Classes
DEA Class; OTC
Common Brand Names; Coricidin HBP Nighttime Multi-Symptom Cold, Tylenol Cough & Sore Throat Nighttime, Vicks NyQuil Cold & Flu, Contac Cold + Flu Night Cooling Relief
Antitussives, Non-narcotic Combos;
Cough/Cold, Non-narcotic Combos
Description
Acetaminophen: Blocks pain impulse generation peripherally and may inhibit prostaglandin generation in CNS; reduces fever by inhibiting hypothalamic heat-regulating center
Doxylamine: Competitively blocks histamine from binding to H1 receptors; significant antimuscarinic activity and penetrates CNS, which causes pronounced tendency to induce sedation
Dextromethorphan: Cough suppressant that acts centrally on cough center in medulla
Indications
Indicated in Cough, Sore Throat, Rhinorrhea, Fever, Headache, Minor Aches & Pains
Contraindications
Hypersensitivity
Asthma
Narrow-angle glaucoma
Symptomatic prostate hypertrophy
Bladder-neck obstruction
Stenosing peptic ulcer
G-6-PD deficiency
Severe hepatic impairment
Adverse Effects
Angioedema
Laryngeal edema
Dizziness
Drowsiness
Pruritic maculopapular rash
Urticaria
Dry mouth, throat, and nose
Agranulocytosis
Leukopenia
Neutropenia
Pancytopenia
Thrombocytopenia
Thrombocytopenic purpura
Hepatotoxicity
Thickening of mucus in nose or throat
Anaphylactoid reaction
Warnings
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
Doxylamine may exacerbate angle closure glaucoma, hyperthyroidism, peptic ulcer, or urinary tract obstruction; xerostomia may occur
Do not take dextromethorphan 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; dextromethorphan may slow the breathing
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
Maximum Dosage
1-2 Tablespoons (15-30mL) PO q6hr; not to exceed a cumulative dose of acetaminophen 4 g/day and dextromethorphan 120 mg/day
2 capsules PO q6hr; not to exeed 8 capsules/day
Liquid formulation ingredients vary in dosage; follow specific brand instructions
Pediatric
<12 Years Old
Ask a pediatrician
>12 Years Old
2 Tablespoons (30mL) PO q6hr; not to exceed 120 mL/day
2 capsules PO q6hr; not to exeed 8 capsules/day