Like its predecessor, Dr. Mario 64 is a falling block tile-matching video game. The playing field is represented on-screen as a medicine bottle populated with viruses of three colors: red, blue, and yellow. The main objective of the game to clear the playing field of all the viruses using two-colored medical capsules dropped into the bottle. The player manipulates the capsules as they fall, moving them left or right and rotating such that they are positioned alongside the viruses and any existing capsules. When four or more capsule halves or viruses of the same colour are aligned in horizontal or vertical configurations, they are removed from play. The player receives a game over if the playing field fills up with capsules such that they obstruct the bottle's narrow neck. Points are awarded when viruses are destroyed.
