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" What is it used for?  Relief from the symptoms of colds and flu at night, including tickly, unproductive coughs, runny nose, fever, headache, aches and pains and sore throats.     How does it work? Night nurse capsules and liquid contain three active ingredients, paracetamol, promethazine and dextromethorphan.  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&amp;#039;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 paracetamol in night nurse helps relieve aches, pains, sore throats and fever associated with colds and flu.  Dextromethorphan is a type of medicine called a cough suppressant. It is used to suppress a dry, tickly, unproductive cough. It works by reducing the nerve signals sent from a part of the brain called the coughing centre to the muscles that produce coughing.  Coughing is a reflex response to irritation of the airways. It is useful for clearing mucus, dust and other particles from the throat and lungs. It is important because it reduces the amount of mucus, dust and bacteria in the airways that would otherwise make breathing difficult. However, sometimes coughing can become overstimulated even when there is no mucus to clear from the lungs or throat. In this situation coughing serves no purpose and can become painful and frustrating. Dextromethorphan can be used to block the cough reflex in situations where the cough serves no purpose, ie when no plegm is being coughed up.  Promethazine is a type of medicine called a sedating antihistamine. It enters the brain in sufficient quantities to cause drowsiness, and this 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. Promethazine 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.  The combination of active ingredients in this medicine helps relieve aches, pains and fever, as well as a runny nose and tickly coughs associated with colds and flu. The medicine has a mild sedative effect and this, together with the relief from symptoms, can help restful sleep.    How do I take it?  You should use either the capsules OR the liquid. Don&amp;#039;t use both together.  If you are using the capsules, the dose for adults and children aged 12 years and over is two capsules taken at bedtime. Don&amp;#039;t take this medicine until at least four hours after taking any other paracetamol-containing medicines (eg Day Nurse).  The capsules should be swallowed with a drink of water. They can be taken either with or without food. If you are using the liquid, the dose for adults and children aged 12 years and over is one 20 ml measured dose (or four 5ml spoonfuls) taken at bedtime. Don&amp;#039;t take this medicine until at least four hours after taking any other paracetamol-containing medicines (eg Day Nurse).  Don&amp;#039;t take more than one dose per night. Don&amp;#039;t use this medicine for longer than three nights without seeking medical advice from your doctor or pharmacist.    Warning!  This medicine may cause drowsiness and so should not be taken during the day. If affected do not drive or operate machinery. Avoid drinking alcohol with this medicine.  You should not take this medicine if you have already taken four doses of a paracetamol containing medicine during the day, as this can easily result in exceeding the maximum recommended daily dose of 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 you have any of the following symptoms you should not take this medicine and consult your doctor so that the cough can be investigated further: coughing up phlegm that is green, rusty brown, yellow, blood-stained or foul smelling; shortness of breath, wheezing or difficulty breathing; chest pain; pain and swelling in the calf; sudden weight loss; recurrent night-time cough; or a long-term persistent cough.    Not to be used in  Children under 12 years of age. Severe liver disease. Severe kidney disease. 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 at risk of severe breathing problems (respiratory failure).  People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days.  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.   Use with caution in  Elderly people. Decreased liver function. Decreased kidney function. Heart disease. People who have difficulty completely emptying their bladder (urinary retention). Men with an enlarged prostate gland. Epilepsy. Glaucoma. Asthma. Night nurse liquid contains 12.8mg glucose in every 20ml dose. This should be taken into account by people with diabetes.  Night nurse liquid contains 37mg sodium in every 20ml dose. This should be taken into account by people on a controlled-sodium diet. Night nurse liquid contains alcohol and may be harmful to people suffering from alcoholism.   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.  Although paracetamol is generally considered safe to take during pregnancy, the safety of dextromethorphan and promethazine for use during pregnancy has not been established. As a result, this medicine is not usually recommended for use by women who are pregnant. Seek further medical advice from your doctor, pharmacist or midwife. Although paracetamol is generally considered safe to take during breastfeeding, it is not known if dextromethorphan passes into breast milk. Promethazine passes into breast milk and there is a risk that it may cause sedation, irritability or excitement in a newborn baby. For these reasons, this medicine is best avoided by mothers who are breastfeeding. Ask your doctor or pharmacist for further advice.   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, it does not mean that all people using this medicine will experience that or any side effect.  Drowsiness. Disorientation. Dizziness. Dry mouth. Blurred vision. Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain. Skin rash. Difficulty passing urine.  The side effects listed above may not include all of the side effects reported by the medicine&amp;#039;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 herbal medicines and those bought without a prescription, you should check with your pharmacist before taking this medicine, to make sure that the combination is safe.  You should not use other cough, cold or flu medicines in combination with this one. You should not take this medicine if you have already taken four doses of a paracetamol containing medicine during the day, 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. Ask your pharmacist for further advice. You should not use this medicine if you are currently taking a type of medicine called a monoamine oxidase inhibitor (MAOI), or have taken one of these medicines in the last 14 days. MAOIs include the antidepressants phenelzine, tranylcypromine, isocarboxazid and moclobemide, and the anti-Parkinson&amp;#039;s medicines selegiline and rasagiline. 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.   There may be an increased risk of side effects such as dry mouth, blurred vision, constipation or difficulty passing urine if this medicine is taken with any of the following medicines:   anticholinergic medicines for urinary incontinence, eg oxybutynin, flavoxate, tolterodine, propiverine, trospium anticholinergic medicines for Parkinson&amp;#039;s disease, eg trihexyphenidyl, orphenadrine, procyclidine  antipsychotic medicines, eg chlorpromazine, clozapine  antispasmodics, eg atropine, hyoscine certain antisickness medicines, eg prochlorperazine, meclozine, cyclizine muscle relaxants, eg baclofen tricyclic or related antidepressants, eg amitriptyline, maprotiline.   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. Day &amp;amp; night nurse is a product that contains a combination of Day nurse capsules for daytime cold and flu symptoms and Night nurse capsules for night time symptoms.  Last updated 19.02.2012 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/medicines/aches-and-pains/a8161/night-nurse/>