Drugs List

Therapeutic Indications

Uses

Alleviation of coughs

Symptomatic relief of diarrhoea

Contraindications

Children under 6 years
Acute respiratory depression (acute asthma attack)
Acute alcoholism
Paralytic ileus
Acute ulcerative colitis
Raised intracranial pressure
Head injury
Hereditary fructose intolerance

Precautions and Warnings

Patients should be advised to consult a doctor if symptoms persist despite treatment.

In addition to treatment, patients should be advised to replace the body fluids lost during diarrhoea.

Pregnancy - see Pregnancy section.

Breastfeeding - see Lactation section .

Use with caution in patients with renal or hepatic impairment.

Due to the morphine content of the product, it should be used with caution in patients with convulsive disorders, hypothyroidism, prostatic hypertrophy, hypotension, in the elderly or debilitated patients.

Contains sorbitol. Preparations with sorbitol are unsuitable in patients with hereditary fructose intolerance.

Pregnancy and Lactation

Pregnancy

Manufacturer advises caution 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 14-17 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

Manufacturer advises caution 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

Nausea
Vomiting
Constipation
Drowsiness
Difficulty in micturition
Ureteric spasm
Biliary spasm
Dry mouth
Sweating
Headache
Facial flushing
Vertigo
Bradycardia
Tachycardia
Palpitations
Postural hypotension
Hypothermia
Hallucinations
Dysphoria
Mood changes
Dependence
Miosis
Reduced libido
Disturbances of potency
Rash
Urticaria
Pruritus

Presentation

Oral mixture containing morphine hydrochloride equivalent to anhydrous morphine 1mg/5ml and peppermint oil 1.5microlitres/5ml.

Drugs List

Therapeutic Indications

Uses

Alleviation of coughs

Symptomatic relief of diarrhoea

Dosage

Adults

Elderly

Children

Patients with Renal Impairment

Patients with Hepatic Impairment

Contraindications

Children under 6 years
Acute respiratory depression (acute asthma attack)
Acute alcoholism
Paralytic ileus
Acute ulcerative colitis
Raised intracranial pressure
Head injury
Hereditary fructose intolerance

Precautions and Warnings

Patients should be advised to consult a doctor if symptoms persist despite treatment.

In addition to treatment, patients should be advised to replace the body fluids lost during diarrhoea.

Pregnancy - see Pregnancy section.

Breastfeeding - see Lactation section .

Use with caution in patients with renal or hepatic impairment.

Due to the morphine content of the product, it should be used with caution in patients with convulsive disorders, hypothyroidism, prostatic hypertrophy, hypotension, in the elderly or debilitated patients.

Contains sorbitol. Preparations with sorbitol are unsuitable in patients with hereditary fructose intolerance.

Pregnancy and Lactation

Pregnancy

Manufacturer advises caution 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 14-17 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

Manufacturer advises caution 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

Effects on Ability to Drive and Operate Machinery

This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). This medicine may be subject to police testing and has specified maximum blood levels for driving. When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them. It is an offence to drive while under the influence of this medicine. However, a patient is not committing an offence (called 'statutory defence') if: 1.The medicine has been prescribed to treat a medical or dental problem and 2.The medicine has been taken according to the instructions given by the prescriber and/or in the information provided with the medicine and 3.The medicine was not affecting the ability to drive safely. For further guidance see https://www.gov.uk

Counselling

Patients should be advised to consult a doctor if symptoms persist despite treatment.

In addition to treatment, patients should be advised to replace the body fluids lost during diarrhoea.

Side Effects

Nausea
Vomiting
Constipation
Drowsiness
Difficulty in micturition
Ureteric spasm
Biliary spasm
Dry mouth
Sweating
Headache
Facial flushing
Vertigo
Bradycardia
Tachycardia
Palpitations
Postural hypotension
Hypothermia
Hallucinations
Dysphoria
Mood changes
Dependence
Miosis
Reduced libido
Disturbances of potency
Rash
Urticaria
Pruritus

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 ).

Shelf Life and Storage

No special precautions for storage required.

Further Information

Last Full Review Date: March 2011

Reference Sources

British National Formulary, 60th Edition (2010) Pharmaceutical Press, London.

Summary of Product Characteristics: J Collis Browne's Mixture. Thornton and Ross Ltd. Revised January 2009.

Gov.uk. Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: https://www.gov.uk Last accessed: 6 January 2015