Taking too much paracetamol can cause serious harm to your liver. Do not take anything else containing paracetamol within four hours of taking this product. Do not take with other antihistamine-containing preparations, including topical antihistamines and cough and cold medicines.

Do not take Night Nurse:

• if you have ever had an allergic reaction to paracetamol, promethazine hydrochloride, dextromethorphan hydrobromide or any of the other ingredients.

• if you have a chest infection, worsening asthma or severe respiratory problems.

• if you are taking or have taken monoamine oxidase inhibitors (MAOIs) prescribed for depression in the last two weeks.

This medicine can lead to dependence ,therefore, the treatment should be of short duration.

• Do not drink alcohol while using Night Nurse.

• Night Nurse contains 18% v/v ethanol (alcohol), i.e. up to 2.9 g per dose, equivalent to 72 ml beer, 30 ml wine per dose. This could be harmful if you suffer from alcoholism. This should also be considered if you are pregnant or breast-feeding, in children and high-risk groups such as patients with liver disease or epilepsy.

• If your symptoms are accompanied by a high temperature, skin rash or persistent headache, see your doctor. • This medicine may affect pregnancy tests based on urine samples, to give false results. Driving and operating machinery This medicine can affect your ability to drive as it may cause drowsiness, dizziness, difficulty concentrating, movement difficulties or blurred vision. If affected do not drive or operate machinery. Ask your doctor before you take this medicine:

• if you have liver or kidney problems.

• if you have glaucoma, epilepsy, difficulty passing urine, or prostate problems.

• if you have chronic or persistent cough accompanied by excessive phlegm or respiratory problems.

• if you have diabetes mellitusEach 20 ml dose contains 12.8 g of glucose.

• if you are on a sodium-controlled diet. Each 20 ml dose contains 37 mg of sodium.

• if you are elderly and suffer from confusion.

• if you have a severe infection, are severely malnourished, severely underweight or are a chronic heavy alcohol user, as this may increase the risk of metabolic acidosis. Signs of metabolic acidosis include: • deep, rapid, difficult breathing • feeling sick (nausea), being sick (vomiting) • loss of appetite

• if you are taking medicines such as certain antidepressants or antipsychotics as Night Nurse may interact with these medicines and you may experience mental status changes (e.g. agitation, hallucinations, coma), and other effects such as body temperature above 38°C, increase in heart rate, unstable blood pressure, and exaggeration of reflexes, muscular rigidity, lack of coordination and/ or gastrointestinal symptoms (e.g nausea, vomiting, diarrhoea).

Taking this medicine regularly, particularly for a long time, can lead to addiction. Only use this medicine as described in the leaflet. Addiction can cause withdrawal symptoms when you stop taking this medicine. Withdrawal symptoms can include restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, loss of appetite, shaking, shivering or sweating. Speak to your doctor if you experience withdrawal symptoms.

Like all medicines Night Nurse can have side effects, but not everyone gets them. Children and the elderly may be more likely to experience side effects with this medicine.

The following effects may occur:

• Drowsiness, dizziness, blurred vision, difficulty concentrating, unsteadiness, clumsiness, headache, dry mouth. Stop taking this medicine and tell your doctor immediately if you experience:

• Allergic reactions which may be severe such as skin rash, itching sometimes with swelling of the mouth or face or shortness of breath. • Skin rash or peeling or mouth ulcers.

• Breathing problems. These are more likely if you have experienced them before when taking other painkillers (such as ibuprofen and aspirin). • Unexplained bruising and bleeding.

• Confusion, feeling restless, sweating, shaking, shivering, sudden jerks of muscles or increased blood pressure (these may be symptoms of serotonin syndrome).

• Difficulty passing urine.

• Nausea, vomiting, stomach ache, sudden weight loss, loss of appetite and yellowing of the eyes and skin.

• Restlessness, nervousness, feeling irritable, increased energy and sleep disturbances, which are more likely to affect children. These effects are rare.

•  If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the leaflet .

Carers should be aware that this medicine should not be given to elderly patients with confusion. The elderly are more likely to develop adverse effects, including confusion, with this medicine.

If you take too much 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. You may experience the following symptoms: nausea and vomiting, involuntary muscle contractions, agitation, confusion, somnolence, disturbances in consciousness, involuntary and rapid eye movements, cardiac disorders (rapid heart beating), coordination disorders, psychosis with visual hallucinations, and hyperexcitability.

Other symptoms in case of massive overdose may be: coma, severe breathing problems, and convulsions. Contact your doctor or hospital straight away if you experience any of the above symptoms.