CYP Inhibitors: Caffeine undergoes extensive metabolism by hepatic microsomal cytochrome P450, factors known to alter the activity of this enzyme system may influence caffeine clearance. Thus, caffeine elimination is enhanced in cigarette smokers and inhibited by cimetidine, disulfiram, and oral contraceptive steroids. Seek advice before using if you are breast feeding, pregnant, planning to become pregnant, or suffer from allergies. Women who are breastfeeding. 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. Ask your doctor or pharmacist for further advice.

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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.

Pharmacy product

Antiemetics: The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and absorption reduced by cholestyramine. 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 T ½ of approximately 2 hours. The major metabolites are glucuronide and sulphate conjugates (>80%) which are excreted in urine. Due to the presence of caffeine, the product should be taken with care in patients with a history of peptic ulcers. Do not take anything else containing paracetamol while taking this medicine. Talk to a doctor at once if you take too much of this medicine, even if you feel well. This is because too much paracetamol can cause delayed, serious liver damage. Taken during pregnancy it appears that the half-life of caffeine is prolonged. This is a possible contributing factor in hyperemesis gravidarum.

Lemsip Max Cold and Flu Capsules - Summary of Product Lemsip Max Cold and Flu Capsules - Summary of Product

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. Don't take Lemsip cough max for mucus cough and cold if you're taking any of the following medicines, because the combination may increase your blood pressure:Do not take if: allergic to any ingredient, if you have heart disease, high blood pressure, overactive thyroid, or are taking or have taken MAOI's (antidepressants) within 14 days, if you are taking other sympathomimetic decongestants. Caffeine/metabolites are excreted in human milk, but at therapeutic doses of the product, no effects on the breastfed new-borns/infants are anticipated. Symptoms - emesis and convulsions may occur. No specific antidote. However, treatment is usually fluid therapy. Fatal poisoning is rare. If symptoms become apparent or overdose is suspected, consult a doctor immediately.

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Use during breastfeeding should be avoided, unless recommended by a healthcare professional (see section 4.6). There have been reports of blood dyscrasias including thrombocytopenia, leucopenia, pancytopenia, neutropenia and agranulocytosis, but these were not necessarily causally related to paracetamol. Sympathomimetic agents: Concomitant use of phenylephrine with other sympathomimetic amines can increase the risk of hypertension and other cardiovascular side effects (see section 4.3). 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. The product should not be used during pregnancy unless recommended by a healthcare professional (see section 4.6).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. Allergic reactions such as a rash or itching. Stop using this medicine and get medical advice if you think you've had an allergic reaction to it. The medicine comes as capsules and sachets for making hot drinks. Both are licensed for adults and adolescents aged 12 years and over. This is a medicine; Consult your doctor or pharmacist if you have an underlying medical condition, are taking any other medication or complementary therapy, or if symptoms persist. 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).

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Paracetamol is excreted in breast milk, but not in a clinically significant amount. Available published data do not contraindicate breastfeeding. Monoamine oxidase inhibitors (including moclobemide) (MAOIs): Hypertensive interactions occur between sympathomimetic amines such as phenylephrine and monoamine oxidase inhibitors (see section 4.3).Lemsip cough max for mucus cough and cold capsules and hot drinks contain the painkiller paracetamol, a cough expectorant called guaifenesin and a decongestant called phenylephrine hydrochloride. These three active ingredients have different actions to relieve your symptoms. If you're taking medicines for high blood pressure you shouldn't take Lemsip cough max for mucus cough and cold, because the decongestant may make your blood pressure medicine less effective. Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with the ingredients of Lemsip cough max for mucus cough and cold. Just because a side effect is stated here doesn't mean that all people using this medicines will experience that or any side effect.