Drugs List

Therapeutic Indications

Uses

Relief of coughs
Relief of sore throat

Contraindications

Children under 12 years
Cardiovascular disorder
Hereditary fructose intolerance

Precautions and Warnings

Breastfeeding
Diabetes mellitus
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of seizures
Pregnancy
Renal impairment

Not all available brands are licensed for all indications
Contains glucose
Preparation contains sucrose
Should not be taken with other cough or cold medicine
Advise patient to seek medical advice if symptoms persist for > 5 days

MHRA/CHM advice (February 2009)

Cough and cold remedies containing glycerin, lemon, honey and ipecacuanha should no longer be used in children under 6 as the balance of benefits and risk has not been shown to be favourable.

However, the MHRA/CHM also lists a number of combination products which are being phased out from the market for use in children under 12 years. This product is included on this list, therefore, it is not recommended for children up to the age of 12 years.

MHRA/CHM advice (March 2008)

Children should not be given more than one cough or cold preparation at a time because different brands may contain the same active ingredient; care should be taken to give the correct dose.

Pregnancy and Lactation

Pregnancy

Caution is recommended when taking this medication during pregnancy; No information or evidence is available on the safe use of ipecacuanha during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Caution is recommended when taking this medication during breastfeeding; No information or evidence is available on the safe use of ipecacuanha during breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Cardiac conduction disturbances
Diarrhoea
Gastric irritation
Nausea
Vomiting

Presentation

Oral solution containing glycerol and ipecacuanha liquid extract

Drugs List

Therapeutic Indications

Uses

Relief of coughs
Relief of sore throat

Dosage

Different brands may provide different dosage information.

Adults

Elderly

Children

Contraindications

Children under 12 years
Cardiovascular disorder
Hereditary fructose intolerance

Precautions and Warnings

Breastfeeding
Diabetes mellitus
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of seizures
Pregnancy
Renal impairment

Not all available brands are licensed for all indications
Contains glucose
Preparation contains sucrose
Should not be taken with other cough or cold medicine
Advise patient to seek medical advice if symptoms persist for > 5 days

MHRA/CHM advice (February 2009)

Cough and cold remedies containing glycerin, lemon, honey and ipecacuanha should no longer be used in children under 6 as the balance of benefits and risk has not been shown to be favourable.

However, the MHRA/CHM also lists a number of combination products which are being phased out from the market for use in children under 12 years. This product is included on this list, therefore, it is not recommended for children up to the age of 12 years.

MHRA/CHM advice (March 2008)

Children should not be given more than one cough or cold preparation at a time because different brands may contain the same active ingredient; care should be taken to give the correct dose.

Pregnancy and Lactation

Pregnancy

Caution is recommended when taking this medication during pregnancy; No information or evidence is available on the safe use of ipecacuanha during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Caution is recommended when taking this medication during breastfeeding; No information or evidence is available on the safe use of ipecacuanha during breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Cardiac conduction disturbances
Diarrhoea
Gastric irritation
Nausea
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: January 2014.

Reference Sources

Reference:
Dear Healthcare Professional Letter. Medicines and Healthcare products Regulatory Agency. 28th February 2009.
https://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=CON038904&RevisionSelectionMethod=LatestReleased
Last accessed: 27th January 2014.

Summary of Product Characteristics: Bell's Chesty Cough Compound of Glycerin Lemon and Ipecacuanha. Bell, Sons & Co (Druggists) Ltd. Revised September 2013.

Summary of Product Characteristics: Glycerin Lemon and Honey with Glucose and Ipecacuanha, Thornton & Ross, revised August 2009.