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BENYLIN MUCUS COUGH & COLD ALL IN ONE RELIEF TABLETS

Active substance(s): GUAIFENESIN / PARACETAMOL / PHENYLEPHRINE HYDROCHLORIDE / GUAIFENESIN / PARACETAMOL / PHENYLEPHRINE HYDROCHLORIDE / GUAIFENESIN / PARACETAMOL / PHENYLEPHRINE HYDROCHLORIDE

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SUMMARY OF PRODUCT CHARACTERISTICS
1

NAME OF THE MEDICINAL PRODUCT
Benylin Mucus Cough & Cold All in One Relief Tablets
Sudafed Mucus Relief Triple Action Cold & Flu Tablets

Benylin Chesty Cough & Cold Tablets

2

QUALITATIVE AND QUANTITATIVE COMPOSITION
Active Ingredient

mg/Tablet

Paracetamol

250

Guaifenesin

100

Phenylephrine Hydrochloride

5

For full list of excipients, see section 6.1.

3

PHARMACEUTICAL FORM
Film-coated tablet
White capsule shaped tablet, embossed with “PGP”, free from specks and blemishes.

4

CLINICAL PARTICULARS

4.1

Therapeutic indications
For the relief of symptoms associated with colds and flu, including aches and pains, headache,
blocked nose and sore throat, chills and chesty cough.

4.2

Posology and method of administration
For oral use. Take tablets with water. Swallow whole, do not chew.
Adults, the Elderly and children aged 12 years and over:
Two tablets. Repeat every four hours as required. Do not take more than 8 tablets (4 doses)
in any 24 hour period.
Do not give to children under 12 years, except on medical advice.

Do not take more medicine than the label tells you to.
4.3

Contraindications
Hypersensitivity to paracetamol and/or any of the ingredients.

Hepatic or severe renal impairment, hypertension, hyperthyroidism, diabetes, heart
disease or those taking tricyclic antidepressants or beta-blocking drugs and those
patients who are taking or have taken, within the last two weeks, monoamine oxidase
inhibitors (see section 4.5).
Use in patients with glaucoma or urinary retention.
Use in patients who are currently receiving other sympathomimetic drugs.
Phaeochromocytoma.
Closed angle glaucoma.

4.4

Special warnings and precautions for use
The physician or pharmacist should check that sympathomimetic-containing
preparations are not simultaneously administered by several routes i.e. orally and
topically (nasal, aural and eye preparations).
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.
Patients suffering from chronic cough or asthma should consult a physician before
taking this product.
Patients should stop using the product and consult a health care professional if cough
lasts for more than 5 days or comes back, or is accompanied by a fever, rash or
persistent headache.
Do not take with a cough suppressant.
Medical advice should be sought before taking this product in patients with these
conditions:
An enlargement of the prostate gland
Occlusive vascular disease (e.g. Raynaud's Phenomenon)
Cardiovascular disease
This product should not be used by patients taking other sympathomimetics (such as
decongestants, appetite suppressants and amphetamine-like psychostimulants).
Concomitant use of other paracetamol-containing products should be avoided. If
symptoms persist consult your doctor.
Use with caution in patients with Raynaud’s Phenomenon and diabetes mellitus.
Patients with prostatic hypertrophy may have increased difficulty with micturition.
Sympathomimetic-containing products should be used with great care in patients
suffering from angina.

Sympathomimetic-containing products may act as cerebral stimulants giving rise to
insomnia, nervousness, hyperpyrexia, tremor and epileptiform convulsions.
Patients with rare hereditary problems of fructose intolerance, glucose-galactose
malabsorption or sucrase-isomaltase insufficiency should not take this medicine.
Contains a source of phenylalanine equivalent to 17 mg per sachet. May be harmful to
people with phenylketonuria.
This medicinal product contains 117 mg of sodium per dose. To be taken into
consideration by patients on a controlled sodium diet.
Long term use of the product is not recommended.
Do not take with alcohol.
Special label warnings
If you are taking medication or are under medical care, consult your doctor before
using this medicine. Do not take with other cold, flu or decongestant products.
Do not exceed the stated dose.
If symptoms persist or worsen, consult your doctor.
Keep all medicines out of the reach and sight of children.
Contains paracetamol. Do not take with any other paracetamol-containing products.
Immediate medical advice should be sought in the event of an overdose, even if you
feel well.
Special leaflet warnings
Contains paracetamol. Do not take with any other paracetamol-containing products.
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.
If you are taking medication or are under medical care, consult your doctor before
using this medicine. Do not take with other cold, flu or decongestant products.

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 and absorption reduced by colestyramine.
The anticoagulant effect of warfarin and other coumarins may be enhanced by
prolonged regular use of paracetamol with increased risk of bleeding, although
occasional doses have no significant effect. The hepato-toxicity of paracetamol may
be potentiated by excessive intake of alcohol. Pharmacological interactions involving
paracetamol with a number of other drugs have been reported. These are considered to
be of unlikely clinical significance in acute use at the dosage regimen proposed.
Drugs which induce hepatic microsomal enzymes, such as alcohol, barbiturates,
monoamine oxidase inhibitors and tricyclic antidepressants, may increase the

hepatotoxicity of paracetamol particularly after overdosage. Contraindicated in
patients currently receiving or within two weeks of stopping therapy with monoamine
oxidase inhibitors because of a risk of hypertensive crisis.
PHENYLEPHRINE HYDROCHLORIDE
Phenylephrine may adversely interact with other sympathomimetics, vasodilators and
beta blockers.
Sympathomimetic-containing products should be used with great care in patients
receiving phenothiazines or tricylic antidepressants.
Sympathomimetic-containing products should be used with caution in patients
receiving digitalis, beta-adrenergic blockers, guanethidine, reserpine, methyldopa or
anti-hypertensive agents.
Concurrent use with halogenated anaesthetic agents such as chloroform,
cyclopropane, halothane, enflurane or isoflurane may provoke or worsen ventricular
arrhythmias.
Phenylephrine should be used with caution in combination with the following drugs
as interactions have been reported:
Monoamine oxidase inhibitors Hypertensive interactions occur
(including moclobemide)
between sympathomimetic amines
such
as
phenylephrine
and
monoamine oxidase inhibitors (see
contraindications).
Sympathomimetic amines
Concomitant use of phenylephrine
with other sympathomimetic amines
can
increase
the
risk
of
cardiovascular side effects.
Beta-blockers
and
other Phenylephrine may reduce the
efficacy of beta-blocking drugs and
antihypertensives (including
debrisoquine,
guanethidine, antihypertensive drugs. The risk of
hypertension
and
other
reserpine, methyldopa)
cardiovascular side effects may be
increased.
Tricyclic
antidepressants
(e.g. May increase the risk of
amitriptyline)
cardiovascular side effects with
phenylephrine.
Ergot alkaloids (ergotamine and Increased risk of ergotism
methylsergide)
Digoxin and cardiac glycosides
Increase the risk of irregular
heartbeat or heart attack

4.6

Fertility, pregnancy and lactation
This product should not be used during pregnancy without medical advice.
PARACETAMOL
Epidemiological studies in human pregnancy have shown no ill effects due to
paracetamol used in the recommended dosage, but patients should follow the advice
of their doctor regarding its use.
Paracetamol is excreted in breast milk but not in a clinically significant amount. This
product should not be used whilst breast feeding without medical advice.
GUAIFENESIN
The safety of guaifenesin in pregnancy and lactation has not been fully established but
this constituent is not thought to be hazardous. However the product should only be
used in pregnancy when considered essential by the doctor.
PHENYLEPHRINE HYDROCHLORIDE
Due to the vasconstrictive properties of phenylephrine, the product should be used
with caution in patients with a history of pre-eclampsia. Phenylephrine may reduce
placental perfusion and the product should be used in pregnancy only if the benefits
outweigh this risk. There is no information on use in lactation.
The safety of phenylephrine during pregnancy has not been established.
Phenylephrine is excreted in breast milk but not in a clinically significant amount.
This product should not be used whilst breast feeding without medical advice.

4.7

Effects on ability to drive and use machines
None known.
Patients should be advised not to drive or operate machinery if affected by dizziness.

4.8

Undesirable effects
The active ingredients are usually well tolerated in normal use.
PARACETAMOL
Adverse events from historical clinical trial data are both infrequent and from small
patient exposure. Events reported from extensive post-marketing experience at
therapeutic/labelled dose and considered attributable are tabulated below by MedDRA
System Organ Class. Due to limited clinical trial data, the frequency of these adverse
events is not known (cannot be estimated from available data), but post-marketing
experience indicates that adverse reactions to paracetamol are rare and serious
reactions are very rare.

Body System
Blood and lymphatic
system disorders

Immune system disorders

Respiratory, thoracic and
mediastinal disorders
Hepatobiliary disorders
Gastrointestinal disorders

Undesirable effect
Thrombocytopenia
Agranulocytosis
These are not necessarily
causally related to
paracetamol
Anaphylaxis
Cutaneous hypersensitivity
reactions including skin
rashes, angioedema and
Stevens Johnson syndrome,
toxic epidermal necrolysis
Bronchospasm*
Hepatic dysfunction
Acute pancreatitis

Very rare cases of serious skin reactions have been reported.
* There have been cases of bronchospasm with paracetamol, but these are more likely
in asthmatics sensitive to aspirin or other NSAIDs.
GUAIFENESIN
The frequency of these events is unknown but considered likely to be rare.
Body System
Immune system disorders

Respiratory, thoracic and
mediastinal disorders
Gastrointestinal disorders
Skin and subcutaneous
disorders

Undesirable effect
Allergic reactions,
angioedema, anaphylactic
reactions
Dyspnoea*
Nausea, vomiting,
abdominal discomfort,
Rash, urticaria

PHENYLEPHRINE HYDROCHLORIDE
The following adverse events have been observed in clinical trials with phenylephrine
and may therefore represent the most commonly occurring adverse events.
Body System
Psychiatric disorders
Nervous system disorders
Cardiac disorders

Undesirable effect
Nervousness, irritability,
restlessness, and excitability
Headache, dizziness,
insomnia
Increased blood pressure

Gastrointestinal disorders

Nausea, Vomiting,
diarrhoea

Adverse reactions identified during post-marketing use are listed below. The
frequency of these reactions is unknown but likely to be rare.
Eye disorders

Cardiac disorders
Skin and subcutaneous
disorders

Renal and urinary disorders

Mydriasis, acute angle
closure glaucoma, most
likely to occur in those with
closed angle glaucoma
Tachycardia, palpitations
Allergic reactions (e.g. rash,
urticaria, allergic
dermatitis).
Hypersensitivity reactions
including cross-sensitivity
with other
sympathomimetics may
occur.
Dysuria, urinary retention.
This is most likely to occur
in those with bladder outlet
obstruction, such as
prostatic hypertrophy.

Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is
important. It allows continued monitoring of the benefit/risk balance of the medicinal
product. Healthcare professionals are asked to report any suspected adverse reactions
via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

4.9

Overdose
PARACETAMOL
Liver damage is possible in adults who have taken 10 g or more of paracetamol.
Ingestion of 5 g 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, phenobarbital, 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 accordance with established treatment guidelines, see British
National Formulary (BNF) overdose section.
Treatment with activated charcoal should be considered if the overdose has been
taken within one hour. Plasma paracetamol concentration should be measured at four
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 eight 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 24 hours from ingestion should be discussed
with the National Poisons Information Service (NPIS) or a liver unit.
GUAIFENESIN
Symptoms and signs
Very large doses of guaifenesin can cause nausea and vomiting.
Treatment
Vomiting should be treated by fluid replacement and monitoring of electrolytes if
indicated.
PHENYLEPHRINE HYDROCHLORIDE
Symptoms and signsPhenylephrine overdosage is likely to result in effects similar to
those listed under adverse reactions. Additional symptoms may include hypertension
and possibly reflux bradycardia. In severe cases confusion, hallucinations, seizures

and arrhythmias may occur. However the amount required to produce serious
phenylephrine toxicity would be greater than required to cause paracetamol-related
toxicity.
Treatment
Treatment should be as clinically appropriate. Severe hypertension may need to be
treated with an alpha blocking drug such as phentolamine.

5

PHARMACOLOGICAL PROPERTIES

5.1

Pharmacodynamic properties
Pharmacotherapeutic Group:

Other analgesics and antipyretics &
Other cold combination preparations

ATC code:

N02B E51

Paracetamol is an analgesic and antipyretic.
Guaifenesin is an expectorant.
Phenylephrine Hydrochloride is a sympathomimetic decongestant.
The active ingredients are not known to cause sedation.

5.2

Pharmacokinetic properties
Paracetamol is rapidly absorbed from the gastrointestinal tract. It is metabolised in the liver
and excreted in the urine, mainly as the glucuronide and sulphate conjugates.
Guaifenesin is rapidly absorbed after oral administration. It is rapidly metabolised by
oxidation to β-(2 methyoxy-phenoxy) lactic acid, which is excreted in the urine.
Phenylephrine hydrochloride is irregularly absorbed from the gastrointestinal tract and
undergoes first-pass metabolism by monoamine oxidase in the gut and liver; orally
administered phenylephrine thus has reduced bioavailability. It is excreted in the urine almost
entirely as the sulphate conjugate.

5.3

Preclinical safety data
Preclinical safety data on these active ingredients in the literature have not revealed any
pertinent and conclusive findings which are of relevance to the recommended dosage and use
in the product and which have not already been mentioned elsewhere in this Summary.

6

PHARMACEUTICAL PARTICULARS

6.1

List of excipients
Core:
Microcrystalline cellulose
Stearic acid
Povidone
Film Coat:
Hypromellose
Polyethylene glycol

6.2

Incompatibilities
None known

6.3

Shelf life
3 years.

6.4

Special precautions for storage
Do not store above 25°C.

6.5

Nature and contents of container
Child Resistant PVC/Al blister.
Pack sizes: 8 and 16 tablets.

6.6

Special precautions for disposal
None

7

MARKETING AUTHORISATION HOLDER
Wrafton Laboratories Limited (T/A Perrigo)
Braunton
Devon
EX33 2DL

8

MARKETING AUTHORISATION NUMBER(S)
PL 12063/0112

9

DATE OF FIRST AUTHORISATION/RENEWAL OF THE
AUTHORISATION
27/04/2011

10

DATE OF REVISION OF THE TEXT
02/03/2016

Expand Transcript

Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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