1. Name Of The Medicinal Product
Cold Relief Capsules
Paramed Cold Relief Capsules
Superdrug Paracetamol Cold Relief with Decongestant
Non-Drowsy Sudafed Dual Relief
Non-Drowsy Sudafed Sinus & Pain Capsules
Sudafed Blocked Nose & Headache Capsules
Non-Drowsy Decongestant with Paracetamol
Paramed Non-Drowsy Decongestant with Paracetamol
Benylin Cold & Flu Multi Action Caps
Wilko Non-Drowsy Decongestant with Paracetamol
Boots Sinus Dual Relief Capsules
Sainsbury's Sinus Dual Relief Capsules
Tesco Sinus Dual Relief Capsules
Teva Cold Relief Capsules
2. Qualitative And Quantitative Composition
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3. Pharmaceutical Form
Capsule.
4. Clinical Particulars
4.1 Therapeutic Indications
For the relief of the symptoms of colds and flu, including headache, feverishness, nasal and sinus congestion and its associated, pressure and pain, catarrh, aches and pains.
4.2 Posology And Method Of Administration
Route of administration: Oral.
Adults, the elderly and children 12 years and over:
2 capsules every 4 to 6 hours as required, up to a maximum of 12 capsules in any 24 hour period.
This product is contraindicated in children under the age of 12 years (see section 4.3).
4.3 Contraindications
Hypersensitivity to paracetamol and/or other constituents.
Not to be used in children under the age of 12 years.
Concurrent administration of monoamine oxidase inhibitors and tricyclic antidepressants, severe hypertension, myocardial infarction, hyperthyroidism and pregnancy.
4.4 Special Warnings And Precautions For Use
PARACETAMOL
Paracetamol should be used with caution in patients with hepatic or renal impairment and alcohol dependence as the hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease.
The following warnings will appear on the pack:-
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- If symptoms persist consult your doctor.
- Do not exceed the stated dose.
- Keep all medicines out of the reach and sight of children.
- The pack shall also say “Do not take with any other paracetamol-containing products” and “Immediate medical advice should be sought in the event of an overdose, even if you feel well”.
- Care is advised in the administration of paracetamol to patients with severe renal or hepatic impairment. The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease.
The leaflet shall say “Immediate medical advice should be sought in the event of an overdose, even if you feel well, because of the risk of delayed, serious liver damage”.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
PARACETAMOL
The speed of absorption of paracetamol may be increased by metoclopramide or domperidone. Colestyramine may reduce the speed of absorption of paracetamol.
The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.
PHENYLEPHRINE HYDROCHLORIDE
Phenylephrine Hydrochloride may cause hypertension, sometimes severe, where used concurrently with both monoamine oxidase, and tricyclic type antidepressants, ganglion blocking agents, adrenergic blocking drugs, and methyldopa.
4.6 Pregnancy And Lactation
PREGNANCY
Although epidemiological studies in human pregnancy have shown no ill effects due to paracetamol used in the recommended doses, patients should follow the advice of their doctor regarding the use of paracetamol during pregnancy.
Paracetamol is excreted in breast milk, but not in a clinically significant amount. Available published data do not contra indicate breast feeding.
PHENYLEPHRINE HYDROCHLORIDE
The safety of phenylephrine hydrochloride in pregnancy has not been established and unless advised medically its use should be avoided.
Although excreted in breast milk, provided maternal intake is not excessive, no harm should come to the neonate during lactation.
4.7 Effects On Ability To Drive And Use Machines
None stated.
4.8 Undesirable Effects
PARACETAMOL
Adverse effects of paracetamol are rare but hypersensitivity including skin rash may occur. There have been reports of blood dyscrasias including thrombocytopenia and agranulocytosis, but these were not necessarily causally related to paracetamol.
CAFFEINE
Nausea and insomnia have been noted.
PHENYLEPHRINE HYDROCHLORIDE
Rarely phenylephrine hydrochloride may elevate blood pressure with headache, palpitation and vomiting; tachycardia or reflex bradycardia; tingling and coolness of the skin.
4.9 Overdose
PARACETAMOL
Liver damage is possible in adults who have taken 10g or more of paracetamol. Ingestion of 5g or more of paracetamol may lead to liver damage if the patient has risk factors (see below).
Risk factors
If the patient
a) Is on long term treatment with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St John's Wort or other drugs that induce liver enzymes.
or
b) Regularly consumes ethanol in excess of recommended amounts.
or
c) Is likely to be glutathione deplete e.g. eating disorders, cystic fibrosis, HIV infection, starvation, cachexia.
Symptoms
Symptoms of paracetamol overdosage in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. In severe poisoning, hepatic failure may progress to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, and death. Acute renal failure with acute tubular necrosis, strongly suggested by loin pain, haematuria and proteinuria, may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported.
Management
Immediate treatment is essential in the management of paracetamol overdose. Despite a lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention. Symptoms may be limited to nausea or vomiting and may not reflect the severity of overdose or the risk of organ damage. Management should be in accordance with established treatment guidelines, see BNF overdose section.
Treatment with activated charcoal should be considered if the overdose has been taken within 1 hour. Plasma paracetamol concentration should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable). Treatment with N-acetylcysteine may be used up to 24 hours after ingestion of paracetamol, however, the maximum protective effect is obtained up to 8 hours post-ingestion. The effectiveness of the antidote declines sharply after this time. If required the patient should be given intravenous N-acetylcysteine, in line with the established dosage schedule. If vomiting is not a problem, oral methionine may be a suitable alternative for remote areas, outside hospital. Management of patients who present with serious hepatic dysfunction beyond 24h from ingestion should be discussed with the NPIS or a liver unit.
CAFFEINE
Doses over 1g are probably necessary to induce toxicity, 2 – 5g to produce severe toxicity and 5 – 10 g is likely to be lethal.
Symptoms include: epigastric pain, vomiting, diuresis, tachycardia, CNS stimulation (insomnia, restlessness, excitement, agitation, jitteriness, tremors, convulsions).
No specific antidote is available, reduce or stop dosage and avoid excessive intake of coffee or tea.
PHENYLEPHRINE HYDROCHLORIDE
Severe overdosage may produce hypertension and associated reflex bradycardia. Treatment measures include early gastric lavage and symptomatic and supportive measures. The hypertensive effects may be treated with an alpha-receptor blocking agent (such as phentolamine mesilate 6 – 10 mg) given intravenously, and the bradycardia treated with atropine, preferably only after the pressure has been controlled.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
PARACETAMOL
Analgesic:
The mechanism of analgesic action has not been fully determined. Paracetamol may act predominantly by inhibiting a prostaglandin synthesis in the central nervous system (CNS) and to a lesser extent through a peripheral action by blocking pain-impulse generation. The peripheral action may also be due to inhibition of prostaglandin synthesis or to inhibition of the synthesis or actions of other substances that sensitise pain receptors to mechanical or chemical stimulation.
Antipyretic:
Paracetamol probably produces antipyresis by acting on the hypothalamic heat-regulating centre to produce peripheral vasodilation resulting in increased blood flow through the skin, sweating and heat loss. The central action probably involves inhibition of prostaglandin synthesis in the hypothalamus.
CAFFEINE
Central nervous system stimulant – Caffeine stimulates all levels of the CNS, although its cortical effects are milder and of shorter duration than those of amfetamines.
Analgesia Adjunct:
Caffeine constricts cerebral vasculature with an accompanying decrease in cerebral blood flow and in the oxygen tension of the brain. It is believed that caffeine helps to relieve headache by providing a more rapid onset of action and/or enhanced pain relief with lower doses of analgesic. Recent studies with ergotamine indicate that the enhancement of effect by the addition of caffeine may also be due to improved gastrointestinal absorption of ergotamine when administered with caffeine.
PHENYLEPHRINE HYDROCHLORIDE
Sympathomimetic amines, such as phenylephrine, act on alpha-adrenergic receptors of the respiratory tract to produce vasoconstriction, which temporarily reduces the swelling associated with inflammation of the mucous membranes lining the nasal and sinus passages. This allows the free drainage of the sinusoidal fluid from the sinuses.
In addition to reducing mucosal lining swelling, decongestants also suppress the production of mucus, therefore preventing a build up of fluid within the cavities which could otherwise lead to pressure and pain.
5.2 Pharmacokinetic Properties
PARACETAMOL
Absorption and Fate
Paracetamol is rapidly absorbed from the gastro-intestinal tract with peak plasma concentrations occurring between 10 and 120 minutes after oral administration. It is metabolised in the liver and excreted in the urine mainly as the glucuronide and sulphate conjugates. Less than 5% is excreted as unchanged paracetamol. The elimination half-life varies from about 1 to 4 hours.
Plasma-protein binding is negligible at usual therapeutic concentrations but increases with increasing concentrations.
A minor hydroxylated metabolite which is usually produced in very small amounts by mixed-function oxidases in the liver and which is usually detoxified by conjugation with liver glutathione may accumulate following paracetamol overdose and cause liver damage.
CAFFEINE
Absorption and Fate
Caffeine is absorbed readily after oral administration and is widely distributed throughout the body. Caffeine is metabolised almost completely via oxidation, demethylation, and acetylation, and is excreted in the urine as 1-methyluric acid, 1-methylxanthine, 7-methylxanthine, 1,7-dimethylxanthine (paraxanthine), 5-acetylamino-6-formylamino-3-methyluracil (AFMU), and other metabolites with only about 1% unchanged.
PHENYLEPHRINE HYDROCHLORIDE
Absorption and Fate
Phenylephrine has reduced bioavailability from the gastro-intestinal tract owing to irregular absorption and first-pass metabolism by monoamine oxidase in the gut and liver.
5.3 Preclinical Safety Data
There are no preclinical data of relevance to the prescriber additional to that already covered in other sections of the SPC.
6. Pharmaceutical Particulars
6.1 List Of Excipients
Capsule contents
Maize Starch
Croscarmellose Sodium
Sodium Lauryl Sulphate
Magnesium Stearate
Capsule
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6.2 Incompatibilities
None other than those listed in 4.3 and 4.5.
6.3 Shelf Life
3 years.
6.4 Special Precautions For Storage
None.
6.5 Nature And Contents Of Container
White opaque UPVC/aluminium foil blisters in cartons of 8, 10, 12, 16, 24, 32 and 48.
30 micron pyramidally embossed hard temper aluminium (with 250 micron PVC blisters).
6.6 Special Precautions For Disposal And Other Handling
None.
7. Marketing Authorisation Holder
Wrafton Laboratories Limited
Wrafton
Braunton
North Devon
EX33 2DL
8. Marketing Authorisation Number(S)
PL 12063/0003.
9. Date Of First Authorisation/Renewal Of The Authorisation
First Authorisation 5 July 1993.
10. Date Of Revision Of The Text
2 June 2010
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