acetaminophen/doxylamine/dextromethorphan/pseudoephedrine (OTC)

Brand and Other Names:Vicks NyQuil D, Vicks NyQuil
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

acetaminophen/doxylamine/dextromethorphan/pseudoephedrine

liquid

  • (325mg/6.25mg/15mg/30mg)/15mL
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Nasal Congestion, Rhinorrhea, Sore Throat, Cough, Fever, Headache

30 mL PO q6-8hr; not to exceed 4 doses/day

Dosage Forms & Strengths

acetaminophen/doxylamine/dextromethorphan/pseudoephedrine

liquid

  • (325mg/6.25mg/15mg/30mg)/15mL
more...

Nasal Congestion, Rhinorrhea, Sore Throat, Cough, Fever, Headache

Vicks NyQuil D

  • <12 years old: Ask a pediatrician
  • >12 years old: 30 mL PO q6-8hr; not to exceed 4 doses/day
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Interactions

Interaction Checker

and acetaminophen/doxylamine/dextromethorphan/pseudoephedrine

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            Adverse Effects

            Frequency Not Defined

            Arrhythmia

            Palpitations

            Convulsion

            Dizziness

            Drowsiness

            Excitability

            Tremor

            Weakness

            Dermatologic rash

            GI disturbances

            Anemia blood dyscrasias (neutropenia, pancytopenia, leukopenia)

            Bilirubin and alkaline phosphatase may increase

            Dry mouth, throat, and nose

            Thickening of mucus in nose or throat

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            Warnings

            Contraindications

            Hypersensitivity to any of the drugs

            Asthma

            Narrow-angle glaucoma

            <2 years of age

            Symptomatic prostate hypertrophy

            Use of MAO inhibitors within 14 days

            Severe hypertension

            Bladder-neck obstruction

            Stenosing peptic ulcer

            G-6-PD deficiency

            Severe hepatic impairment

            Cautions

            Acetaminophen hepatotoxicity possible in chronic alcoholics following various dose levels

            Severe or recurrent pain or high or continued fever may indicate a serious illness

            Acetaminophen contained in many OTC products and combined use with these products may result in toxicity due to cumulative doses exceeding recommended maximum dose

            Acetaminophen: Risk for rare, but serious skin reactions that can be fatal; these reactions include Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP); symptoms may include skin redness, blisters and rash

            Dextromethorphan: Do not take for persistent or chronic cough associated with smoking, asthma, or emphysema, or if it is accompanied by excessive phlegm unless directed by a healthcare provider; may slow respiration rate

            Doxylamine: May exacerbate angle closure glaucoma, hyperthyroidism, peptic ulcer, or urinary tract obstruction; xerostomia may occur

            Pseudoephedrine: Caution in cardiovascular disease, diabetes mellitus, prostatic hypertrophy and increased intraocular pressure

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            Pregnancy & Lactation

            Pregnancy category: C

            Lacation: excreted in breast milk, use caution

            Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Acetaminophen: Blocks pain impulse generation peripherally & may inhibit the generation of prostaglandin in the CNS; reduces fever by inhibiting the hypothalamic heat-regulating center

            Dextromethorphan: Cough suppressant that acts centrally on cough center in medulla

            Doxylamine: Competitively blocks histamine from binding to H1 receptors; significant antimuscarinic activity and penetrates CNS, which causes pronounced tendency to induce sedation

            Pseudoephedrine: Stimulates the alpha-adrenergic receptors causing bronchodilation & vasoconstriction

            Acetaminophen

            Peak plasma time: 10-60 min (PO immediate release); 60-120 min (PO extended release); 6 hr (PO 500 mg tablet); 8 hr (PO 650 mg extended release tablet)

            Vd: 1 L/kg

            Protein binding: 10-25%

            Metabolism: Liver (microsomal enzyme systems); conjugation (glucuronic acid)

            Half-life: 1.25-3hr

            Excretion: Urine

            Dextromethorphan

            Onset: 15-30 min

            Duration: 3-6 hr

            Metabolism: Hepatic P450 enzyme CYP2D6

            Excretion: Urine

            Half-life: 2-4 hr (extensive metabolizers); 24 hr (poor metabolizers)

            Peak plasma time: 2-3 hr

            Doxylamine

            Peak plasma time: 2-3 hr

            Half-life: 10-12 hr

            Excretion: Urine

            Metabolism: Liver (CYP450)

            Pseudoephedrine

            Half-Life: 3 hr (children); 9-16 hr (adults)

            Onset: 30 min (decongestant)

            Duration: 3-8 hr  

            Peak Plasma

            Time: 1.97 hr

            Concentration: 422 ng/mL

            Metabolism: Liver, by N-demethylation

            Metabolites: Inactive

            Clearance: 7.3-7.6 mL/min/kg

            Excretion: Urine (43-96%)

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