Boots Paracetamol 6 Years Plus 250mg/5ml Oral Suspension.

See section 4.4 for further information.

For a full list of excipients, see Section 6.1

Oral Suspension

An off-white, strawberry-flavoured, syrupy suspension.

Indicated for the treatment of mild to moderate pain and as an antipyretic. It can be used in many conditions including headache, toothache, earache, sore throat, colds and influenza, aches and pains and post-immunisation fever.

For oral use only.

It is important to shake the bottle for at least 10 seconds before use.

Children aged 6 to 12 years:

Children aged 12-16 years: 10-15 ml up to 4 times a day.

Adults and children over 16 years: 10-20 ml up to 4 times a day.

Elderly: In the elderly, the rate and extent of paracetamol absorption is normal but plasma half-life is longer and paracetamol clearance is lower than in young adults.

Hypersensitivity to paracetamol, or any of the other ingredients.

Caution in patients with severe renal impairment or severe hepatic impairment. The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease.

Sorbitol may have a mild laxative effect. Each 5 ml spoonful of this product contains 1.1 g sorbitol.

Calorific values: 3kcal/g sorbitol.

The label will state:

Do not give anything else containing paracetamol while giving this medicine.

Do not give more medicine than the label tells you to.

If your child does not get better, talk to their doctor.

Talk to a doctor at once if your child takes too much of this medicine, even if they seem well

Keep out of the reach and sight of children.

The label should convey the following information:

For oral use only.

Never give more medicine than shown in the table.

Always use the syringe supplied with the pack.

Do not give to children under 6 years of age.

Do not give more than 4 doses in any 24 hour period.

Leave at least 4 hours between doses.

Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist.

As with all medicines, if your child is currently taking any medicine consult your doctor or pharmacist before giving this product.

Do not store above 25°C. Store in the original package.

Shake the bottle for at least 10 seconds before use.

The leaflet will state:

Talk to a doctor at once if your child takes too much of this medicine even if they seem well. This is because too much paracetamol can cause delayed, serious liver damage

This product contains sorbitol, patients with rare hereditary problems of fructose intolerance should not take this medicine.

Methyl hydroxybenzoate (E218) may cause allergic reactions (possibly delayed).

The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and absorption reduced by cholestyramine.

The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.

Patients who have taken barbiturates, tricyclic antidepressants and alcohol may show diminished ability to metabolise large doses of paracetamol, the plasma half-life of which can be prolonged.

Chronic alcohol intake can increase the hepatotoxicity of paracetamol overdose and may have contributed to the acute pancreatitis reported in one patient who had taken an overdose of paracetamol. Acute alcohol intake may diminish an individual's ability to metabolise large doses of paracetamol, the plasma half-life of which can be prolonged.

The use of drugs that induce hepatic microsomal enzymes, such as anticonvulsants and oral contraceptives, may increase the extent of metabolism of paracetamol, resulting in reduced plasma concentrations of the drug and a faster elimination rate.

A large amount of data on pregnant women indicate neither malformative, nor feto/neonatal toxicity. Epidemiological studies on neurodevelopment in children exposed to paracetamol in utero show inconclusive results. If clinically needed, paracetamol can be used during pregnancy however it should be used at the lowest effective dose for the shortest possible time and at the lowest possible frequency.

Paracetamol is excreted in breast milk but not in a clinically significant amount. Available published data do not contraindicate breast feeding.

None known.

Adverse effects of paracetamol are rare. Very rarely hypersensitivity and anaphylactic reactions including skin rash may occur.

Very rare cases of serious skin reactions have been reported.

There have been reports of blood dyscrasias including thrombocytopenia and agranulocytosis, but these were not necessarily causally related to paracetamol.

Chronic hepatic necrosis has been reported in a patient who took daily therapeutic doses of paracetamol for about a year and liver damage has been reported after daily ingestion of excessive amounts for shorter periods. A review of a group of patients with chronic active hepatitis failed to reveal differences in the abnormalities of liver function in those who were long-term users of paracetamol nor was the control of the disease improved after paracetamol withdrawal.

Nephrotoxicity following therapeutic doses of paracetamol is uncommon.

Papillary necrosis has been reported after prolonged administration.

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.

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 and any patient who had ingested around 7.5 g or more of paracetamol in the preceding 4 hours should undergo gastric lavage.

Administration of oral methionine or intravenous N-acetylcysteine which may have beneficial effect up to at least 48 hours after overdose, may be required. General supportive measures must be available

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, coma and death. Acute renal failure with acute tubular necrosis may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported.

Liver damage is possible in adults who have taken 10 g or more of paracetamol.

Ingestion of lower doses equivalent to 5 g or more of paracetamol may lead to liver damage if the patient has risk factors. These include if:

• They are undergoing long-term treatment with drugs that induce liver enzymes

• They regularly consume ethanol in excess of advised amounts

• They are likely to be glutathione deplete e.g. as in cystic fibrosis, eating disorders, HIV infection, starvation, cachexia

ATC code: N02BE01

Paracetamol has analgesic and antipyretic effects similar to those of aspirin and is useful in the treatment of mild to moderate pain. It has weak anti-inflammatory effects.

Paracetamol is rapidly and almost completely absorbed from the gastrointestinal tract. Peak plasma concentrations are reached 30-90 minutes post dose and the plasma half-life is in the range of 1 to 3 hours after therapeutic doses. Drug is widely distributed throughout most body fluids. Following therapeutic doses 90-100% of the drug is recovered in the urine within 24 hours almost entirely following hepatic conjugation with glucuronic acid (about 60%), sulphuric acid (about 35%) or cysteine (about 3%). Small amounts of hydroxylated and deacetylated metabolites have also been detected. Children have less capacity for glucuronidation of the drug than do adults. In overdosage there is increased N-hydroxylation followed by glutathione conjugation. When the latter is exhausted, reaction with hepatic proteins is increased leading to necrosis.

Conventional studies using the currently accepted standards for the evaluation of toxicity to reproduction and development are not available.

Sorbitol solution (E420)

Glycerol

Dispersible cellulose (containing microcrystalline cellulose and sodium carboxymethylcellulose)

Hydroxyethylcellulose

Acesulfame potassium

Methyl hydroxybenzoate (E218)

Strawberry flavour ABJH9 (containing benzyl alcohol, ethyl benzoate, propylene glycol)

Cream flavour ACP3P (containing propylene glycol)

Purified water

None known.

24 months

Do not store above 25°C. Store in the original package.

70ml or 80ml, amber PET bottle with polypropylene child resistant closure with expanded polyethylene liner or polyethylene plug.

Syringe composed of a natural polypropylene barrel and a polyethylene pigmented white plunger.

Not all pack sizes may be marketed.

Not applicable.

The Boots Company PLC

1 Thane Road West

Nottingham NG2 3AA

Trading as BCM

PL00014/0860

5 November 2012

29^th July 2019