Pseudoephedrine should be discontinued if sudden loss of vision or decreased visual acuity such as scotoma occurs. Pholcodine (ingredient included in Day capsule only), The frequency of reactions identified during post-marketing use is not known, Hypersensitivity reactions including skin rashes, angioedema, anaphylaxis, Respiratory, thoracic and mediastinal disorders, Acute generalized exanthematous pustulosis (see section 4.4). Concomitant use of potent CYP2D6 enzyme inhibitors can increase the dextromethorphan concentrations in the body to levels multifold higher than normal. Allow at least 4 hours between taking last dose of Day capsules and the dose of Night capsules. Promethazine may potentiate the sedative effects of other CNS depressant drugs. In a small proportion of individuals, metabolism proceeds more slowly and dextromethorphan predominates in blood and urine. To view the changes to a medicine you must sign up and log in. Contains ethanol (alcohol) 18% v/v, sodium and glucose. • However, you would not be committing an offence (called 'statutory defence') if: o The medicine has been taken to treat a medical or dental problem and, o You have taken it according to the information provided with the medicine and. Not to be given to children under 16 years of age, Adults and children aged 16 years and over, Two capsules every four hours, up to a maximum of three doses in any 24 hour period. Only one dose should be taken at night. Dosage: Adults and children 16 years and over: 20 ml or 2 capsules before bed. Do not take if you have already taken 4 doses (4000mg) of a paracetamol-containing product in any 24 hour period. Symptoms reported included sudden onset of severe headache, nausea, vomiting, and visual disturbances. Central nervous system depression, including respiratory depression, may develop but is unlikely to be severe unless other sedative agents have been co-ingested, including alcohol, or the overdose is very large. Night nurse capsules and liquid are available from pharmacies. If signs and symptoms such as pyrexia, erythema, or many small pustules are observed, administration of Day and Night Nurse Capsules should be discontinued and appropriate measures taken if needed. The medicine contains three active ingredients. Excipients. Night Nurse Liquid has been specially formulated to provide a complete night-time cold and flu treatment by quickly providing relief from the major cold and flu symptoms. Reporting suspected adverse reactions after authorisation of the medicinal product is important. When taking this medicine, patients should be told: • The medicine is likely to affect your ability to drive, • Do not drive until you know how the medicine affects you, • It is an offence to drive while under the influence of this medicine. There is a risk that it may cause sedation, irritability or excitement in a new-born baby. If you are thinking of taking Nurse Nurse, read the following key information: • Night Nurse is suitable for adults and teenagers aged 16 years and over. How to take Night Nurse 4. There have been rare cases of posterior reversible encephalopathy (PRES)/reversible cerebral vasoconstriction syndrome (RCVS) reported with sympathomimetic drugs, including pseudoephedrine. 10% as the sulphoxide metabolite being excreted in the urine over a 72 hour period. So for someone with a drinking habit, a (160ml) bottle of Night Nurse would give them 28.8mls of pure alcohol, but would also give them the equivalent of … Night Nurse should only be used for the short period to relief the symptoms of cold or flu. 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. It contains two different products: Night Nurse Capsules; Day Nurse Capsules; The Day Nurse capsules are intended for day time use and contain: Tylenol (acetaminophen, also known as paracetamol): Analgesic Each tray holds 6 Day Nurse capsules and 2 Night Nurse capsules. Two capsules just before bedtime. Indications: Symptomatic relief of colds, chills and influenza at night. Paracetamol: Night Nurse contains a dose of paracetamol which works as a painkiller to reduce any headaches or aches and pains and also reduces a high temperature. Paracetamol . No relevant data are available for products containing dextromethorphan. • with severe hypertension or coronary artery disease. Concomitant use of this medication with sympathomimetic agents which interfere with the catabolism of sympathomimietic amines, may occasionally cause a rise in blood pressure. The green and white night nurse capsules also contain three active ingredients, paracetamol, promethazine and dextromethorphan. Pack sizes: 24 capsules (3 trays) comprising 18 Day Nurse capsules and 6 Night Nurse capsules. The elderly are more susceptible to anticholinergic effects of promethazine. Medical advice should be sought before taking this product in people taking the following medications (See interactions): • selective serotonin reuptake inhibitors (SSRI), • drugs which cause CNS depression, such as antipsychotics, hypnotics and anxiolytics, as concurrent use may cause an increase in sedative effects, • drugs with anticholinergic effects (e.g. The medicine contains three active ingredients: Paracetamol is a painkiller and reduces your temperature when you have a fever. What are the exercise rules during lockdown 3.0? Liver damage is possible in adults who have taken 10g or more of paracetamol. • Don’t take more than one dose of Night Nurse per night. 1. Drowsiness is a very common side effect of Night Nurse, which affects more that 1 in 10 people taking it. Should not be used with other paracetamol-containing products; decongestants antihistamine containing products (including those used on the skin) or cough and cold medicines. Liver damage may become apparent 12 to 48 hours after ingestion. Medical advice should be sought before taking paracetamol-promethazine- dextromethorphan (Night capsules) in combination with these drugs: Monoamine-oxidase inhibitors (MAOIs), selective serotonin re-uptake inhibitors (SSRIs), tricylic antidepressants. Pholcodine may predispose patients to developing anaphylaxis with neuromuscular blocking agents. • People with diabetes. Think of it as your body’s way of recharging its batteries. It is metabolised in the liver and excreted as demethylated metabolites including dextrorphan, and as a minor proportion of unchanged dextromethorphan. See leaflet. Night Nurse Capsules contain a different blend of active ingredients to relieve colds and flu symptoms, as well as helping you get a good night's sleep: Paracetamol: a pain killer that also reduces your temperature when you have a fever Day and Night Nurse contains 24 capsules, 18 day-time capsules and 6 night-time capsules. Underlying liver disease increases the risk of paracetamol-related liver damage. Night Nurse capsules These green and white coloured capsules help to relieve fever, sore throat pain, headaches, and tickly cough, so you can get a good night's sleep. If required the patient should be given intravenous N-acetylcysteine, in line with the established dosage schedule. • People have difficulty emptying your bladder, for example men with an enlarged prostate gland. Is it safe to take Night Nurse when you’re pregnant? Lv 6. Night Nurse Capsules are used for night-time relief of the major symptoms of colds, chills and influenza. Night Nurse contains paracetamol with dextromethorphan to suppress a cough and promethazine to dry up a runny nose and help you sleep. mg/capsule. Paracetamol also works to bring down a fever and this stops you feeling hot or shivery. Patients should be advised of the signs and symptoms and monitored closely for skin reactions. Some of the ingredients in the syrup base of Night … Specially concentrated, just one dose at bedtime relieves major cold and flu symptoms, helping you to get a good night… This can help reduce a runny nose and relieve coughs caused by mucus tickling the back of the throat. • with bronchiolitis or bronchiectasis, due to sputum retention. Dextromethorphan overdose may be associated with nausea, vomiting, dystonia, agitation, confusion, somnolence, stupor, nystagmus, cardiotoxicity (tachycardia, abnormal ECG including QTc prolongation), ataxia, toxic psychosis with visual hallucinations, hyperexcitability. Do cold and flu home remedies really work? The frequency of drug dependence and withdrawal reactions is unknown: General disorders and administration site conditions, Promethazine (ingredient included in Night capsule only). The capsules can be taken either with or without food and swallowed with a drink of water. Is it safe to take Night Nurse while you’re breastfeeding? It may be an offence to drive while you are taking Night Nurse. The hazard of overdose is greater in those with non-cirrhotic alcoholic liver disease. Some of the ingredients in the syrup base of Night Nurse have changed. In concomitant use with quinidine, plasma concentrations of dextromethorphan have increased up to 20-fold, which has increased the CNS adverse effects of the agent. Anticholinergic drugs such as atropine, MAOIs and tricyclic antidepressants. How to use stud 100 - Day And Night Nurse Ingredients . Metoclopramide and domperidone speed up the absorption of paracetamol from the gut, making it start to work quicker. paracetamol; promethazine hydrochloride; dextromethorphan hydrobromide Pseudoephedrine is secreted into breast milk in small amounts but the effect of this on breast fed infants is unknown. The day capsule may cause dizziness. Taking a capsule before bed helps relieve your symptoms, allowing you to sleep through the night and wake up refreshed. If overdose is severe, nalaxone may be helpful, particulary for patients with respiratory depression. Night Nurse contains 3 active ingredients which means that Night Nurse works in 3 ways. paracetamol; pholcodine; promethazine hydrochloride; dextromethorphan hydrobromide; pseudoephedrine hydrochloride Night nurse liquid contains 37mg sodium in every 20ml dose. The frequency of these adverse is not known (cannot be estimated from available data). Cardiac arrhythmias and pancreatitis have been reported. Tricyclic or related antidepressants, for example amitriptyline, maprotiline. Night Nurse is not suitable for the following groups of people: • People at risk of severe breathing problems (respiratory failure), for example people having an asthma attack or flare-up of asthma, or people with pneumonia or chronic bronchitis or emphysema. Ingredients. Paracetamol is distributed into most body tissues. For the symptomatic relief of colds, chills and influenza at night. Tricyclic antidepressants, such as amitriptyline. The contain paracetamol 500mg, Promethazine hydrochloride 10mg, Dextromethorphan hydrobromide 7.5mg to bring you relief from your cold and flu and aid a restful nights sleep. So each 20ml dose contains 3.6ml of alcohol. • In patients taking other CNS depressants (including alcohol). Abnormalities of glucose metabolism and metabolic acidosis may occur. In the event of massive overdose the following symptoms may be observed: coma, respiratory depression, convulsions. Date of first authorisation/renewal of the authorisation. Active ingredient. 7.5 . It allows continued monitoring of the benefit/risk balance of the medicinal product. the product should not be taken by elderly patients with confusion. Or c, Is likely to be glutathione deplete e.g. Caution is needed in patients with a history of drug abuse. • People with a condition called bronchiectasis, in which there is persistent widening of the airways as a result of lung disease, for example infection, inflammation, tumours or cystic fibrosis. Medical advice should be sought before taking paracetamol-pseudoephedrine- Pholcodine (Day capsules) in combination with these drugs: Should not be given to patients being treated with monoamine oxidase inhibitors or within 14 days of stopping such treatment as may lead to hypertensive crisis, CNS depressant drugs such as barbiturates, hypnotics, narcotic analgesics, sedatives and tranquillisers. • Do not take Night Nurse if you have already taken four doses of another paracetamol-containing medicine during the day. This acute pustular eruption may occur within the first 2 days of treatment, with fever, and numerous, small, mostly non-follicular pustules arising on a widespread oedematous erythema and mainly localized on the skin folds, trunk, and upper extremities. The drug withdrawal syndrome is characterised by some or all of the following: restlessness, lacrimation, rhinorrhoea, yawning, perspiration, chills, myalgia, mydriasis and palpitations. Hallucinations (particularly in children), Vomiting, dry mouth, nausea, ischaemic colitis, Diarrhoea or constipation, epigastric pain, anorexia, Rash, allergic dermatitis**, Severe skin reactions, including acute generalized exanthematous pustulosis (AGEP), sweating, *Increases in systolic blood pressure have been observed. The elimination half-life ranges from 32 to 43 hours. Adults and teenagers aged 16 years and over should take two capsules at bedtime. Genetically controlled O-demethylation (CYD2D6) is the main determinant of dextromethorphan pharmacokinetics in human volunteers. Promethazine hydrochloride is an antihistamine which dries up a runny nose and aids restful sleep. The drug has a large volume of distribution and is only 23.5% protein bound. Pseudoephedrine (included in Day capsule only). Suitable for adults and children aged 16 and over. For the relief of: Headaches; Shivers; Aches & Pains; Sore throat pain; Relieves tickly cough; Runny Nose ; How to Take. You may be able to find more information about this and similar content at piano.io, Crackling and popping in your ears explained. Pseudoephedrine may increase the possibility of arrhythmias in digitalised patients. If you have misplaced the dosage instructions, try the following: • Night Nurse capsules or liquid should not be taken is you have already taken four doses of a paracetamol-containing medicine during the day. Accordingly, events reported from extensive post-marketing experience at therapeutic/labelled dose and considered attributable are tabulated below by system class. Night Nurse is used for the night-time relief of the major symptoms of colds, chills and flu. This is caused by the ingredient promethazine, which is a sedating antihistamine that helps to dry up a runny nose and mucus that may be irritating the back of the throat. Common: Psychomotor impairment, disturbance in attention, dizziness, headache. Drinking alcohol with Night Nurse can make you feel very sleepy, dizzy or confused. Overdose symptoms may include nausea, drowsiness, restlessness, excitement and ataxia. Caution should therefore be exercised in patients who are slow metabolizers of CYP2D6 or use CYP2D6 inhibitors (see also section 4.5). Promethazine hydrochloride is readily absorbed from the gastrointestinal tract, but undergoes extensive first pass metabolism in the liver, with only 25% of the oral dose reaching the systemic circulation unchanged. The activity of this enzyme is genetically determined. Store in the original package. Adverse reaction identified during post-marketing use with dextromethorphan are listed below. Night Nurse liquid contains three ingredients; Promethazine - an antihistamine which dries up runny noses. Using more than one medicine with the same (or similar) active ingredients at the same time could lead to you exceeding the maximum dose or having a higher risk of side effects. Many over-the-counter painkillers and cold and flu remedies contain these ingredients. rash, urticaria, angiodema), Serotonin syndrome (with changes in mental status, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor and hypertension) has been reported when dextromethorphan has been taken concurrently with MAOIs or serotonergic drugs such as SSRIs. Management of patients who present with serious hepatic dysfunction beyond 24h from ingestion should be discussed with the NPIS or a liver unit. The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular daily use of paracetamol with increase risk of bleeding; occasional doses have no significant effect. Day nurse capsules and liquid contain three active ingredients, paracetamol, pholcodine and pseudoephedrine. It’s important to check the ingredients of any medicines you buy without a prescription before taking them with Night Nurse or ask your pharmacist for advice. CNS depressant drugs such as antipsychotics, hypnotics or anxiolytics. The effects in overdosage will be potentiated by simultaneous ingestion of alcohol and psychotropic drugs. Management should be in accordance with established treatment guidelines, see BNF overdose section. This helps stop an annoying or painful cough. 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. It is eliminated mainly as metabolites, predominantly by the faecal (via biliary) route, with < 1% of the parent compound and ca. If signs and symptoms suggestive of these reactions appear, Day Nurse should be discontinued immediately. Do not use for longer than 3 days without medical advice. Allergic reactions (e.g. For the symptomatic relief of colds, chills and influenza during the day. Night nurse capsules are also available in a combination pack with Day nurse capsules with contain only paracetamol and dextromethorphan, but no promethazine, which make you drowsy. • Night Nurse capsules or liquid should be taken at least four hours after taking any other paracetamol-containing medicines such as Day nurse capsules or liquid. Night Nurse is used to relieve the symptoms of colds and flu at night, including a tickly dry cough, runny nose, sinus pain, fever, headache, aches and pains and sore throats. In some individuals metabolism proceeds more slowly and unchanged dextromethorphan predominates in the blood and urine. Ingredient matches for Night Nurse Dextromethorphan. Anticholinergic medicines for urinary incontinence, for example oxybutynin, flavoxate, tolterodine, propiverine, trospium, Anticholinergic medicines for Parkinson's disease, for example trihexyphenidyl, orphenadrine, procyclidine, Antipsychotic medicines, for example chlorpromazine, clozapine, Antispasmodics, for example atropine, hyoscine, Certain antisickness medicines, for example prochlorperazine, meclozine, cyclizine. Concomitant use of alcohol with dextromethorphan and promethazine may increase the CNS depressant effects of these drugs. As promethazine has some anticholinergic activity, the effects of some anticholinergic drugs may be potentiated. • Chronic or persistant cough, such as occurs with asthma and emphysema, chronic bronchitis or where cough is accompanied by excessive secretions. increased energy, irritability, restlessness, nervousness, sleep disturbance), *The elderly are more susceptible to confusion, disorientation and paradoxical excitation, **Children are more susceptible to paradoxical excitation. Night Nurse Capsules: Lactose Monohydrate / Dimeticone / Colloidal Anhydrous Silica / Gelatin / Patent Blue V (E131) / Erythrosine (E127) / Quinoline Yellow (E104) / Titanium Dioxide (E171). Promethazine Hydrochloride(ingredient included in Night capsule only). Paracetamol overdose may cause liver failure which may require liver transplant or lead to death. The elimination half-life varies from about 1 to 4 hours. Or b, Regularly consumes ethanol in excess of recommended amounts. 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