BOOTS COLD AND FLU RELIEF HOT BLACKCURRANT - summary of medicine characteristics

1 NAME OF THE MEDICINAL PRODUCT

Boots Cold and Flu Relief Hot Blackcurrant

Active Ingredient                     ­Quantity/Dose Unit (mg)

Paracetamol Fine crystals EP          650

Ascorbic Acid Fine powder EP 50

4   CLINICAL PARTICULARS

4.1 Therapeutic indications

For the symptomatic relief of colds and influenza and to provide extra vitamin C during such infections.

4.2 Posology and method of administration

For oral administration, following solution in hot water.

Adults And Children Over 12 Years: The contents of the sachet dissolved in freshly boiled water to be taken at bedtime and repeat every four hours during the day if necessary, up to a maximum of 4 doses in 24 hours.

Children Under 12 Years: Not to be given without medical advice.

Elderly: There is no need for dosage reduction in the elderly.

4.3 Contraindications

Hypersensitivity to any of the ingredients.

Severe liver disease or kidney damage.

4.4 Special warnings and precautions for use

Label:

Immediate medical advice should be sought in the event of an overdose, even if you feel well.

Leaflet or combined label/leaflet:

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.

Caution in patients with impaired liver or kidney function.

The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease.

Do not take more than 4 doses in 24 hours.

Do not exceed the stated dose.

Children under 12 years should not be given this medicine without medical advice.

If symptoms persist, consult your doctor.

Keep all medicines out of the reach of children.

Contains Paracetamol.

Do not take this product for more than three days without consulting your doctor.

Do not take with any other paracetamol-containing products.

4.5 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 use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.

4.6 Fertility, pregnancy and lactation

A large amount of data on pregnant women indicate neither malformative, nor feto/neonatal toxicity. Epidemiological studies on neurodevelopment in children exposed to paracetamol in utero show inconclusive results. If clinically needed, paracetamol can be used during pregnancy however it should be used at the lowest effective dose for the shortest possible time and at the lowest possible frequency.

Paracetamol is excreted in breast milk but not in a clinically significant amount. Available published data do not contraindicate breast feeding.

4.7 Effects on ability to drive and use machines No adverse effects stated.

4.8 Undesirable effects

Very rare cases of serious skin reactions have been reported.

Side-effects are usually rare and mild and may occasionally include skin rashes and other allergic reactions. There have been reports of blood dyscrasias including thrombocytopenia and agranulocytosis, but these were not necessarily causally related to paracetamol.

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

Liver damage is possible in adults who have taken 10G 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, 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 odema 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 the 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) but results should not delay initiation of treatment beyond 8 hours after ingestion, as 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 of hospital.

5.1

Paracetamol is a peripherally acting analgesic with antipyretic properties.

Ascorbic acid is a source of vitamin c which may be beneficial during infection when vitamin c levels are believed to fall.

5.2 Pharmacokinetic properties

Paracetamol is readily absorbed from the gastrointestinal tract with peak plasma concentrations occurring about 30 mins to 2 hours after ingestion. Paracetamol is metabolised in the liver and excreted in the urine mainly as the glucuronide and sulphate conjugates, with about 10% as glutathione 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, although this is done dependent.

Ascorbic acid is readily absorbed from the gastrointestinal tract and is widely distributed in the body tissues. Ascorbic acid is reversibly oxidised to dehydro ascorbic acid; some is metabolised to ascorbate-2-sulphate which is inactive and oxalic acid which is excreted in the urine. Ascorbic acid crosses the placenta and is distributed into the breast milk.

5.3 Preclinical safety data

Conventional studies using the currently accepted standards for the evaluation of toxicity to reproduction and development are not available.

6 PHARMACEUTICAL PARTICULARS

6.1 List of excipients

Pulverised sugar

Castor sugar

Light Magnesium carbonate

Sodium saccharin recryst (76% saccharin)

Dried maize starch pdr

Anhydrous citric acid gran

Blackcurrant flavour 213 IFF

Anthocyanin

Sodium citrate

6.2 Incompatibilities

None stated

6.3 Shelf life

36 months

6.4 Special precautions for storage

None

6.5 Nature and contents of container

Heat sealed paper/aluminium foil/polythene sachets/ contained in a cardboard carton.

Pack size: 5 or 10 sachets.