Day & night nurse

How does it work?

Day & night nurse is a combination pack containing two types of capsules. The orange and white day nurse capsules contain three active ingredients, paracetamol, pseudoephedrine and pholcodine. The green and white night nurse capsules also 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'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 found in both the day and night capsules helps relieve aches, pains, sore throats and fever associated with colds and flu.

The pseudoephedrine in the day nurse capsules is a type of medicine called a decongestant. It works by acting on alpha receptors that are found in the walls of blood vessels in the linings of the nasal passages and sinuses. It causes these blood vessels to contract and narrow, thereby decreasing blood flow into the linings of the nose and sinuses. This reduces the feeling of congestion and also reduces the production of mucus.

The pholcodine in the day nurse capsules and the dextromethorphan in the night nurse capsules are both a type of medicine called a cough suppressant. They are used to suppress a dry, tickly, unproductive cough. Both work by reducing the nerve signals sent from a part of the brain called the coughing centre to the muscles that produce coughing.

The promethazine in the night nurse capsules 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 day nurse capsules help relieve aches, pains and fever, as well as a blocked or runny nose and tickly coughs associated with colds and flu. They are non-drowsy so help you continue with your day to day activities.

The night nurse capsules help relieve aches, pains and fever, as well as a runny nose and tickly coughs associated with colds and flu. They have a mild sedative effect and this, together with the relief from symptoms, can help restful sleep.

Two day nurse capsules should be taken every 4 hours during the day, up to a maximum of three doses (six capsules) in a day. Two night nurse capsules should be taken just before going to bed at night. Do not take more capsules than this - see warnings below.

What is it used for?

Relief from the symptoms of colds and flu, including tickly, unproductive coughs, blocked or runny nose, fever, headache, aches and pains and sore throats.

Warning!

The night nurse capsules may cause drowsiness and so should not be taken during the day. If affected do not drive or operate machinery. Alcohol should be avoided.

Do not take the day or night nurse capsules 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. Do not use for longer than seven days unless your doctor agrees.

If you have any of the following symptoms you should 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.

Use with caution in

Decreased liver function

Decreased kidney function

Asthma.

Not to be used in

Children under 12 years of age

Severe liver disease

Severe kidney disease

Disease involving the heart and blood vessels

High blood pressure

Overactive thyroid gland

Tumour of the adrenal gland (phaeochromocytoma)

Enlarged prostate gland

Closed angle glaucoma

Diabetes

Epilepsy

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

Pregnancy

Breastfeeding

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.

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 should not be used by pregnant women unless your doctor considers that the potential benefits outweigh any possible risks to the developing baby. Seek medical advice from your doctor.

The safety of this medicine for use during breastfeeding has not been established. As a result, this medicine should be avoided by women who are breastfeeding. Seek medical advice from your doctor.

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. 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 (night nurse capsules)

Dizziness (night nurse capsules)

Dry mouth (night nurse capsules)

Blurred vision (night nurse capsules)

Difficulty sleeping (day nurse capsules)

Restlessness (day nurse capsules)

Shakiness (day nurse capsules)

Increased heart rate (day nurse capsules)

Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain (both)

Headache (both)

Skin rash (both)

Difficulty in passing urine (both)

The side effects listed above may not include all of the side effects reported by the drug'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.

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