acetaminophen/doxylamine/dextromethorphan/pseudoephedrine (Vicks NyQuil D, Vicks NyQuil)
Classes: Cough/Cold, Non-narcotic Combos
- Dosing and uses of Vicks NyQuil D, Vicks NyQuil (acetaminophen/doxylamine/dextromethorphan/pseudoephedrine)
- Vicks NyQuil D, Vicks NyQuil (acetaminophen/doxylamine/dextromethorphan/pseudoephedrine) adverse (side) effects
- Warnings
- Pregnancy
- Pharmacology of Vicks NyQuil D, Vicks NyQuil (acetaminophen/doxylamine/dextromethorphan/pseudoephedrine)
Dosing and uses of Vicks NyQuil D, Vicks NyQuil (acetaminophen/doxylamine/dextromethorphan/pseudoephedrine)
Adult dosage forms and strengths
acetaminophen/doxylamine/dextromethorphan/pseudoephedrine
liquid
- (325mg/6.25mg/15mg/30mg)/15mL
Nasal Congestion, Rhinorrhea, Sore Throat, Cough, Fever, Headache
30 mL PO q6-8hr; not to exceed 4 doses/day
Pediatric dosage forms and strengths
acetaminophen/doxylamine/dextromethorphan/pseudoephedrine
liquid
- (325mg/6.25mg/15mg/30mg)/15mL
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
Vicks NyQuil D, Vicks NyQuil (acetaminophen/doxylamine/dextromethorphan/pseudoephedrine) adverse (side) 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
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
Pregnancy and 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.
Pharmacology of Vicks NyQuil D, Vicks NyQuil (acetaminophen/doxylamine/dextromethorphan/pseudoephedrine)
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%)