Contains paracetamol. Do not use with any other paracetamol-containing products, decongestants, antihistamines or cold and flu medicines. The concomitant use with other products containing paracetamol may lead to an overdose. Paracetamol overdose may cause liver failure which can lead to liver transplant or death.
Caution should be exercised in patients with mild to moderate kidney impairment and in those with hepatic impairment. Underlying liver disease increases the risk of paracetamol-related liver damage.
Cases of hepatic dysfunction/failure have been reported in patients with depleted glutathione levels, such as those who are severely malnourished, anorexic, have a low body mass index or are chronic heavy users of alcohol.
Caution should be exercised in patients with cardiovascular disease, arrhythmias, hypertension, hyperthyroidism, prostatic enlargement, diabetes, glaucoma, phaeochromocytoma, epilepsy, bronchitis, bronchiectasis and bronchial asthma.
Caution should be exercised in patients with glutathione depleted states such as sepsis, the use of paracetamol may increase the risk of metabolic acidosis.
There have been reports of ischaemic colitis with pseudoephedrine. Pseudoephedrine should be discontinued immediately and medical advice sought if sudden abdominal pain, rectal bleeding or other symptoms of ischaemic colitis develop.
There have been rare cases of posterior reversible encephalopathy (PRES)/reversible cerebral vasoconstriction syndrome (RCVS) reported with sympathomimetic drugs, including pseudoephedrine. Symptoms reported included sudden onset of severeheadache, nausea, vomiting, and visual disturbances. Most cases improved or resolved within a few days following appropriate treatment. Psuedoephedrine should be discontinued immediately and medical advice sought if signs/symptoms of PRES/RCVS develop.
The anticholinergic properties of chlorphenamine may cause drowsiness, dizziness, blurred vision and psychomotor impairment in some patients which may seriously affect ability to drive and use machinery.

Chlorphenamine may increase the effects of alcohol and therefore concurrent use should be avoided.
Concurrent use with drugs which cause sedation, such as anxiolytics and hypnotics may cause an increase in sedative effects, therefore medical advice should be sought before taking chlorphenamine concurrently with these medicines.

Use with caution in patients taking beta-blockers or other anti-hypertensives.
Children and the elderly are more likely to experience neurological anticholinergic effects and paradoxical excitation (e.g. increased energy, restlessness, nervousness).
If symptoms persist, medical advice must be sought.
Keep out of sight and reach of children.

The anticoagulant effect of warfarin and other coumarins may be enhanced by prolongedregular daily use of paracetamol-containing products with increased risk of bleeding;occasional doses have no significant effect.
Concomitant administration of pseudoephedrine hydrochloride-containing products andMAOIs (or within two weeks of stopping of MAOI) may lead to hypertensive crisis. Theanticholinergic effects of chlorphenamine are intensified by MAOIs.
Concomitant use of this medication with sympathomimetic agents (such asdecongestants, appetite suppressants and amphetamine-like psychostimulants) which interfere with the catabolism of sympathomimetic amines, may occasionally cause a rise in blood pressure (see Contraindications).

Pseudoephedrine-containing products may antagonise the effect of certain classes ofantihypertensives (e.g. beta blockers, methyl-dopa, reserpine, debrisoquine, guanethidine).

Concurrent use of chlorphenamine and hypnotics or anxiolytics may potentiatedrowsiness. Concurrent use of alcohol may have a similar effect.

Chlorphenamine inhibits phenytoin metabolism and can lead to phenytoin toxicity.

This product should not be used during pregnancy unless considered essential by a physician.
Safe use of pseudoephedrine in pregnancy has not been established despite widespread use over many years. Caution should therefore be exercised by balancing the potential benefit of treatment to the mother against any possible hazards to the developing foetus.
There are no adequate data from the use of chlorphenamine maleate in pregnant women. The potential risk for humans is unknown. Use during the third trimester may result in reactions in the newborn or premature neonates.

The anticholinergic properties of chlorphenamine may cause drowsiness, dizziness, blurred vision and psychomotor impairment in some patients which may seriously affect ability to drive and use machinery.