drowsiness, excitability in children, and additive sedation with alcohol, sedatives and tranquillisers. (Source 5)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: adults and children 12 years and older taking the combination product.
• How long: as needed, not more than 6 caplets per day.
• Result: no rates are given on the label.
• Funding: not applicable (manufacturer label)

you may get drowsy avoid alcoholic drinks excitability may occur, especially in children alcohol, sedatives, and tranquilizers may increase drowsiness be careful when driving a motor vehicle or operating machinery

The label of the pyrilamine-containing cough syrup directs anyone already taking sedatives or tranquillisers to ask a doctor or pharmacist before using it. (Source 9)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: people with common cold or allergic rhinitis symptoms who are already taking sedatives or tranquillisers.
• How long: not applicable.
• Result: no rates are given on the label.
• Funding: not applicable (manufacturer label)

Ask a doctor or pharmacist before use if you are taking sedatives or tranquilizers.

What the evidence supports

In strips of human uterus in an organ bath, paracetamol combined with pyrilamine produced a synergistic rather than merely additive relaxation. (Source 4)

• Lab study in cells, Very low certainty.
• Size: uterine strips from non-pregnant human donors (number of donors not given in the abstract)
• Who: isolated non-pregnant human myometrium pre-contracted with potassium chloride.
• How long: not applicable.
• Result: EC30 for paracetamol 2391.3±595.3 microM and for pyrilamine 14.7±1.7 microM; experimental EC30 for the combination 401.8±129.8 microM against a theoretical additive value of 1203.0±297.7 microM (p<0.05); interaction index 0.33±0.14.
• Funding: not stated.

Limit of this finding: Tissue in a bath is not a person. This cannot support a claim that the combination relieves period pain in women.

The derived experimental EC30 for the PPC was 401.8±129.8 μM. This value was significantly lower (p<0.05) than the theoretical EC30 expected for a purely additive interaction, which was 1203.0±297.7 μM for the PPC.

What the evidence does not support

In the Cochrane review of over-the-counter cough medicines, antihistamines were no more effective than placebo for cough in adults, and in children antihistamines and antihistamine-decongestant combinations were also no better than placebo. (Source 3)

• Systematic review, Low certainty.
• Size: 29 placebo-controlled randomised trials, 4835 people (3799 adults and 1036 children)
• Who: children and adults with acute cough from upper respiratory tract infection in community settings.
• How long: trials of a few days.
• Result: Three adult trials found antihistamines no more effective than placebo; in children, antihistamines (three studies) and antihistamine-decongestants (two studies) were no more effective than placebo. The review authors judged pooling inappropriate.
• Funding: independent (all three review authors declared no conflict of interest)

Three trials found that antihistamines were no more effective than placebo in relieving cough symptoms.

Cochrane's conclusion on antihistamine-containing cold combinations is that the effect on individual symptoms is probably too small to be clinically relevant and that there is no evidence of effectiveness in young children. (Source 10)

• Systematic review, Low certainty.
• Size: 30 studies, 6304 participants, 31 treatment comparisons.
• Who: children and adults with the common cold.
• How long: 3 to 10 days in the pooled global-effect analyses.
• Result: For antihistamine-analgesic-decongestant combinations the odds ratio of treatment failure was 0.47 (95% CI 0.33 to 0.67), low certainty evidence, number needed to treat 5.6 (95% CI 3.8 to 10.2); one trial in children aged 2 to 12 years and two in adults found no beneficial effect.
• Funding: independent (review authors declared no conflict of interest)

Limit of this finding: The review's conclusion pulls in two directions in its own words: it says the data are scarce and the effect on individual symptoms is probably too small to be clinically relevant, and then that the combinations have 'some general benefit in adults and older children'. Neither sentence should be quoted without the other. Its closing remark about the US FDA concerns phenylpropanolamine in 2005 and is a historical note inside the review, not a current regulatory position.

Based on these scarce data, the effect on individual symptoms is probably too small to be clinically relevant. The current evidence suggests that antihistamine-analgesic-decongestant combinations have some general benefit in adults and older children. These benefits must be weighed against the risk of adverse effects. There is no evidence of effectiveness in young children.

A retrospective physician survey concluded that first-generation antihistamines did not play a relevant role in falls in older patients, which runs against the usual class concern. (Source 11)

• Survey study, Very low certainty.
• Size: 313,046 patients treated by 169 participating physicians; detailed information on 379 patients with 505 falls.
• Who: patients of German general practitioners and resident neurologists, including those aged 65 and over.
• How long: a six-month look-back window.
• Result: total fall rate 3.2% (9,922 patients); fall rate 1.1% under 65 years, 3.9% at 65-84 years and 9.9% at 85 years and over; first-generation antihistamine use documented in 9.5% (940) of the 9,922 who fell; physicians judged no causal link in 72.5% (366) of the 505 detailed falls.
• Funding: not stated; described as a retrospective post-authorisation safety study.

Limit of this finding: Causality was assigned by the treating physicians answering a survey, only 3.8% of invited physicians opened the survey, and exposure was taken from records. This design cannot exclude a real effect, and it directly contradicts the anticholinergic-burden literature; we report the disagreement rather than resolving it. The paper's own arithmetic does not add up either: it reports 505 falls of which 366 had no causal link, then calls the remainder '123 falls', where 505 minus 366 is 139. We have kept the figures as printed; the 72.5 per cent is right for 366 of 505, so the error is in the remainder, and no conclusion should be drawn from the 123.

The analysis of these cases indicates that in almost three quarters of falls (72.5%, 366 falls) there is no causal link between the intake of first-generation antihistamines and the fall.

Where the evidence is mixed

In a randomised double-blind trial in primary dysmenorrhoea, a paracetamol-pyrilamine-pamabrom combination reduced pain as much as a naproxen-paracetamol-pamabrom combination, but the trial had no placebo arm. (Source 2)

• Randomized trial, Low certainty.
• Size: 189 women in the intention-to-treat population (91 on paracetamol, pyrilamine and pamabrom; 98 on naproxen sodium, paracetamol and pamabrom)
• Who: Mexican women older than 17 years with primary dysmenorrhoea and pain greater than 45 mm on a visual analogue scale.
• How long: one menstrual cycle.
• Result: Visual analogue scale pain fell significantly in both groups (p<0.05) with no significant difference between groups (p>0.05); because both arms were active, the trial gives no estimate of the effect of pyrilamine against placebo.
• Funding: not stated.

Limit of this finding: An equivalence result between two active combinations cannot show that either works, and cannot isolate pyrilamine from the paracetamol and pamabrom beside it.

assessments of pain on the Visual Analogue Scale during the menstrual cycle demonstrated a significant reduction in both treatment groups (p<0.05). There is no significant difference in efficacy between both groups (p>0.05).

The same trial's authors concluded only that the two combinations did not differ, not that either beat placebo. (Source 12)

• Randomized trial, Low certainty.
• Size: 189 women.
• Who: women with primary dysmenorrhoea.
• How long: one menstrual cycle.
• Result: no difference between the two fixed-dose combinations in reducing dysmenorrhoeic pain.
• Funding: not stated.

The results showed that both drug combinations were not different in reducing dysmenorrheic pain. Likewise, both treatments were well tolerated.

Pyrilamine is still marketed at 12.5 mg per 5 mL inside a prescription cough-and-cold syrup alongside dextromethorphan and phenylephrine, for symptoms including cough, with no trial of that combination cited on its label. (Source 9)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: people with common cold or allergic rhinitis symptoms.
• How long: not applicable.
• Result: no efficacy data are presented on the label.
• Funding: not applicable (manufacturer label)

Limit of this finding: The label's claimed relief of cough sits against Cochrane's finding that antihistamines were no more effective than placebo for cough.

Dextromethorphan HBr............... 7.5 mg Phenylephrine HCl....................... 5 mg Pyrilamine Maleate................. 12.5 mg Ask a doctor or pharmacist before use if you are taking sedatives or tranquilizers. Uses temporarily relieves these symptoms due to the common cold, hay fever (allergic rhinitis) or other upper respiratory allergies: runny nose sneezing itching of nose or throat itchy, watery eyes cough due to minor throat and bronchial irritation nasal congestion

Where the research disagrees

Whether sedating first-generation antihistamines such as pyrilamine meaningfully increase the risk of falls and cognitive harm in older people

• Gray and colleagues, prospective cohort in the Adult Changes in Thought study, prospective population-based cohort with 10-year dispensing data: A 10-year cumulative dose-response relationship was observed for dementia and Alzheimer disease (Source 7)
• Gomez Perez and colleagues, retrospective post-authorisation safety study, retrospective physician survey with causality judged by treating doctors: This suggests that first-generation antihistamines do not play a relevant role in the fall incidents. (Source 11)

How much

• Reference intake: There is no reference intake for a medicine. Dosing is set by the prescriber, or for the over-the-counter products by the label. The over-the-counter menstrual-relief label records a position of 2 caplets, each containing pyrilamine maleate 15 mg, repeated every 6 hours as needed for adults and children 12 years and older, with children under 12 told to consult a doctor. (Source 5)
• Upper limit: The same label sets a maximum of 6 caplets per day, which corresponds to pyrilamine maleate 90 mg per day in that product. This is the manufacturer's labelled ceiling, not a toxicological upper limit derived from study of pyrilamine. (Source 5)
• Studied: The randomised dysmenorrhoea trial gave tablets containing paracetamol, pyrilamine and pamabrom over one menstrual cycle; the abstract states the combination but not the mg amounts. (Source 13)
• Studied: In the isolated human uterus experiment, pyrilamine was applied at concentrations of 3.2 to 100 microM, which is a laboratory concentration and not a dose given to a person. (Source 4)

A common belief, and what the research shows

The belief: The antihistamine in menstrual-relief caplets is there to treat bloating and water retention, and it has been shown to help.

What the research shows: No placebo-controlled trial of pyrilamine for menstrual symptoms was found in our searches. The only randomised trial we found compared a paracetamol-pyrilamine-pamabrom combination with a naproxen-containing combination and found no difference between them, which tells you nothing about whether the pyrilamine contributes. The label itself lists water-weight gain among the symptoms the whole caplet is for, and attributes the diuretic purpose to caffeine, not to pyrilamine.

Questions and answers

What is it?

Pyrilamine maleate is a first-generation antihistamine, known as mepyramine outside the United States. It blocks the histamine H1 receptor and, unlike newer antihistamines, enters the brain and causes drowsiness. Today it is sold almost entirely inside combination products: 15 mg per caplet alongside acetaminophen 500 mg and caffeine 60 mg in over-the-counter menstrual-relief caplets, and in some cough-and-cold syrups. (Source 5)

What does it do in the body?

Its named action is blocking the histamine H1 receptor, which reduces the sneezing, itching and runny nose that histamine drives, and which also makes people sleepy. Laboratory work shows mepyramine additionally blocks voltage-gated sodium channels in pain-sensing nerves at concentrations found in poisoned people, so sedation and confusion in overdose are not purely antihistamine effects. The sodium-channel work is in cells and animals, not people. (Source 1)

Is it good or bad for you?

It depends almost entirely on context, and the evidence base is thin either way. For acute cough, antihistamines were no better than placebo in the Cochrane review, so taking it for a cough is unlikely to help and does carry adverse effects. For menstrual symptoms the only trial we found cannot separate pyrilamine from the paracetamol beside it. The documented downsides are drowsiness and impaired driving in the short term, and, across the sedating-antihistamine class, an observational association between long cumulative anticholinergic use and dementia in older adults. (Source 3)

How do you get more of it?

This question does not apply in the way it does to a nutrient. Pyrilamine is a manufactured medicine, not something the body needs or stores, and there is no reason to want more of it. Where it exists at all, it is bought over the counter inside combination caplets with a labelled maximum of 6 caplets a day, or supplied on prescription inside a cough syrup. We report the label as a position, not as advice. (Source 5)

If it is harmful, what reduces it?

Pyrilamine is cleared by the body after each dose, so stopping the product is what reduces exposure; no antidote or elimination treatment specific to pyrilamine was found in our searches. In overdose, the recorded problems are central: drowsiness, impaired thinking, convulsion and coma, which are managed supportively in hospital. The label directs people to get medical help or contact a poison centre in case of overdose. (Source 1)

Why might someone be low in it or missing it?

Being low in pyrilamine is not a condition; it is a drug, so most people have none of it and that is normal. What varies is access and formulation: single-ingredient pyrilamine is not marketed in the United States, so the only way to encounter it is inside a combination product aimed at menstrual symptoms or inside a prescription cough syrup. Its own label also excludes some people from using it, including those with glaucoma, prostatic enlargement or chronic breathing problems, who are told to ask a doctor first. (Source 6)

Which whole foods contain it or feed it?

No food contains pyrilamine. It is a synthetic ethylenediamine antihistamine made for medical use, so there is no dietary source and no food that feeds it. The only food-related point in the labelling is the opposite direction: because the caplets also contain caffeine, caffeine-containing foods and drinks add to the total caffeine load. (Source 5)

What happens if you do not have it?

Nothing happens from not having pyrilamine; it is not required for any body function. The relevant question is what you lose by not taking it, and for cough the answer appears to be nothing, because antihistamines did not beat placebo in Cochrane's review and the review authors noted that these drugs can cause serious harm in children. For menstrual symptoms, no placebo-controlled trial of pyrilamine was found, so no benefit has been established to forgo. (Source 14)

How can you test for it?

There is no routine clinical blood test for pyrilamine and no reason to measure it in ordinary care. Drug concentrations can be measured in poisoning and forensic toxicology, and the laboratory paper on mepyramine anchored its sodium-channel potency to concentrations detected in poisoned patients, which shows such measurement exists in that setting. We found no validated, clinically useful test of pyrilamine status. (Source 1)

We searched: Europe PMC and PubMed searches for pyrilamine or mepyramine with overdose, toxicity, poisoning, death and assay terms; the only assay papers found measured pyrilamine in dosage forms rather than in patients.

References

1. FASEB journal : official publication of the Federation of American Societies for Experimental Biology. The widely used antihistamine mepyramine causes topical pain relief through direct blockade of nociceptor sodium channels. 2021. PMID 34758144, DOI 10.1096/fj.202100976RR. Read the source
2. Medwave. Naproxen, paracetamol and pamabrom versus paracetamol, pyrilamine and pamabrom in primary dysmenorrhea: a randomized, double-blind clinical trial - Results section of the abstract. 2016. PMID 27813503, DOI 10.5867/medwave.2016.09.6587. Read the source
3. The Cochrane database of systematic reviews. Over-the-counter (OTC) medications for acute cough in children and adults in community settings - Main results section of the abstract. 2014. PMID 25420096, DOI 10.1002/14651858.CD001831.pub5. Read the source
4. European journal of obstetrics, gynecology, and reproductive biology. Synergistic relaxing effect of the paracetamol and pyrilamine combination in isolated human myometrium - Results section of the abstract. 2011. PMID 21439705, DOI 10.1016/j.ejogrb.2011.02.011. Read the source
5. DailyMed, US National Library of Medicine (FDA OTC monograph label). MIDOL COMPLETE (acetaminophen, caffeine and pyrilamine maleate) OTC Drug Facts label - active ingredients, Uses, When using this product, Stop use and Directions. 2026. Read the source
6. DailyMed, US National Library of Medicine (FDA OTC monograph label). MIDOL COMPLETE (acetaminophen, caffeine and pyrilamine maleate) OTC Drug Facts label - Ask a doctor before use if you have and Ask a doctor or pharmacist before use if you are sections. 2026. Read the source
7. JAMA internal medicine. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study - Results section of the abstract. 2015. PMID 25621434, DOI 10.1001/jamainternmed.2014.7663. Read the source
8. The Cochrane database of systematic reviews. Oral antihistamine-decongestant-analgesic combinations for the common cold - Main results section of the abstract. 2022. PMID 35060618, DOI 10.1002/14651858.CD004976.pub4. Read the source
9. DailyMed, US National Library of Medicine (FDA label). POLYTUSSIN DM (dextromethorphan HBr, phenylephrine HCl, pyrilamine maleate) syrup label - active ingredients, Ask a doctor or pharmacist before use, Uses, Warnings and Ask a doctor before use if you have sections, contiguous and in the label's own order. 2026. Read the source
10. The Cochrane database of systematic reviews. Oral antihistamine-decongestant-analgesic combinations for the common cold - Authors' conclusions section of the abstract. 2022. PMID 35060618, DOI 10.1002/14651858.CD004976.pub4. Read the source
11. Die Pharmazie. Retrospective post-authorisation safety study investigating the relationship of first-generation antihistamines with sedative effect and the risk of falls in older patients. 2020. PMID 33303062, DOI 10.1691/ph.2020.0784. Read the source
12. Medwave. Naproxen, paracetamol and pamabrom versus paracetamol, pyrilamine and pamabrom in primary dysmenorrhea: a randomized, double-blind clinical trial - Conclusions section of the abstract. 2016. PMID 27813503, DOI 10.5867/medwave.2016.09.6587. Read the source
13. Medwave. Naproxen, paracetamol and pamabrom versus paracetamol, pyrilamine and pamabrom in primary dysmenorrhea: a randomized, double-blind clinical trial - Methods section of the abstract. 2016. PMID 27813503, DOI 10.5867/medwave.2016.09.6587. Read the source
14. The Cochrane database of systematic reviews. Over-the-counter (OTC) medications for acute cough in children and adults in community settings - Authors' conclusions section of the abstract. 2014. PMID 25420096, DOI 10.1002/14651858.CD001831.pub5. Read the source