Phenylephrine overdose is likely to result in: nervousness, headache, dizziness, insomnia, increased blood pressure, nausea, vomiting, reflex bradycardia, mydriasis, acute angle closure glaucoma (most likely to occur in those with closed angle glaucoma), tachycardia, palpitations, allergic reactions (e.g. rash, urticaria and allergic dermatitis), dysuria and urinary retention (most likely to occur in those with bladder outlet obstruction, such as prostatic hypertrophy). There have been reports of blood dyscrasias including thrombocytopenia, leucopenia, pancytopenia, neutropenia and agranulocytosis, but these were not necessarily causally related to paracetamol. If the symptoms of your cold or flu persist for more than three days, or worsen, consult your pharmacist. 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 preeclampsia. Kondo K, Inoue Y, Hamada H, Yokoyama A, Kohno N, Hiwada K. Acetaminophen-induced eosinophilic pneumonia. Chest. 1993;104:291-2.

Other medicines. Some drugs may affect the way in which paracetamol works, including those used to i treat blood cholesterol (cholestyramine) and nausea and vomiting (metoclopramide and domperidone). Prostaglandins are produced by the body in response to injury and certain diseases. One of their actions is to sensitise nerve endings, so that when that area is stimulated it causes pain (presumably to prevent us from causing further harm to the area). As paracetamol reduces the production of these nerve sensitising prostaglandins it's thought it may increase our pain threshold, so that although the cause of the pain remains, we can feel it less.Pregnancy and breast-feeding: This product should not be used in women with a history of pre-eclampsia. Ask your doctor or pharmacist for advice before taking this product if you are pregnant or breast-feeding.

Kurtovic J, Riordan SM. Paracetamol-induced hepatotoxicity at recommended dosage. J Intern Med. 2003;253:240-3. http://www.medicines.org.uk/emc/medicine/28101 for Honey & Ginger, and https://www.medicines.org.uk/emc/medicine/23354 for Lemon. The capsules shouldn't be given to children under 12 years of age. The hot drinks shouldn't be given to children under 16 years of age. Epidemiological studies in human pregnancy have shown no ill effects due to paracetamol used in the recommended dosage. Lemsip max all in one sachets: Available in lemon and wild berry and hot orange flavours. Each sachet contains 1000mg paracetamol, 200mg guaifenesin and 12.2mg phenylephrine. Adults and adolescents aged 16 years and over should take one sachet up to four times a day as needed. Leave at least four hours between doses. Do not take more than four sachets in 24 hours. The contents of each sachet should be dissolved in a mug of hot (not boiling) water. You can add cold water and sugar if you want before drinking.

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

Hull, HU8 7DS. Information about this product, including adverse reactions, precautions, contra-indications, and method of use can be Lemsip Max Flu Lemon is considered high in sodium. This should be particularly taken into account for those on a low salt diet." The product should not be used during pregnancy unless recommended by a healthcare professional (see section 4.6). 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.

Pharmacy product

Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine. LEMSIP MAX ALL IN ONE COLD & FLU CAPSULES, LEMSIP COUGH MAX FOR MUCUS COUGH & COLD: 500mg/100 MG/6.1 MG CAPSULES: Each capsule It is safe to take Lemsip cold & flu sachets with ibuprofen or aspirin. However, do not take them with co-codamol, co-dydramol or Tramacet because these contain paracetamol.

Phenylephrine overdose is likely to result in: nervousness, headache, dizziness, insomnia, increased blood pressure, nausea, vomiting, reflex bradycardia, 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). There are many other cold and flu and cough remedies available to buy without a prescription. Many of these will also contain paracetamol, phenylephrine hydrochloride and guaifenesin among their ingredients. Additional symptoms may include, hypertension, and possibly reflex bradycardia. In severe cases confusion, 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. Don't take Lemsip max all in one 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). If you're taking medicines for high blood pressure you shouldn't take Lemsip max all in one, because the decongestant may make your blood pressure medicine less effective.reactions, precautions, contra-indications, and method of use can be found at: http://www.medicines.org.uk/emc/medicine/23352 for All-in-One Tricyclic antidepressants: Tricyclic antidepressants (e.g. amitriptyline) may increase the risk of cardiovascular side effects with phenylephrine (see section 4.3). Anticoagulants: 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.