contains Paracetamol 500 mg, Guaifenesin 100 mg Phenylephrine hydrochloride 6.1 mg Indications: For the relief of symptoms of colds and Immediate medical advice should be sought in the event of an overdose, even if the patient feels well because of the risk of delayed serious liver damage (see section 4.9). Good news, you can ease your symptoms to help you cope and get on with life. There is a good range of Lemsip cough remedies, decongestant powders and oral solutions specially designed for chest congestion. Available over the counter at your local pharmacy or supermarket. Lemsip cough max for mucus cough and cold capsules: Each capsule contains 500mg paracetamol, 100mg guaifenesin and 6.1mg phenylephrine. Adults and adolescents aged 16 years and over should take two capsules up to four times a day as needed. Adolescents aged 12 to 15 years should take one capsule up to four times a day as needed. Leave at least four hours between doses. Don't take more than four doses in 24 hours. The capsules should be swallowed whole with a drink of water. They can be taken either with or without food.

Do not take more than the recommended dose. You should also avoid taking more than one paracetamol-containing medicine at the same time, as this can easily result in exceeding the maximum dose of paracetamol. Tricyclic antidepressants (e.g. amitriptyline): may increase the risk of cardiovascular side effects with phenylephrine (see section 4.3). Bonkovsky HL, Kane RE, Jones DP, Galinsky RE, Banner B. Acute hepatic and renal toxicity from low doses of acetaminophen in the absence of alcohol abuse or malnutrition - evidence for increased susceptibility to drug toxicity due to cardiopulmonary and renal insufficiency. Hepatology. 1994;19:1141-8.Kurtovic J, Riordan SM. Paracetamol-induced hepatotoxicity at recommended dosage. J Intern Med. 2003;253:240-3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB. Acetaminophen hepatotoxicity in alcoholics. Ann Intern Med. 1986;104:399-404. 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. Information about this product, including adverse reactions, precautions, contra-indications, and method of use can be found at:

Empty the contents of the sachet into a cup. Add half a cup of hot (not boiling) water and stir to dissolve. You can add cold water and sugar if you want before drinking. Caution should be taken when paracetamol is used concomitantly with flucloxacillin as concurrent intake has been associated with high anion gap metabolic acidosis, especially in patients with risks factors (see section 4.4). Minton NA, Henry JA, Frankel RJ. Fatal paracetamol poisoning in an epileptic. Hum Toxicol. 1988;7:33-4. Zimmerman HJ, Maddrey WC. Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure. Hepatology. 1995;22:767-73.

Summary of medicine characteristics - LEMSIP COUGH MAX FOR CHESTY COUGH & COLD RELIEF CAPSULES

Expectorants such as guaifenesin are used to treat a productive, chesty or mucus cough, where you cough up phlegm. Guaifenesin helps to thin and loosen the mucus in the airways, making it easier to cough up. It's not known if phenylephrine passes into breast milk, or its effect on a nursing infant. When taken by mouth, decongestants such as phenylephrine can also temporarily decrease the production of breast milk with just one or two doses. Lemsip max should not be used by woman who are breastfeeding. Ask your doctor or pharmacist for further advice. Lemsip max cold and flu capsules should be used with caution in: reactions, precautions, contra-indications, and method of use can be found at: http://www.medicines.org.uk/emc/medicine/23352 for All-in-One 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. 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).

Kondo K, Inoue Y, Hamada H, Yokoyama A, Kohno N, Hiwada K. Acetaminophen-induced eosinophilic pneumonia. Chest. 1993;104:291-2.Monoamine oxidase inhibitors (including moclobemide) (MAOIs): Hypertensive interactions occur between sympathomimetic amines such as phenylephrine and monoamine oxidase inhibitors (see section 4.3). Don't take Lemsip cough max for mucus cough and cold if you have taken a type of medicine called a monoamine oxidase inhibitor (MAOI) in the last 14 days. MAOIs include the antidepressants phenelzine, tranylcypromine, isocarboxazid and moclobemide, and the anti-Parkinson's medicines selegiline, safinamide and rasagiline. This is because the combination of phenylephrine with these medicines could cause a dangerous increase in blood pressure (hypertensive crisis). Avoid taking Lemsip max flu lemon if you're already taking any of the following medicines because the combination may increase your blood pressure: Caffeine/metabolites are excreted in human milk, but at therapeutic doses of the product, no effects on the breastfed new-borns/infants are anticipated.

This product contains 129.0mg (5.61mmol) sodium per dose – to be taken into consideration for patients on a controlled sodium diet. Kumar S, Rex DK. Failure of physicians to recognize acetaminophen hepatotoxicity in chronic alcoholics. Arch Intern Med. 1991;151:1189-91. Tricyclic antidepressants: Tricyclic antidepressants (e.g. amitriptyline) may increase the risk of cardiovascular side effects with phenylephrine (see section 4.3). 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). Brotodihardjo AE, Batey RG, Farrell GC, Byth K. Hepatotoxicity from paracetamol self-poisoning in Western Sydney: a continuing challenge. Med J Aust. 1992;157:382-5.

More about Lemsip Max (acetaminophen)

Phenylephrine hydrochloride: Due to the vasoconstrictive 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. 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.