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Are NyQuil nights more wasted than drunken nights?

 

Carolyn Darbin

Date: 10/14/2006

 

  

My Story

 

Sickand tired, I stole a NyQuil tablet from my roommate. All night long, my eyes were closed but my mind was wide-awake. Somehow the medication which I supposed would relieve my symptoms and lull me to sleep instead induced a strange, half-dreaming state. After a while the dreams turned into night mares and I vowed to stay away from Vicks forever.

 

Additionally, my best friend seems to be somewhat addicted to NyQuil, as she relies on it and abuses it many nights a week. Her bad days call for a NyQuil night.

 

Vicks’s Story

 

In order to promote the sales and profits of a pharmaceutical company, the representatives of Proctor and Gamble present the following information about their questionable product:

 

“NyQuil multi-system formula relieves all of your major cold symptoms at night so you can get the rest you need to have a good morning” (Vicks, 2005).

 

 

 

ActiveIngredients

 

*        Acetaminophen 500mg (pain reliever/fever reducer)

*        Dextromethorphan HBr 15mg (cough suppressant)

*        Doxylaminesuccinate 6.25mg (antihistamine)

*        Pseudoephedrine Hydrochloride 30mg (nasal decongestant)

 

 

RelievedSymptoms

 

*        nasal congestion

*        cough due to minor throat and bronchial irritation

*        sore throat

*        headache

*        minor aches and pains

*        muscular aches

*        fever

*        runny nose and sneezing

 

 

RelievedConditions

 

TheCommon Cold

 

Colds begin gradually and are easily to spread to others byhand contact or viruses released into the air by sneezing, or coughing. Over200 viruses cause colds and so antibiotics are an ineffective form of treatment, allowing colds to last 7-14 days. Although there is no cure, over-the-counter products, which treat the symptoms, are available.

 

 

TheFlu

 

Flu symptoms do not come on gradually in any way, they hit you fast. It may only take a few hours to find yourself in bed with a fever. The main symptoms usually last 4 to 7 days, while fatigue and weakness potentially last 2 to 3weeks. The best treatment is to rest and stay hydrated by drinking as many fluids as possible. Flu symptoms are also treatable with an over-the-counter product, but if symptoms continue after a week or you have a temperature greater than 102°F, call a doctor.

 

Sleep deprivation

 

 

“Sleep touches every aspect of our lives from our health to how we interact with others. Sleep is an important component of your overall health and well-being, and is essential when you're recovering from an illness”, according to Dr. James Maas, sleep expert, professor of psychology at Cornell University and author of Power Sleep. Sleep is so important - in particularly in how it impacts your alertness, your productivity, your mood and especially your health.

“Missed sleep is cumulative - missing one hour of sleep a night for six nights in a row has the same effect as pulling an all-nighter. The more sleep you miss, the worse you'll feel." Once you've erased your debt and are starting with a clean slate, you can proactively avoid accumulating sleep debt in the future.

Your sleep debt can't be wiped out with just one good night's sleep.

 

You must have a plan for adding hours to your "sleep bank account, "consciously thinking about how and when to make up for missed sleep” (http://vicks.com/sleep_better/7_sleeping_habits.shtml). When you are sick, instead of creating more “sleep debt,” it is therefore beneficial to take a medication which can relief the symptoms and allow you to rest.

 

 

Medical Researcher’s Story

 

OverdoseRisk

 

Doxylamine succinate is the active ingredient in Nyquil and other over-the-counter antihistamines which are used commonly as a sleep aids and which also contain antitussive and decongestant agents for relieving cold and flu symptoms. Frequently, Doxylamine is involved in accidental and intentional overdoses, and, according to Leybishkis B, Fasseas P, & Ryan KF(2001), Rhabdomyolysis and secondary acute renal failure are “rare but potentially serious complications…which are just as life threatening as those associated with prescription drugs.”

 

They reported an observation of severe rhabdomyolysis in association with doxylamine overdose and warranted a high index of suspicion and evaluation for further complications in antihistamine toxicity, especially with the great number of nonprescription drugs containing doxylamine which are available to the general public.

 

The Case Reports of Soto LF, Miller CH, & Ognibere AJ. (1993) warranted similar concern for clinicians with patients who ingest doxylamine, recommending prompt intervention and further careful assessment of “renal function, urinary output, and serum creatine kinase levels.”

 

Clinical symptoms of doxylamine succinate overdose include somnolence, coma, seizures, mydriasis, tachycardia, psychosis, as well as rhabdomyolysis (Lee YD, Lee ST,2002).

 

Effectson sleep

 

The separate and combined effects of doxylamine succinate (25 mg) and acetaminophen(1 gm) on sleep were studied by interview procedures and information from medical records of 2,931 postoperative patients in a randomized control trial by Smith GM, Smith PH. (1985). The presence of either drug tended to enhance the sleep benefit of the other, but the domxylamine induced an unpleasant feeling of being overly drugged.

 

SuicideRisk

 

The Case Reports, Review, and Review of Reported Cases by Bockholdt B, Klug E,Schneider V. (2001) found that doxylamine concentrations were found in the blood and organs of two cases of suicide. Although only a few reports are found in the literature about lethal intoxications with doxylamine, there are many with combined intoxications and therefore a heightened suicide alert should exist for large doses of doxylamine medication.

 

InCombination with Oral Contraceptive

 

There is some concern that women taking the pill may experience different reactions to doxylamine medications.  contraceptives and 12 age-matched drug-free control women received a single 25 mg oral dose of doxylamine succinate in the fasting state. The low-dose estrogen-containing oral contraceptives were not found to significantly influence the pharmacokinetics of the antihistamines doxylamine or diphenhydramine (Luna BG, Scavone JM, Greenblatt DJ, 1989).

 

LiverInjury

Acetaminophen,a commonly used medication, is present in many over-the-counter remedies, including Nyquil. Its potential to cause severe liver injury has been increasingly appreciated in recent years, which puts chronic abusers of alcohol may be particularly at risk to hepatotoxicity from acetaminophen. Foust RT, Reddy KR, Jeffers LJ,& Schiff ER. (1989) reported two cases of unintentional liver injury associated with ingestion of Nyquil,  which contains acetaminophen and 25%alcohol.

 

Bookstaff RC, Murphy VA, Skare JA, Minnema D, Sanzgiri U, Parkinson A. (1996) studied the effects of doxylamine succinate on microsomal enzyme activity and serum thyroid hormone levels in B6C3F1 mice following dietary exposure for 7 or 15 days. Exposure of mice to doxylamine produced dose-related increases in liver weight at both time points examined, and the Doxylamine treatment caused a dose-dependent increase (up to 2.6-fold) in liver microsomal cytochrome P450 in both male and female mice, at both time points. Their results suggest that doxylamine is an inducer of liver microsomal cytochrome P450 in B6C3F1 mice, and so exposure to doxylamine also resulted in decreases in serum thyroxine levels with compensatory increases in serum thyroid-stimulating hormone level.

 

 

Conclusion

 

Although there is no extremely straight-forward medical proof that NyQuil causes the strange state I found myself in, there is much evidence supporting the fact that it can often do much more harm than good, especially in the case of overdoses. The medical literature, along with the fact that the drug already contains 25% alcohol, presents a reasonable case for the fact that often a NyQuil night can be more harmful and wasted than a night of drinking.

 

References

 

Bockholdt B, Klug E, Schneider V. (2001). Suicide throughdoxylamine poisoning. Forensic Science International, 119(1):138-40.

 

BookstaffRC, Murphy VA, Skare JA, Minnema D, Sanzgiri U, Parkinson A. (1996). Effects ofdoxylamine succinate on thyroid hormone balance and enzyme induction in mice.Toxicological Applications in Pharmacology, 141(2):584-94.

 

FoustRT, Reddy KR, Jeffers LJ, Schiff ER. (1989). Nyquil-associated liver injury.American Journal of Gastroenterology, 84(4):422-5.

 

LeeYD, Lee ST. (2002). Acute pancreatitis and acute renal failure complicatingdoxylamine succinate intoxication. Veterinary Human Toxicology. (3):165-6.

 

LeybishkisB, Fasseas P, & Ryan KF. (2001). Doxylamine overdose as a potential causeof rhabdomyolysis. American Journal of Medical Science, 322(1):48-9.

 

LunaBG, Scavone JM, Greenblatt DJ. (1989). Doxylamine and diphenhydraminepharmacokinetics in women on low-dose estrogen oral contraceptives. Journal ofClinical Pharmacology, 29(3):257-60.

 

SotoLF, Miller CH, Ognibere AJ. (1993). Severe rhabdomyolysis after doxylamineoverdose.

PostgraduateMedicine, 93(8):227-9, 232.

 

SmithGM, Smith PH. (1985). Effects of doxylamine and acetaminophen on postoperativesleep. Clinical Pharmacology Therapy, 37(5):549-57.

Vick’s.http://vicks.com/products/nyquil_liquid.shtm. 18 September, 2005.

 

 

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