acetaminophen / dextromethorphan / doxylamine
Nyquil Cold and Flu is a combination medication containing acetaminophen (a pain reliever), dextromethorphan (a cough suppressant), and doxylamine (an antihistamine). It's used to treat cold and flu symptoms, like sore throat, fever, cough, runny nose, sneezing, and aches, in adults and children. Nyquil Cold and Flu is available as pills and a liquid. This medication can make you feel sleepy and dizzy as side effects.
What is Nyquil Cold and Flu?
What is Nyquil Cold and Flu used for?
Temporarily relieves common cold and flu symptoms, including:
Cough
Sore throat
Headache
Minor aches and pains
Fever
Runny nose
Sneezing
How Nyquil Cold and Flu works
Nyquil Cold and Flu is a combination of three medications:
Acetaminophen is an analgesic that relieves pain and lowers fever by stopping the production of certain chemicals in the brain that cause both pain and fever.
Dextromethorphan is a cough suppressant that works in the part of your brain that makes you cough, calming it down and telling your body to cough less.
Doxylamine is an antihistamine that works by blocking histamine, a natural chemical in your body that causes congestion, sneezing, and wakefulness.
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What are the side effects of Nyquil Cold and Flu?
Common Side Effects
- Sleepiness
- Dizziness
- Dry mouth
Other Side Effects
- Blurry vision
- Trouble urinating
Serious Side Effects
- Allergic reactions: rash; hives; difficulty breathing; swelling of face, lips, tongue, or throat
- Serious skin reaction: skin reddening, blisters, rash
- Liver damage: severe stomach pain, yellowing of skin or whites of the eyes, nausea, vomiting, loss of appetite
- Excessive sleepiness or dizziness
- Serotonin syndrome: fast heart rate, sweating, muscle stiffness or spasms, high fever, confusion
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Trouble passing urine
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Confusion
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Fatigue
- Headache
Pros and cons of Nyquil Cold and Flu
Pros
Available over the counter
Works within 30 minutes to relieve cold and flu symptoms
Available in capsules and a liquid
Combines three medications in one product for convenience
Available as a lower-cost generic
Cons
Needs to be taken multiple times per day
Can cause extreme sleepiness
More difficult to customize the dose since it's a fixed combination of three medications
Need to avoid alcohol while taking it
Not meant for long-term use
Pharmacist tips for Nyquil Cold and Flu
You can take Nyquil Cold and Flu with or without food. If it upsets your stomach, try taking the medication with food.
Nyquil Cold and Flu is only meant to be used short-term. You should stop using this medication and talk to your provider if your pain or cough lasts longer than a week or stops and returns, or fever that worsens or lasts for more than 3 days. These can be signs of a more serious condition that Nyquil Cold and Flu won't be able to treat.
Nyquil Cold and Flu can make you sleepy or dizzy during the day, which can affect your ability to focus, think, or react. Don't drive until you know how the medication affects you. To prevent daytime sleepiness, it might help to take the least amount of medication possible (that will still relieve your symptoms) at night.
While Nyquil Cold and Flu usually makes adults sleepy, it's possible for children who use this medication to become overly excited or energetic. If this happens to your child, speak to your child's provider. They can recommend other treatment options.
Tell your provider or pharmacist about all the medications you're taking so they can check for interactions. For example, the acetaminophen in Nyquil Cold and Flu can interact with warfarin (Coumadin) and raise your risk for bleeding. Also, the doxylamine in Nyquil Cold and Flu can interact with sleep or anxiety medications and make you more sleepy.
Don't start any new medications while taking Nyquil Cold and Flu, especially other medications containing acetaminophen, other cough suppressants, or other antihistamines, without talking to your provider or pharmacist first. Doing so can raise your risk of overdose and severe side effects.
Don't take Nyquil Cold and Flu with a monoamine oxidase inhibitor (MAOI), such as selegiline or phenelzine (Nardil). This combination can raise your risk for severe side effects (e.g., serotonin syndrome, dizziness). If you're currently taking or have taken an MAOI in the last 2 weeks, don't use Nyquil Cold and Flu. Contact your provider for other options to treat your cold or flu symptoms.
More tips for Nyquil Cold and Flu liquid form:
The liquid products might contain 10% of alcohol. But there are alcohol-free alternatives available, such as Vicks Nyquil Alcohol Free or Coricidin-Maximum Strength Multi-Symptom Flu.
Some liquid products contain sodium. Ask your provider if it's okay to use a product with sodium if you have a history of heart problems and you're on a low-salt diet.
Use a medication dose cup or an oral syringe to measure your dose of Nyquil Cold and Flu. Don't use household spoons because they aren't always accurate and might cause you to take the wrong dose.
Store at room temperature in the original bottle it came from and protect it from light.
More on Nyquil Cold and Flu tips
Frequently asked questions about Nyquil Cold and Flu
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What are the risks and warnings for Nyquil Cold and Flu?
Nyquil Cold and Flu can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver damage
Risk factors: Drinking three or more alcoholic beverages a day | Taking other medications containing acetaminophen | Taking too much Nyquil Cold and Flu | History of liver disease
Taking too much acetaminophen can cause permanent and life-threatening liver damage. For adults, the maximum amount of acetaminophen that can be taken is 3 or 4 grams in a 24-hour period, depending on your provider's instructions. For children, ask your child's provider.
Speak to your provider before using Nyquil Cold and Flu if you have liver problems, since it can cause further damage to your liver. Avoid drinking alcohol while taking this medication.
Signs of liver problems include dark urine, fatigue, stomach pain, or yellowing of skin or eyes. If you notice any of these symptoms, call your provider right away.
Serotonin syndrome
Risk factors: Taking monoamine oxidase inhibitors (MAOI) 14 days before starting Nyquil Cold and Flu | Taking other medications that raise serotonin levels in your brain
Serotonin syndrome is a rare, but potentially life-threatening condition where there's too much serotonin in the brain. Serotonin is one of the chemicals in your brain responsible for your mood. Your risk for this condition goes up if you use Nyquil Cold and Flu with other medications that affect serotonin levels, such as antidepressants (e.g., sertraline (Zoloft), duloxetine (Cymbalta)), MAOIs (e.g., phenelzine (Nardil)), lithium, and certain migraine medications (e.g., sumatriptan (Imitrex)). Make sure your provider knows about all the medications you take (including over-the-counter medications and supplements) before starting Nyquil Cold and Flu so they can check that your medications are safe for you. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, high fever, and confusion. Get medical help right away if you have any of these symptoms.
Accidental overdose
Nyquil Cold and Flu contains an analgesic (acetaminophen), a cough suppressant (dextromethorphan), and an antihistamine (doxylamine), which can be found in many other over-the-counter products. Using more than one medication containing acetaminophen, dextromethorphan, doxylamine, can lead to an accidental overdose and cause serious side effects. These serious side effects include liver failure, seizures, hallucinations (seeing things that aren't real), or even death. To prevent an accidental overdose, read package labels carefully. If you're not sure if a product has any similar ingredients, ask your pharmacist. If you or your loved one experiences an accidental overdose, get medical help as soon as possible or contact a poison control center at 1-800-222-1222.
Worsening of medical conditions
Risk factors: Liver disease | Glaucoma | Cough from asthma or another breathing problem | Mucus-producing cough | Breathing problems (e.g., emphysema, long-term bronchitis) | Enlarged prostate gland
Don't take Nyquil Cold and Flu if you have any of the risk factors listed above unless your provider said it's safe to do so. Taking this medication can worsen your condition(s) and cause serious side effects. Make sure your provider knows about all medical conditions you have or have had in the past before starting Nyquil Cold and Flu.
Allergic skin reactions
Although rare, Nyquil Cold and Flu can cause serious skin reactions, such as rash, blisters, skin reddening, or skin peeling. If you notice changes in your skin, stop using Nyquil Cold and Flu and get medical attention right away.
More on Nyquil Cold and Flu warnings
Nyquil Cold and Flu dosage forms
Typical dosing for Nyquil Cold and Flu
Nyquil Cold and Flu and its generics might come in different strengths and have different dosing directions. Read the manufacturer's label for instructions specific for your medication. Some examples include:
Nyquil Cold and Flu liquid: Each 30 mL dose cup contains 650 mg of acetaminophen, 30 mg of dextromethorphan, and 12.5 mg of doxylamine.
Adults and children 12 years and older: The typical dose is 30 mL (2 tablespoons) by mouth every 6 hours. Don't take more than 120 mL (8 tablespoons) in a 24-hour period unless your provider specifically told you to do so.
Children 4 to 11 years old: Ask your child's provider.
Children 3 years and younger: Don't use.
Nyquil Cold and Flu capsules: Each capsule contains 325 mg of acetaminophen, 15 mg of dextromethorphan, and 6.25 mg of doxylamine.
Adults and children 12 years and older: The typical dose is 2 capsules by mouth with water every 6 hours. Don't take more than 8 capsules in a 24-hour period unless your provider specifically told you to do so.
Children 4 to 11 years old: Ask your child's provider.
Children 3 years and younger: Don't use.
More on Nyquil Cold and Flu dosage forms
How much does Nyquil Cold and Flu cost?
Nyquil Cold and Flu contraindications
Taking Nyquil Cold and Flu with any other medication containing acetaminophen
Currently take or have taken an MAOI in the last 2 weeks
Using to make a child sleep
What are alternatives to Nyquil Cold and Flu?
Temporarily relieves common cold and flu symptoms, including:
Cough
Sore throat
Headache
Minor aches and pains
Fever
Runny nose
Sneezing
Cough
Runny nose
Sneezing
Sore throat
Headache
Minor aches and pains
Fever
Minor aches and pains
Headache
Cough
Sore throat
Runny nose
Sneezing
Itchy nose or throat
Itchy, watery eyes due to hay fever or allergies
Fever
What is the latest news about Nyquil Cold and Flu?
Nyquil Cold and Flu images
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References
Best studies we foundBorowy, C. S., et al. (2023). Antihistamine toxicity. StatPearls.
Church, M. K., et al. (2013). Pharmacology of antihistamines. Indian Journal of Dermatology.
Oh, S., et al. (2023). Dextromethorphan. StatPearls.
Pagel, J. F., et al. (2009). Excessive daytime sleepiness. American Family Physician.
The Procter & Gamble Manufacturing Company. (2024). Vicks Nyquil Alcohol Free Cold and Flu Nighttime Relief- acetaminophen, chlorpheniramine maleate, and dextromethorphan hydrobromide liquid [package insert]. DailyMed.
The Procter & Gamble Manufacturing Company. (2024). Vicks Nyquil Cold and Flu- acetaminophen, dextromethorphan hydrobromide, and doxylamine succinate capsule, liquid filled [package insert]. DailyMed.
The Procter & Gamble Manufacturing Company. (2024). Vicks Nyquil Cold and Flu Nighttime Relief- acetaminophen, dextromethorphan hydrobromide, and doxylamine succinate liquid [package insert]. DailyMed.
U.S. Food and Drug Administration. (2016). FDA drug safety communication: FDA warns of rare but serious skin reactions with the pain reliever/fever reducer acetaminophen.
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