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LEMSIP MAX COLD & FLU DIRECT LEMON
NAME OF THE MEDICINAL PRODUCT
Lemsip Max Cold & Flu Direct Lemon.
QUALITATIVE AND QUANTITATIVE COMPOSITION
*This is equivalent to 10 mg phenylephrine base.
For excipients, see 6.1.
A white to off-white unit-dose powder with the odour and flavour of lemons.
For relief of symptoms associated with the common cold and influenza, including the relief
of aches and pains, sore throat, headache, nasal congestion and lowering of temperature.
Posology and method of administration
Adults and children 12 and over: One single-dose container. The product is taken orally
The dose may be repeated in 4 hours.
No more than four doses should be taken in 24 hours.
Not to be given to children under 12 without medical advice.
There is no indication that dosage need be modified in the elderly.
Severe coronary heart disease and cardiovascular disorders. Hypertension. Hyperthyroidism.
Contraindicated in patients currently receiving or within two weeks of stopping therapy with
monoamine oxidase inhibitors. Hypersensitivity to paracetamol, phenylephrine or any other
Special warnings and precautions for use
Use with caution in patients with Raynaud's phenomenon or diabetes mellitus.
Care is advised in the administration of paracetamol to patients with severe renal or severe hepatic
impairment. The hazard of overdose is greater in those with non-cirrhotic alcoholic liver disease.
Patients should be advised not to take other paracetamol-containing products concurrently.
Due to its aspartame content this product should not be given to patients with phenylketonuria.
Phenylephrine should be used with care in patients with cardiovascular disease, diabetes mellitus,
closed angle glaucoma, prostatic enlargement and hypertension.
Interaction with other medicinal products and other forms of interaction
The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and
absorption reduced by cholestyramine.
The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular
daily use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.
Medicinal products which induce hepatic microsomal enzymes such as alcohol, barbiturates,
monoamine oxidase inhibitors and tricyclic antidepressants, may increase the hepatotoxicity of
paracetamol particularly after overdose.
Monoamine oxidase inhibitors (including moclobemide): hypertensive interactions occur between
sympathomimetic amines such as phenylephrine and monoamine oxidase inhibitors (see section 4.3).
Sympathomimetic amines: concomitant use of phenylephrine with other sympathomimetic amines
can increase the risk of cardiovascular side effects.
Beta-blockers and other antihypertensives (including debrisoquine, guanethidine, reserpine,
methyldopa): phenylephrine may reduce the efficacy of beta-blockers and antihypertensives. The
risk of hypertension and other cardiovascular side effects may be increased (see section 4.3).
Tricyclic antidepressants (e.g. amitriptyline): may increase the risk of cardiovascular side effects
with phenylephrine (see section 4.3).
Digoxin and cardiac glycosides: concomitant use of phenylephrine may increase the risk of irregular
heartbeat or heart attack.
Pregnancy and lactation
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. Available published data do not contraindicate breast feeding.
The safety of this medicine during pregnancy and lactation has not been established but in
view of a possible association of foetal abnormalities with first trimester exposure to
phenylephrine, the use of the product during pregnancy should be avoided. In addition,
because phenylephrine may reduce placental perfusion, the product should not be used in
patients with a history of pre-eclampsia.
In view of the lack of data on the use of phenylephrine during lactation, this medicine
should not be used during breast feeding.
Effects on ability to drive and use machines
Lemsip Max Cold & Flu Direct Lemon has no or negligible influence on ability to drive or use
Adverse effects of paracetamol are rare, but hypersensitivity including skin rash may occur.
There have been a few reports of blood dyscrasias including thrombocytopenia, leucopenia,
pancytopenia, neutropenia and agranulocytosis, but these were not necessarily causally
related to paracetamol.
Acute pancreatitis after ingestion of above normal amounts.
High blood pressure with headache and vomiting, probably only in overdose. Rarely
palpitations. Also, rare reports of allergic reactions and occasionally urinary retention in
Liver damage is possible in adults who have taken 10 g or more of paracetamol. Ingestion of
5 g of more of paracetamol may lead to liver damage if the patient has risk factors (see
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.
(b) Regularly consumes ethanol in excess of recommended amounts.
(c) Is likely to be glutathione depleted, e.g. eating disorders, cystic fibrosis, HIV infection,
Symptoms of paracetamol overdose 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.
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 24 hours from ingestion should be discussed with
the NPIS or a liver unit.
Features of severe overdose of phenylephrine include haemodynamic changes and
cardiovascular collapse with respiratory depression. Treatment includes early gastric lavage
and symptomatic and supportive measures. Hypertensive effects may be treated with an i.v.
alpha-receptor blocking agent.
Phenylephrine overdose is likely to result in: nervousness, headache, dizziness, insomnia,
increased blood pressure, nausea, vomiting, 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), dysuria, urinary retention (most likely to
occur in those with bladder outlet obstruction, such as prostatic hypertrophy).
Additional symptoms may include, hypertension, and possibly reflex bradycardia. In severe
cases confusion, hallucinations, seizures and arrhythmias may occur. However the amount
required to produce serious phenylephrine toxicity would be greater than that required to
cause paracetamol-related liver toxicity.
Treatment should be as clinically appropriate. Severe hypertension may need to be treated
with alpha blocking medicinal products such as phentolamine.
Paracetamol: Paracetamol has both analgesic and antipyretic activity which is believed to be
mediated principally through its inhibition of prostaglandin synthesis within the central
Phenylephrine: Phenylephrine is a post-synaptic α-receptor agonist with low cardioselective
β - receptor affinity and minimal central stimulant activity. It is a recognised decongestant
and acts by vasoconstriction to reduce oedema and nasal swelling.
Paracetamol: Paracetamol is absorbed rapidly and completely mainly from the small
intestine producing peak plasma levels after 15-20 minutes following oral dosing. The
systemic availability is subject to first-pass metabolism and varies with dose between 70%
and 90%. The drug is rapidly and widely distributed throughout the body and is eliminated
from plasma with a T½ of approximately 2 hours. The major metabolites are glucuronide
and sulphate conjugates (>80%) which are excreted in urine.
Phenylephrine: Phenylephrine is absorbed from the gastrointestinal tract, but has reduced
bioavailability by the oral route due to first-pass metabolism. It retains activity as a nasal
decongestant when given orally, the drug distributing through the systemic circulation to the
vascular bed of nasal mucosa. When taken by mouth as a nasal decongestant phenylephrine
is usually given at intervals of 4-6 hours.
Preclinical safety data
No preclinical findings of relevance have been reported.
List of Excipients
Ethyl cellulose, ascorbic acid, glyceryl tristearate, tartaric acid, sodium carbonate anhydrous,
aspartame, lemon flavour, sweet flavour and xylitol.
Special Precautions for Storage
Do not store above 25°C and store in the original package.
Nature and Content of Container
Polyethylene terephthalate / aluminium / polyethylene sachets.
Pack size: 1, 8 and 10.
Instructions for Use, Handling and Disposal
There are no special instructions for handling.
MARKETING AUTHORISATION HOLDER
Reckitt Benckiser Healthcare (UK) Limited
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION / RENEWAL OF THE AUTHORISATION
19 July 2002
DATE OF REVISION OF THE TEXT