Paracetamol 500mg Capsules
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
PARACETAMOL 500mg CAPSULES
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Each tablet contains 500mg of paracetamol.
Excipients with known effect: Also contains Methyl parahydroxybenzoate (E218) and Propyl parahydroxybenzoate (E216).
For the full list of excipients, see section6.1.
3 PHARMACEUTICAL FORM
HARD GELATIN CAPSULES
Red cap, white body, hard gelatin capsule, containing a white free flowing powder.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
For relief of mild to moderate pain including headaches, migraine, aches and pains, symptomatic relief of rheumatic aches and pains and of influenza, muscular and back pain, neuralgia, toothache, sore throat and period pain and to relieve the symptoms of feverishness and colds and flu.
4.2 Posology and method of administration
Posology:
Unless otherwise directed by a doctor
Adults, the elderly and children aged 16 years and over:
2 capsules up to 4 times a day, as required.
Do not take more frequently than every 4 hours and not more than 8 capsules in any 24 hour period.
Children aged 12 to 15 years:
One capsule every 4 - 6 hours when necessary to a maximum of 4 doses in 24 hours
Do not take more than 4 capsules in any 24 hour period Children under 12:
Not recommended for children under 12 years of age.
Method of administration:
For oral administration
Intake of paracetamol with food and drink does not affect the efficacy of the medicinal product.
4.3. Contraindications
Hypersensitivity to paracetamol or to any of the excipients listed in section 6.1
4.4 Special warnings and precautions for use
Prolonged or frequent use is discouraged. Patients should be advised not to take other Paracetamol containing products concurrently. Taking multiple daily doses in one administration can severely damage the liver; in such case unconsciousness does not occur. However, medical assistance should be sought immediately. Prolonged use except under medical supervision may be harmful. In adolescents treated with 60mg/kg daily of Paracetamol, the combination with another antipyretic is not justified except in the case of ineffectiveness.
Caution is advised in the administration of Paracetamol to patients with moderate and severe renal insufficiency, mild to moderate hepatic insufficiency (including Gilbert's syndrome), severe hepatic insufficiency (child-pugh>9), acute hepatitis, concomitant treatment with medicinal products affecting hepatic functions, glucose-6-phosphatedehydrogenase deficiency, hemolytic anemia, alcohol abuse dehydration and chronic malnutrition (see section 4.2).
The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease. Caution should be exercised in cases of chronic alcoholism. The daily dose should not exceed 2 grams in such case. Alcohol should not be used during the treatment with Paracetamol.
Caution is advised in asthmatic patients sensitive to aspirin, because light reaction bronchospasm with paracetamol (cross-reaction) has been reported in less than 5% of the patients tested.
In the case of high fever, or signs of secondary infection or persistence of symptoms a doctor should be consulted.
Immediate medical advice should be sought in the event of overdosage even if the patient feels well because of the risk of irreversible liver damage (see section 4.9).
Do not take anything else containing paracetamol while taking this medicine. Do not take more medicine than the label tells you to. If you do not get better, talk to your doctor.
Label
Talk to a doctor at once if you take too much of this medicine, even if you feel well.
Leaflet or Label/leaflet
Talk to a doctor at once if you take too much of this medicine even if you feel well. This is because too much paracetamol can cause delayed, serious liver damage.
Keep this medicine out of the sight and reach of children.
Important information regarding the ingredients of this medicine
This medicine contains Methyl parahydroxybenzoate (E218) and Propyl parahydroxybenzoate (E216), which may cause allergic reactions (possibly delayed) and exceptionally bronchospasm.
4.5 Interaction with other medicinal products and other forms of interaction
Hepatotoxic substances may increase the possibility of Paracetamol accumulation and overdose. The risk of hepatotoxicity of paracetamol may be increased by drugs which induce liver microsomal enzymes such as barbiturates, tricyclic antidepressants, and alcohol.
Probenecid causes an almost 2-fold reduction in clearance of Paracetamol by inhibiting its conjugation with glucuronic acid. A reduction of the Paracetamol dose should be considered for concomitant treatment with probenecid.
Salicylamide may prolong the elimination t1/2 of Paracetamol
Cholestyramine: The speed of absorption of paracetamol is reduced by cholestyramine. Therefore, the cholestyramine should not be taken within one hour if maximal analgesia is required.
Metoclopramide and Domperidone: The speed of absorption of paracetamol may be increased by metoclopramide and domperidone. However, concurrent use need not be avoided.
Concomitant use of Paracetamol (4 g per day for at least 4 days) with oral anticoagulants may lead to slight variations of INR values. In this case, increased monitoring of INR values should be done during the duration of the combination and after its discontinuation. The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular daily use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.
Isoniazid: Reduction of paracetamol clearance, with possible potentiation of its action and/or toxicity, by inhibiting its metabolism in the liver.
Lamotrigine: Decrease in the bioavailability of lamotrigine, with possible reduction of its effect, due to possible induction of its metabolism in the liver.
Interference with laboratory tests: Paracetamol may affect uric acid tests by wolframatop phosphoric acid, and blood sugar tests by glucose-oxydase-peroxydase.
Chloramphenicol: Increased plasma concentration of chloramphenicol.
4.6 Fertility, pregnancy and lactation
Pregnancy
Epidemiological data on the oral administration of therapeutic doses of Paracetamol indicate no adverse effects on pregnancy or on the health of the fetus/newborn child. Prospective data on overdose during pregnancy showed no increased risk of malformations. Reproduction studies investigating oral administration did not indicate any signs of malformation or fetotoxicity (see
section 5.3). Paracetamol is considered to be safe in normal therapeutic doses for short-term use as a minor analgesic/antipyretic in pregnancy.
Lactation
Following oral administration, Paracetamol is excreted into breast milk in small quantities. To date, no adverse reactions or undesirable effects are known in association with lactation. Therapeutic doses of Paracetamol can be administered during breast-feeding.
4.7 Effects on ability to drive and use machines
Paracetamol has no influence on the ability to drive and use machines.
4.8 Undesirable effects
The frequency using the following convention: very common (> 1/10); common (>1/100 to < 1/10); uncommon (>1/1000 to < 1/100); rare (>1/10000 to < 1/1000); very rare (< 1/10000), including isolated reports; not known:
frequency cannot be estimated from the available data. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.
|
Frequency |
System |
Symptoms |
|
Rare >1/10000 - < 1/1000 |
Blood and lymphatic system disorders |
Platelet disorders, stem cell disorders. |
|
Immune system disorders |
Allergies (excluding angioedema). | |
|
Psychiatric disorders |
Depression NOS, confusion, hallucinations. | |
|
Nervous system disorders |
Tremor NOS, headache NOS. | |
|
Eye disorders |
Abnormal vision. | |
|
Cardiac disorders |
Oedema. | |
|
Gastrointestinal disorders |
Haemorrhage NOS, abdominal pain NOS, diarrhoea NOS, nausea, vomiting. | |
|
Hepato-biliary disorders |
Hepatic function abnormal, hepatic failure, hepatic necrosis, jaundice. | |
|
Skin and subcutaneous tissue disorders |
Pruritus, rash, sweating, purpura, angioedema, urticaria. Very rare cases of serious skin reactions have been reported. | |
|
General disorders and administration site conditions |
Dizziness (excluding vertigo), malaise, pyrexia, sedation, drug interaction NOS. |
|
Injury, poisoning and procedural complications |
Overdose and poisoning | |
|
Very Rare |
Hepato-biliary disorders |
hepatotoxicity |
|
(< 10 000) |
General disorders and administration site conditions |
hypersensitivity reaction (requiring discontinuation of treatment) |
|
Blood and lymphatic system disorders |
thrombocytopenia leukopenia neutropenia hemolytic anemia agranulocytosis | |
|
Metabolism and nutrition disorders |
Hypoglycaemia | |
|
Renal and urinary disorders |
Sterile pyuria (cloudy urine) and renal side effects |
Not known: Some cases of edema of the larynx, anaphylactic shock, anaemia, bronchospasm*, liver alteration and hepatitis, renal alteration (severe renal impairment, nephrite interstitial, haematuria, anuresis), gastrointestinal effects and vertigo have been reported.
* There have been cases of bronchospasm with paracetamol, but these are more likely in asthmatics sensitive to aspirin or other NSAIDs.
Reporting of Suspected Adverse Reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
4.9. Overdose
There is a risk of poisoning, particularly in elderly subjects, in young adolescents, in patients with liver disease, in cases of chronic alcoholism, in patients with chronic malnutrition. Overdosing may be fatal.
Liver damage is possible in adults who have taken 10g or more of paracetamol. Ingestion of 5g or more of paracetamol may lead to liver damage if the patient has risk factors (see below).
Risk Factors:
If the patient
a) Is on long term treatment with carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, St John’s Wort or other drugs that induce liver enzymes.
Or
b) Regularly consumes ethanol in excess of recommended amounts.
Or
C ) Is likely to be glutathione deplete e.g. eating disorders, cystic fibrosis, HIV infection, starvation, cachexia.
Symptoms
Symptoms of paracetamol overdosage in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. In severe poisoning, hepatic failure may progress to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, and death. Acute renal failure with acute tubular necrosis, strongly suggested by loin pain, haematuria and proteinuria, may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported. Management
Immediate treatment is essential in the management of paracetamol overdose. Despite a lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention. Symptoms may be limited to nausea or vomiting and may not reflect the severity of overdose or the risk of organ damage. Management should be in accordance with established treatment guidelines, see BNF overdose section.
Treatment with activated charcoal should be considered if the overdose has been taken within 1 hour. Plasma paracetamol concentration should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable).Treatment with N-acetylcysteine may be used up to 24 hours after ingestion of paracetamol, however, the maximum protective effect is obtained up to 8 hours post-ingestion. The effectiveness of the antidote declines sharply after this time.
If required the patient should be given intravenous N-acetylcysteine, in line with the established dosage schedule. If vomiting is not a problem, oral methionine may be a suitable alternative for remote areas, outside hospital. Management of patients who present with serious hepatic dysfunction beyond 24 hrs from ingestion should be discussed with the NPIS or a liver unit.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Analgesic and Antipyretic ATC code: N02B E01
Mechanism of Action/ Effect
Analgesic - the mechanism of analgesic action has not been fully determined. Paracetamol may act predominantly by inhibiting prostaglandin synthesis in the central nervous system (CNS) and to a lesser extent, through a peripheral action by blocking pain- impulse generation.
The peripheral action may also be due to inhibition of prostaglandin synthesis or to inhibition of synthesis or actions of other substances that sensitise pain receptors to mechanical or chemical stimulation.
Antipyretic- paracetamol probably produces antipyresis by acting centrally on the hypothalamic heat - regulation centre to produce peripheral vasodilation resulting in increased blood flow through the skin, sweating and heat loss. The central action probably involves inhibition of prostaglandin synthesis in the hypothalamus.
5.2. Pharmacokinetic properties
Absorption: Paracetamol is readily absorbed from the gastrointestinal tract.
Distrubution: Peak plasma concentrations occur about 10 to 60 minutes after oral doses. Paracetamol is distributed into most body tissues. It crosses the placenta and is present in breast milk. Plasma-protein binding is negligible at usual therapeutic concentrations but increases with increasing concentrations.
Metabolism: It is metabolised in the liver. A minor hydroxylated metabolite which is usually produced in very small amounts by mixed-function oxidases in the liver and which is usually detoxified by conjugation with liver glutathione may accumulate following paracetamol overdosage and cause tissue damage.
Elimination: It is excreted in the urine, mainly as the glucuronide and sulphate conjugates. The elimination half-life varies from about 1 to 4 hours.
5.3 Preclinical safety data
There are no preclinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.
PHARMACEUTICAL PARTICULARS
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6.1 List of excipients
Pregelatinised maize starch Magnesium stearate Sodium laurilsulfate
Capsule shell:
Titanium dioxide E171 Erythrosine E127 Quinoline yellow E104 Patent Blue V E131 Gelatin
Methyl parahydroxybenzoate E218 Propyl parahydroxybenzoate E216
6.2 Incompatibilities
None known
6.3 Shelf life
4 years
6.4 Special precautions for storage
Do not store above 25°C. Store in the original package.
6.5. Nature and contents of container
Child resistant blister packs comprised of 20pm hard aluminium foil laminated to 15pm rigid PVC, and 250pm PVC. Pack size of 100 capsules.
No special requirements.
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MARKETING AUTHORISATION HOLDER
Bristol Laboratories Ltd,
Unit 3, Canalside,
Northbridge Road,
Berkhamsted,
Hertfordshire HP4 1EG
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02/09/2016