Minton NA, Henry JA, Frankel RJ. Fatal paracetamol poisoning in an epileptic. Hum Toxicol. 1988;7:33-4. Use with caution in patients with Raynaud's phe­nomenon or diabetes mellitus. Care is advised in the administration of paracetamol to patients with severe renal or severe hepatic impairment. The hazard of overdose is greater in those with non-cirrhotic alcoholic liver disease.

Smilkstein MJ, Douglas Dr, Daya MR. Acetaminophen poisoning and liver function. N Engl J Med. 1994;331:1310-1. 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. Caution should be taken when paracetamol is used concomitantly with flucloxacillin as concurrent intake has been associated with high anion gap metabolic acidosis, especially in patients with risks factors (see section 4.4). 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). Hartleb M. Do thyroid hormones promote hepatotoxicity to acetaminophen? Am J Gastroenterol. 1994;89:1269-70.

Summary of medicine characteristics - LEMSIP COUGH MAX FOR CHESTY COUGH & COLD RELIEF CAPSULES

There have been reports of blood dyscrasias including thrombocytopenia, leucopenia, pancytopenia, neutropenia and agranulocytosis, but these were not necessarily causally related to paracetamol.

Do not take more than the recommended dose. You should also avoid taking more than one paracetamol-containing medicine at the same time, as this can easily result in exceeding the maximum dose of paracetamol. hydrochloride 6.1 mg. Night capsule contains Paracetamol 500 mg, Phenylephrine hydrochloride 6.1 mg. Indications: For the relief of Don't use this medicine for longer than three days without getting medical advice from your doctor or pharmacist.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 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. Indications: For the relief of symptoms associated with the common cold and influenza, including relief of aches and pains, sore throat, a) Is on long-term treatment with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St John's Wort or other drugs that induce liver enzymes, Caffeine: Caffeine is absorbed readily from oral, rectal or parenteral administration, but absorption from the gastrointestinal tract may be erratic. There is little evidence of accumulation in any particular tissue. Caffeine passes readily into the central nervous system and into saliva. Concentrations have also been detected in breast milk. It is metabolised almost completely and is excreted in the urine as 1-methyluric acid, 1-methylxanthine and other metabolites, with only about 1% unchanged.

Tricyclic antidepressants (e.g. amitriptyline): may increase the risk of cardiovascular side effects with phenylephrine (see section 4.3). a) Is on long-term treatment with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St John's Wort or other drugs that induce liver enzymes. Do not exceed the stated dose. Do not take with any other paracetamol-containing products. If symptoms persist, consult your doctor. Keep out of the reach and sight of children. If you are pregnant or are being prescribed medicine by your doctor, seek his advice before taking this product. An overdose of paracetamol is dangerous and capable of causing serious damage to the liver and kidneys. Get immediate medical advice if you or someone you know takes too much paracetamol, even if you feel well, because of the risk of delayed, serious liver damage.This product also contains 1973.3mg sucrose per dose (total sugars 2g). Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. 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. Empty the contents of the sachet into a cup. Add half a cup of hot (not boiling) water and stir to dissolve. You can add cold water and sugar if you want before drinking. Healthcare (UK) Ltd, Hull, HU8 7DS. Information about this product, including adverse reactions, precautions, contra indications, Adults aged 16 years and over should take two capsules every four to six hours as necessary, up to a maximum of four doses in 24 hours. Do not take more than eight capsules in 24 hours.