How does it work?

Vicks cold & flu care medinite complete syrup contains four active ingredients, dextromethorphan, doxylamine, pseudoephedrine and paracetamol.

Dextromethorphan is a type of medicine called a coughsuppressant. It is used to suppress a dry, tickly, unproductive cough.

Coughing is a reflex response to irritation of the airways. Itis useful for clearing mucus, dust and other particles from the throat andlungs. It is important because it reduces the amount of mucus, dust andbacteria in the airways that would otherwise make breathing difficult. However,sometimes coughing can become overstimulated even when there is no mucus toclear from the lungs or throat. In this situation coughing serves no purposeand can become painful and frustrating.

Dextromethorphan is used to block the cough reflex insituations where the cough serves no purpose, ie when no plegm is being coughedup. It works by reducing the nerve signals sent from a part of the brain calledthe coughing centre to the muscles that produce coughing.

Doxylamine is a type of medicine called a sedating antihistamine. It enters the brain in sufficient quantities to cause drowsiness. When taken at bedtime it can help give a restful nights sleep. Its sedative effect may also help suppress a cough.

Nasal mucus can often be the cause of cough in a cold, because it drips down the back of the throat, causing irritation. Doxylamine also drys nasal secretions, by stopping a natural body chemical called histamine from binding to its receptors. Histamine is a chemical produced naturally by the body that has many effects, including the production of allergic symptoms, such as a runny nose. Blocking histamine receptors prevents the actions of histamine, which reduces the production of mucus in the nose.

Pseudoephedrine is a type of medicine called a decongestant. Itworks by acting on alpha receptors that are found in the walls of blood vesselsin the linings of the nasal passages and sinuses. It causes these blood vesselsto contract and narrow, thereby decreasing blood flow into the linings of thenose and sinuses. This reduces the feeling of congestion and also reduces theproduction of mucus.

Pseudoephedrine also has a weak effect on receptors in the lungscalled beta 2 receptors. By acting on these receptors it causes the muscles inthe airways to relax. This allows the airways to open, making breathing easier.

Paracetamol is a simple painkilling medicine used to relieve mild to moderate pain and fever. Despite its widespread use for over 100 years, we still don't fully understand how paracetamol works to relieve pain and reduce fever. However, it is now thought that it works by reducing the production of prostaglandins in the brain and spinal cord.

The body produces prostaglandins in response to injury and certain diseases. One of the effects of prostaglandins is to sensitise nerve endings, causing pain (presumably to prevent us from causing further harm to the area). As paracetamol reduces the production of these nerve sensitising prostaglandins it is thought it may increase our pain threshold, so that although the cause of the pain remains, we can feel it less.

It is thought paracetamol reduces fever by affecting an area of the brain that regulates our body temperature (the hypothalamic heat-regulating center).

The combination of active ingredients in Vicks cold & flu care medinite complete helps to relieve the symptoms of colds and flu, such as aches and pains, fever, runny nose, nasal congestion, sore throat and cough, and can help you get a good nights sleep.

What is it used for?

• Relief from the symptoms of colds and flu, such as headache, sore throat, aches and pains, fever, coughing, runny nose and nasal congestion.

How do I take it?

• Adults and children over 12 years of age should take a 30ml dose from the measuring cup supplied at bedtime.

Warning!

• This medicine may cause drowsiness. If affected do not drive or operate machinery. Alcohol should be avoided.
• Do not take this medicine with any other products that contain paracetamol. Many over-the-counter painkillers and cold and flu remedies contain paracetamol. It is important to check the ingredients of any medicines you buy without a prescription before taking them in combination with this medicine. Seek further advice from your pharmacist.
• An overdose of paracetamol is dangerous and capable of causing serious damage to the liver and kidneys. You should never exceed the dose stated in the information leaflet supplied with this medicine. Immediate medical advice should be sought in the event of an overdose with this medicine, even if you feel well, because of the risk of delayed, serious liver damage.
• Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is taken. The hazards of paracetamol overdose are greater in persistant heavy drinkers and in people with alcoholic liver disease.
• If symptoms persist despite treatment, seek medical advice from your doctor or pharmacist.

Use with caution in

• Asthma.
• High blood pressure (hypertension).
• Enlarged prostate gland (prostatic hypertrophy).
• Difficulty passing urine (urinary retention).
• Raised pressure in the eye ball, eg glaucoma.

Not to be used in

• Children under 12 years of age.
• Severely decreased kidney function.
• Severely decreased liver function.
• Disease involving the heart and blood vessels (cardiovascular disease).
• Thyroid disease.
• Diabetes.
• Chronic bronchitis.
• Condition called bronchiectasis, in which there is persistent widening of the airways as a result of lung disease, eg infection, inflammation, tumours or cystic fibrosis.
• People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days.
• Pregnancy.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• The safety of this medicine for use during pregnancy has not been established. It is not recommended for use during pregnancy, unless considered essential by your doctor. Seek medical advice from your doctor.
• This medicine may pass into breast milk in small amounts. It should only be used during breastfeeding if the benefit to the mother outweighs any potential risk to the nursing infant. Seek medical advice from your doctor.

Label warnings

• Do not take this medication with any other products containing paracetamol.
• Refer to the printed instructions for maximum daily intake.

Side effects

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 this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

• Drowsiness.
• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain.
• Dizziness.
• Restlessness.
• Difficulty sleeping (insomnia).
• Anxiety.
• Increased heart rate.
• Rash.
• Difficulty passing urine.
• False perceptions of things that are not really there (hallucinations).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

If you are already taking any other medicines, including herbalmedicines and those bought without a prescription, you should check with yourpharmacist before using this medicine, to ensure that thecombination is safe.

You should not take other medicines that contain paracetamol in combination with this medicine, as this can easily result in exceeding the maximum recommended daily dose of paracetamol. Many cold and flu remedies and over-the-counter painkillers contain paracetamol, so be sure to check the ingredients of any other medicines before taking them with this one.

This medicine should not be used by people who are currentlytaking a monoamine oxidase inhibitor antidepressant, eg phenelzine,tranylcypromine, isocarboxazid or moclobemide, or who have taken one of thesemedicines in the last 14 days. This is because the combination ofpseudoephedrine with these medicines could cause a dangerous rise in bloodpressure (hypertensive crisis).

If pseudoephedrine is taken with any of the following thecombination may cause an increase in blood pressure:

• other decongestants (often found in non-prescription cough and cold remedies)
• tricyclic antidepressants, eg amitriptyline
• appetite suppressants
• amphetamine-like stimulants, eg methylphenidate, dexamfetamine.

Pseudoephedrine may reduce the effects of medicines to treathigh blood pressure (antihypertensives). If you are taking medicines for highblood pressure you should not take this medicine unless on the advice of a doctor.

This medicine may cause drowsiness. If this occurs, it may be made worse if the medicine is taken in combination with any of the following, which can also cause drowsiness:

• alcohol
• benzodiazepines, eg temazepam, diazepam
• sedating antihistamines, eg chlorphenamine, diphenhydramine, triprolidine (these are often found in other non-prescription cough and cold or hayfever remedies)
• sleeping tablets, eg zopiclone
• strong opioid painkillers, eg codeine, dihydrocodeine, morphine
• tricyclic antidepressants, eg amitriptyline.

Cholestyramine reduces the absorption of paracetamol from the gut. It should not be taken within an hour of taking paracetamol or the effect of the paracetamol will be reduced.

Metoclopramide and domperidone may increase the absorption of paracetamol from the gut.

Long-term or regular use of paracetamol may increase the anti-blood-clotting effect of warfarin and other anticoagulant medicines, leading to an increased risk of bleeding. This effect does not occur with occasional pain-killing doses.

Other medicines containing the same active ingredients

There are currently no other medicines available in the UK that contain this combination of active ingredients.