This information is intended for use by health professionals
Boots Nirolex Night Time Cough Relief Linctus
Boots Night Cough Relief Oral Solution
Diphenhydramine hydrochloride Ph Eur
Pholcodine Ph Eur
Excipients of Known Effect
For the symptomatic relief of dry, ticklish and unproductive coughs.
Adults and Children over 12 years: 20ml (4 teaspoonfuls) at bedtime.
Children under 12 years: Not recommended.
Elderly: There is no need for dosage reduction.
For oral administration.
Hypersensitivity to any of the ingredients, liver disease, ventilatory failure and porphyria.
Children under 12 years should not be given this medicine.
Cough suppressants may cause sputum retention and this may be harmful in patients with chronic bronchitis and bronchiectasis.
Severe cutaneous adverse reactions (SCARs) including acute generalized exanthematous pustulosis (AGEP), which can be life-threatening or fatal, have been reported in patients treated with pholcodine-containing products, most likely in the first week. Patients should be advised of the signs and symptoms and monitored closely for skin reactions. If signs and symptoms suggestive of these reactions appear, Cough Relief Linctus/Solution should be withdrawn immediately.
This medicine should be used with care in conditions such as closed angle glaucoma, urinary retention, prostatic hypertrophy or pyloroduodenal obstruction.
Caution should also be observed in patients with epilepsy and severe cardiovascular disorders.
As pholcodine is a sedative, caution is needed in those patients who have airway disease e.g. asthma, chronic obstructive pulmonary disease (COPD) and ventilatory insufficiency, as respiratory depression may occur. Caution is also needed in patients with kidney disease or a history of drug abuse.
Caution is needed in patients with a history of drug abuse. Pholcodine is an opioid and addiction is observed with opioids as a class.
Cross-reactivity leading to serious allergic reactions (anaphylaxis) have been reported between pholcodine and NMBAs (Neuromuscular Blocking Agents). A precise at-risk period of time between the exposures of pholcodine and NMBAs has not been determined. Clinicians should be aware of this potential in case of future anaesthetic procedures involving NMBAs.
Warning: May cause drowsiness. If affected do not drive or operate machinery.Avoid alcoholic drink.
Do not exceed the stated dose.
If symptoms persist for longer than 5 days talk to your doctor.
Keep all medicines out of the reach of children.
Information related specifically to the excipients in this formulation (see section 6.1)
Sucrose: Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Contains 9g of sucrose per dose. This should be taken into account in patients with diabetes mellitus.
Ethanol: Each 20ml dose contains 0.8g alcohol (ethanol), equivalent to 20ml beer or 8ml wine. Harmful for those suffering from alcoholism. To be taken into account in pregnant or breastfeeding women, children and high-risk groups such as patients with liver disease or epilepsy.
Sodium: this medicinal product contains 41mg of sodium per 20ml, equivalent to 2.05% of the WHO recommended maximum daily intake of 2 g sodium for an adult.
Sodium Benzoate: This medicine contains 2.4 mg sodium benzoate in each 20 ml which is equivalent to 0.12 mg/ 1 ml. Increase in bilirubinaemia following its displacement from albumin may increase neonatal jaundice which may develop kernicterus (non-conjugated bilirubin deposits in the brain tissue).
CNS depressants: may enhance the sedative effects of CNS depressants including barbiturates, hypnotics, opioid analgesics, anxiolytic sedatives, antipsychotics and alcohol.
Antimuscarinic drugs: may have an additive antimuscarinic action with other drugs, such as atropine and some antidepressants.
MAOIs: not to be used in patients with MAOIs or within 14 days of stopping treatment as there is a risk of serotonin syndrome.
Not to be used in patients taking MAOIs or within 14 days of stopping treatment.
Interaction with neuromuscular blocking agents (anaphylaxis) has been reported.
The reduction in blood pressure caused by antihypertensives may accentuate the hypotensive effects of pholcodine. Diuretics may have the same effect. Pholcodine may enhance the sedative effect of central nervous system depressants including alcohol, barbiturates, hypnotics, narcotic analgesics, sedatives and tranquillisers (phenothiazines and tricyclic antidepressants).
The safety of pholcodine in pregnancy has not been fully established but its use has not revealed any direct evidence of teratogenicity. However, in view of the possible association of foetal abnormalities with first trimester exposure to diphenhydramine, use of the product during pregnancy should be avoided. The safety of this product during lactation has not been established and use during this period should be avoided.
May cause drowsiness. If affected do not drive or operate machinery.
This medicine can impair cognitive function and can affect a patient's ability to drive safely. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988. When prescribing 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
• However, you would not be committing an offence (called a 'statutory defence') if:
- The medicine has been prescribed to treat a medical or dental problem and
- You have taken it according to the instructions given by the prescriber and in the information provided with the medicine and
- It was not affecting your ability to drive safely
May occasionally cause nausea, vomiting, drowsiness skin rashes and anticholinergic side effects such as dryness of the mouth, constipation, urinary retention and blurred vision. May also cause elation or depression, irritability and nightmares.
Immune system disorders: hypersensitivity reactions, anaphylaxis.
Skin and subcutaneous tissue disorders:
Acute generalized exanthematous pustulosis (see section 4.4) (frequency unknown)
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 or search for MHRA Yellow Card in the Google Play or Apple App Store.
Symptoms of overdosage may include nausea, vomiting, drowsiness, restlessness excitement, ataxia, respiratory depression and occasionally convulsions and hyperpyrexia. In cases of severe overdosage, the stomach should be emptied by aspiration and lavage. The patient should be kept quiet to minimise excitation which occurs particularly in children. The specific narcotic antagonist naloxone may be used to reverse any respiratory depression. Convulsions may be controlled with intravenous diazepam. Otherwise treatment should be symptomatic and supportive.
Pholcodine is a cough suppressant with mild sedative but little analgesic action.
Diphenhydramine has antihistamine properties with a pronounced sedative action.
Pholcodine is readily absorbed from the gastrointestinal tract. It can relieve local irritation of the respiratory tract for about 4 to 5 hours.
Peak plasma levels of diphenhydramine hydrochloride occur 2 to 4 hours after administration. Diphenhydramine is about 85 - 98% bound to plasma proteins. The plasma half life ranges from 2.4 to 8 hours.
Diphenhydramine undergoes extensive pre-systemic metabolism which results in 50% metabolism of an oral dose. The major route of elimination is in the urine, largely as metabolites with very little unchanged drug present.
Citric acid monohydrate
Patent Blue V
Grenadine flavour 514485E GIV (contains propylene glycol)
Do not store above 25°C.
1. A 50ml, 100ml, 125ml, 150ml, 200ml or 250ml glass bottle either with a child resistant polypropylene cap without a liner or a roll on pilfer proof cap with a liner.
2. A 50ml, 100ml, 125ml, 150ml, 200ml, or 250ml amber glass bottle either with a child resistant polypropylene cap without a liner or a roll on pilfer proof cap with a liner.
3. A 50ml, 100ml, 125ml, 150ml, 200ml or 250ml amber PET bottle fitted with a child resistant polypropylene cap and an expanded polyethylene liner.
The Boots Company PLC
1 Thane Road West
Trading as: BCM
12/02/1981 / 15/03/2006