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.
Symptomatic and supportive measures should be undertaken, particularly with regard to the cardiovascular and respiratory systems. Convulsions should be controlled with intravenous diazepam. Chlorpromazine may be used to control marked excitement and hallucinations. Severe hypertension may need to be treated with an alpha-adrenoreceptor blocking drug, such as phentolamine. A beta blocker may be required to control cardiac arrhythmias.
36 months.
Hypersensitivity to the active substances or any of the excipients.
Severe renal impairment
Cardiovascular disease including hypertension and peripheral vascular disease.
Diabetes mellitus
Phaeochromocytoma
Hyperthyroidism
Closed angle glaucoma or where intraocular pressure is raised
Severe liver disease
Concomitant use of other sympathomimetic decongestants
Monoamine oxidase inhibitors
Beta-blockers -
Not to be used in children under the age of 6 years
None.
Pregelatinised maize starch
Microcrystalline cellulose
Sodium lauryl sulphate
Magnesium stearate
Quinoline yellow (E104)
Croscarmellose sodium
Tablets
Pseudoephedrine
Cardiovascular disorders: Tachycardia, palpitations, other cardiac dysrhythmias.
Gastrointestinal disorders: Nausea and/or vomiting.
General disorders and administration site conditions: Irritability.
Immune system disorders: Hypersensitivity reactions, including cross-sensitivity that may occur with other sympathomimetics.
Nervous system disorders: Headache, tremor, anxiety, restlessness, excitability, insomnia, hallucinations (particularly in children) and paranoid delusions.
Psychiatric disorders: Sleep disturbance.
Renal and urinary disorders: Urinary retention.
Skin and subcutaneous tissue disorders: Skin reactions including rash.
Vascular disorders: Hypertension.
Paracetamol
Hypersensitivity to paracetamol, including a skin rash, may occur.
Very rare cases of serious skin reactions have been reported.
Blood and lymphatic system disorders: There have rarely been reports of blood dyscrasias including thrombocytopenia and agranulocytosis, but these were not necessarily causally related to paracetamol.
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.
There are no preclinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.
For the symptomatic relief of the symptoms of colds and influenza including feverishness, aches and pains, headache, nasal and sinus congestion (blocked nose and sinuses).
For oral administration.
Paracetamol is a peripherally acting analgesic with antipyretic activity.
Pseudoephedrine is a sympathomimetic agent with direct and indirect effects on adrenergic receptors. It has alpha and beta adrenergic activity and some stimulant effect on the central nervous system. The sympathomimetic effect of pseudoephedrine produces vasoconstriction which in turn relieves nasal congestion.
Paracetamol is readily absorbed from the gastrointestinal tract with peak plasma concentrations occurring about 30 minutes 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 1-4 hours. Plasma protein binding is negligible at usual therapeutic concentrations, although this is dose-dependent.
The rate and extent of paracetamol absorption is normal in the elderly but plasma half life is longer and paracetamol clearance lower than in young adults.
In renal impairment though the mean plasma half-life of paracetamol is similar in normal and renally impaired subjects at 2-8 hours, from 8-24 hours paracetamol is eliminated less rapidly. An increase in the interval between doses of paracetamol has been recommended for adults with chronic renal failure.
With severe hepatic impairment the mean plasma half life of paracetamol is significantly prolonged (by approximately 75%). The clinical significance of this is however unclear, as no evidence exists of drug accumulation or hepatotoxicity in patients with liver disease.
Pseudoephedrine is readily and completely absorbed from the gastrointestinal tract. It is resistant to metabolism by monoamine oxidase and is largely excreted in the urine unchanged. It has an elimination half-life of 5 to 8 hours but its urinary elimination and hence half-life is pH dependent. Pseudoephedrine is rapidly distributed throughout the body, its volume of distribution being 2 to 3L/Kg bodyweight.
31 March 2017
Otrivine Mu-Cron
Boots Decongestant with Pain Relief Tablets
| The Boots Company PLC 1 Thane Road West Nottingham NG2 3AA | or | The Boots Company PLC trading as BCM |
Do not store above 30°C.
Store in the original package.
A child-resistant push through pack of opaque 250 micron PVC/40gsm PVdC blisters, heat sealed to 35gsm Glassine paper/9 micron soft temper aluminium foil.
Pack sizes: 6, 12.
PL 00014/0594
|
Active ingredient |
mg/tab |
|
Paracetamol Ph Eur Pseudoephedrine hydrochloride BP |
500.0 60.0 |
Caution in moderate to severe renal impairment.
Should be taken with caution by patients with hepatic impairment, prostatic enlargement and alcohol dependence.
If any of the following occur, the product should be stopped:
Hallucinations
Restlessness
Sleep disturbances
Not to be given to children under 6 years.
Do not take for longer than five days, unless your doctor agrees.
If symptoms persist, consult your doctor.
Do not take with any other decongestant-containing products.
Do not take with any other paracetamol-containing products.
Label
Immediate medical advice should be sought in the event of an overdose, even if you feel well.
Leaflet or combination 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.
No adverse effects known.
Adults and children over 12 years
One tablet to be taken three or four times a day, up to a maximum daily dose of 4 tablets (240mg pseudoephedrine and 2g paracetamol).
Elderly
Although no specific studies have been carried out in this age group, there is no need for dosage reduction in the elderly.
Children 6 to 12 years
Half a tablet to be taken four times a day, up to a maximum daily dose of 2 tablets (120mg pseudoephedrine and 1g paracetamol).
This medicine is contraindicated in children under 6 years of age.
Children of 6-12 years of age: not to be used for more than 5 days without the advice of a doctor. Parents or carers should seek medical attention if the child's condition deteriorates during treatment.
Administration in those with hepatic disorders
Care should be taken in administering this product to patients with severe hepatic impairment.
Administration in those with renal disorders
Care should be taken in administering this product to patients with moderate to severe renal impairment.
Warning: Do not exceed the stated dose.
Keep all medicines out of the sight and reach of children.
None.
First authorisation: 29 July 1999
