Some popular cough medicines are being withdrawn from sale over fears people may suffer a serious allergic reaction.
The watchdog the Medicines and Healthcare products Regulatory Agency (MHRA) took the decision “as a precaution”.
Its assessment suggests people who consumed products containing pholcodine may experience a severe allergic reaction to muscle relaxants known as neuromuscular blocking agents, which are used during general anaesthesia in surgery.
So what exactly are pholcodine and neuromuscular blocking agents, which products are being withdrawn, and what are patients using the withdrawn medications advised to do?
Here is everything we know.
What is pholcodine?
Pholcodine is an opioid cough suppressant that helps mildly sedate a patient and relieve their cough. It is found in cough medications and certain lozenges.
The suppressant is available in countries such as the UK, Belgium, Finland, Norway and New Zealand. However, the United States doesn’t allow it to be prescribed as it’s within its most highly controlled drugs category alongside heroin, LSD, and ecstasy.
Excluding the MHRA’s recent findings, the agent’s side effects are known to be dizziness, gastrointestinal disturbances, drowsiness, nausea and respiratory depression.
Its anaphylactic impact during general anaesthesia has been a highly debated subject; the French National Agency for the Safety of Medicines and Health Products withdrew all pholcodine-containing medicines in September 2022.
What are neuromuscular blocking agents?
Neuromuscular blocking agents (NMBAs) are chemical agents that paralyse the skeletal muscles by disrupting the communications between motor neurons and muscle fibres.
They are often used during general anaesthesia while operating on or intubating a patient, as they reduce movement and can help to protect the vocal cord.
As a precaution, pholcodine-containing cough and cold meds can no longer be bought.
— MHRAgovuk (@MHRAgovuk) March 14, 2023
If you are taking one of these medicines and have any questions, talk to your pharmacist about alternatives.
Find out more: https://t.co/lZRqoRdoDg pic.twitter.com/R3gV34wA1A
Which cough medications are being withdrawn?
The following products have been recalled:
- Boots Night Cough Relief Oral Solution,
- PL 00014/0230 Boots Dry Cough Syrup 6 Years+,
- PL 00014/0523 Boots Day Cold & Flu Relief Oral Solution,
- PL 00014/0565 Cofsed Linctus,
- PL 00240/0097 Care Pholcodine 5mg/5ml Oral Solution Sugar Free,
- PL 00240/0101 Galenphol Linctus,
- PL 00240/0101 Galenphol Paediatric Linctus,
- PL 00240/0102 Galenphol Strong Linctus,
- PL 00240/0103 Covonia Dry Cough Sugar Free Formula,
- PL 00240/0353 Pholcodine Linctus Bells Healthcare 5mg Per 5ml Oral Solution,
- PL 03105/0059 Numark Pholcodine 5mg per 5ml Oral Solution,
- PL 03105/0059 Well Pharmaceuticals Pholcodine 5mg per 5ml Oral Solution,
- PL 03105/0059 Superdrug Pholcodine Linctus BP,
- PL 03105/0059 Strong Pholcodine Linctus BP, PL 03105/0060Pholcodine Linctus BP,
- PL 04917/0002 Strong Pholcodine Linctus BP,
- PL 04917/0005 Pholcodine Linctus,
- PL 12965/0030 Day & Night Nurse Capsules,
- PL 44673/0068 Day Nurse Capsules,
- PL 44673/0069 Day Nurse, PL 44673/0075
What are the patients using these medications advised to do?
Dr Alison Cave, MHRA chief safety officer, said: “If you are taking a cough or cold medicine, check the packaging, label or patient information leaflet to see if pholcodine is a listed ingredient.
“If it is, and you have any questions, you can talk to your pharmacist who will suggest an alternative medicine.”
If you suspect that you may have used a medication with pholcodine in it in the past 12 months and you are due to have an operation, you should tell your medical team and anaesthetist.
Dr Cave said: “The anaesthetist will be well placed to take this into account. Anaesthetists are highly trained in managing anaphylaxis.”
