Popular cold and flu medicines have been banned in the UK over fears they could trigger deadly allergic reactions, leaving many Brits wondering how to treat their symptoms.
But Dr Hilary Jones has shared how people can manage their coughs without turning to pholcodine, which the UK’s medicines regulator says raises the risk of life-threatening anaphylaxis among patients put under general anaesthetic.
Twenty products are being urgently withdrawn, including ones made by Day & Night Nurse and Covonia — as well as own-brand versions on sale in Boots and Superdrug.
But the GP and Good Morning Britain expert said hot lemon and honey, steam inhalations and lozenges are among ‘plenty’ of alternative remedies to treat a cough, while noting that the risk from the medications being pulled from shelves is ‘tiny’.
Twenty cold and flu products are being withdrawn in the UK, including some of those made by Day & Night Nurse and Covonia — as well as own-brand versions sold in Boots (pictured)
Dr Hilary Jones (pictured) has shared how people can manage their coughs without turning to pholcodine, which the UK’s medicines regulator says raises the risk of life-threatening anaphylaxis among patients put under general anaesthetic
Asked on Good Morning Britain what people should do if they have the banned medications in their cupboard, he said: ‘It’s an effective antitussive, it’s good for a dry cough, isn’t it.
‘But the advice people are being given is to go and talk to your pharmacist or your doctor and say “what are the alternatives to this”, and the pharmacist will say “give me that back, I’ll dispose of that for you, there are plenty of alternatives”.
‘Hot lemon and honey, steam inhalations, lozenges, simple linctus, which don’t contain pholcodine, which is, after all, a dilute opioid.’
Hot lemon and honey eases cold-like symptoms, because the citrus fruit contains vitamin C and helps break down mucus, while honey has antibacterial properties.
Consuming them together in a hot drink can soothe inflammation and boost hydration.
Which medications are affected?
The Boots Company PLC
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
Thornton & Ross Limited
Cofsed Linctus PL 00240/0097
Care Pholcodine 5mg/5ml Oral Solution Sugar Free PL 00240/0101
Galenphol Paediatric Linctus PL 00240/0102
Galenphol Strong Linctus, PL 00240/0103
Covonia Dry Cough Sugar Free Formula PL 00240/0353
Bell Sons & Company (Druggists) Limited
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 03105/0060
Pinewood Laboratories Limited
Pholcodine Linctus BP PL 04917/0002
Strong Pholcodine Linctus BP, PL 04917/0005
Pholcodine Linctus PL 12965/0030
Glaxosmithkline Consumer Healthcare (UK) Trading Limited
Day & Night Nurse Capsules PL 44673/0068
Day Nurse Capsules PL 44673/0069
Day Nurse PL 44673/0075
Meanwhile, steam inhalation — hovering over a bowl of hot water and covering your head with a towel — helps cold and flu symptoms.
The warm, moist air helps to soothe and open up inflamed nasal passages and the NHS says it is also thought to loosen mucus in the throat and lungs.
Another remedy, throat lozenges, can ease a sore throat by keeping it lubricated.
Options such as Strepsils and Soothers may also be packed with ingredients such as lemon, honey, antiseptics and pain relievers.
And simple linctus, a cough syrup that can be used by adults and children over the age of 12, contains citric acid, which helps reduce inflammation.
The medicine can also help make it easier to cough up phlegm — mucus from the lungs and lower airways that protects against germs and foreign contaminants.
There are plenty of other cough medicines on the high street that don’t contain the now-banned ingredient, meaning some versions of Night Nurse, Covonia and own-brand options can still be used.
It comes after the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA), which polices the safety of drugs used in Britain, yesterday confirmed that it is recalling any medicines that contain pholcodine as a precaution.
The opioid suppresses cough reflexes by reducing the nerve signals sent from the brain to the muscles involved.
But the Commission on Human Medicine (CHM) — which advises the MHRA on the safety of medicines — flagged concerns among patients who took the drug ahead of being put under general anaesthetic with neuromuscular blocking agents (NMBAs).
NMBAs are used in around half of general anaesthetics administered in the UK to relax the muscles before some operations.
One use is when a patient needs to be intubated, with the NMBA paralysing or relaxing the jaw and the vocal cords.
Those who took pholcodine in the 12 months before being exposed to NMBAs were at increased risk of having a life-threatening allergic reaction, called anaphylaxis.
This causes a patient’s blood pressure to drop and their airways to narrow, blocking breathing. It can be life-threatening without immediate treatment.
The CHM admitted that ‘the absolute risk of anaphylaxis remains very small in patients who have taken pholcodine’.
Currently the risk it is thought to affect only around one in 10,000 procedures, with many doctors never encountering the reaction in their entire career.
Explaining the move, Dr Jones said: ‘Pholcodine has been around for 70 years. It’s a very common ingredient and I have to say that this is a precaution. The risk of this anaphylactic reaction is very, very small.
‘However, safety is paramount and that’s why the MHRA have decided to withdraw these things from the shelves.’
He said the move will not stop anyone having an operation and that he ‘has not seen this reaction in 45 years of medical practice, most doctors won’t either’.
Bosses at the European Medicines Agency also recommended that pholcodine products should be withdrawn from the EU market last December following similar concerns.
And two weeks ago, Australia issued a national recall for 55 medicines containing pholcodine on the same grounds. Health chiefs said it was aware of 50 cases of this anaphylactic shock during general anaesthesia that were linked with pholcodine, including one death.
Dr Hilary Jones said hot lemon and honey (left) and lozenges (right) are among the alternatives people can use to can manage their coughs without turning to pholcodine
Dr Hilary Jones said steam inhalation (left) and simple linctus (right) are among the alternatives people can use to can manage their coughs without turning to pholcodine
Ben Jephcott, from Shrewsbury, said that the decision to ban pholcodine, which he says is ‘safe and actually works’, is a ‘ludicrous over-reaction’
Another Twitter user, Sandy Karenso, said pholcodine is ‘absolutely the best cough remedy’. She urged health chiefs to ‘leave us alone’ and ‘let us make our own decisions’
No comparable figures have been released for the UK.
In Britain, the affected products, which include Day & Night Nurse Capsules, Boots Night Cough Relief Oral Solution and Superdrug Pholcodine Linctus, will no longer be available in pharmacies.
Brits taking tablets or syrups for a cough have been told to check the packaging, label or information leaflet to see if pholcodine is a listed ingredient.
If it is, they can talk to their pharmacists who can suggest a different medicine.
They have also been advised to tell an anaesthetist before surgery if they have taken a medicine containing pholcodine in the previous 12 months.
Despite the MHRA warning that the potential risk of taking medicines containing pholcodine outweighs the benefits, desperate Brits have hit out at the move.
Ben Jephcott, from Shrewsbury, said that the decision to ban pholcodine, which he says ‘actually works’, is a ‘ludicrous over-reaction’.
He called for a national ‘Save our Cough Mixture campaign’ in a bid to reverse the decision.
Another Twitter user, Sandy Karenso, said pholcodine is ‘absolutely the best cough remedy’. She urged health chiefs to ‘leave us alone’ and ‘let us make our own decisions’.
Online pharmacies have displayed ‘out of stock’ messages, while others including Boots, reported ‘stock coming soon’.
Patients took to social media to complain of issues getting hold of depleted stocks of medication.
One woman reacting to the news tweeted: ‘This is outrageous. I’ve had trouble getting Day Nurse and Night Nurse for months so it isn’t new.’
Meanwhile, another wrote: ‘Day and Night Nurse being withdrawn from the UK market is actually quite sad, it’s the only medicine that has been touching the sides with this never ending cold I currently have. It’s been so hard to get hold of recently too.’
Another wrote: ‘What, always take night nurse! Never had a problem! Need to stock up!!’, one tweeted.
One said: ‘Utterly ridiculous. Been available for years, works like a charm too. Day and night nurse are great. Hope they’re back on the shelves soon.’
What Brits should take instead of banned cold and flu medicines
Hot lemon and honey
You were likely told as a child that the miracle cure for a sore throat is hot lemon water and honey.
But it’s an age-old remedy for a reason.
Honey has many antibacterial properties, while lemon is packed with Vitamin C and helps to break down mucus.
And mixing these with hot water soothes inflammation and keeps you hydrated.
A study by scientists in India looked at the healing property of honey and found that the bee enzyme glucose oxidase produces hydrogen peroxide – an antiseptic that kills viruses and various forms of bacteria.
Even non-peroxide manuka honey provides antibacterial benefits which experts suggest is due to the low pH combined with a high sugar content stunting the growth of bacteria.
Lemon contributes to the healing process by shrinking the swollen mucus tissue which makes swallowing painful, while its acidity can make the throat a hard place for bacteria and viruses to survive.
The Vitamin C in lemon can also boost your immune system, helping your body fight off infection.
And drinking water when you are unwell is key, as proper hydration is essential for maintaining good health and ensuring your body is functioning effectively, according to the British Nutrition Foundation.
Ducking over a bowl of hot water and covering your heard with a towel is a go-to ritual when you have a cold.
The warm, moist air helps to soothe and open up inflamed nasal passages, with the NHS saying it is also thought to loosen mucus in the throat and lungs.
Many people use the bowl and towel method, often with a drop of liquid decongestant such as Olbas Oil.
But others opt for electric steam inhalers, some which can be used for the whole face or have fittings that just focus on the nose or throat.
The NHS suggest steaming once or twice a day for 10 to 15 minutes.
It is recommended that you steam when your symptoms are most noticeable, such as your throat feels particularly dry or you have been using your voice more heavily.
Steam inhalation will not cure a virus or bacterial infection, but it may relieve your symptoms and make you feel better while your body recovers.
Throat lozenges, such as Strepsils, can be a lifesaver when you have a sore throat but have a busy day ahead.
They can help lubricate the throat as the sucking action produces saliva.
And many lozenges may contain ingredients such as lemon and honey, which have antibacterial and immune system boosting properties.
Other ingredients added to lozenges to help fight illness are antiseptics, pain relievers and menthol and eucalyptus oil – which is thought to be antibacterial.
But David King, senior lecturer in general practice at the University of Queensland, wrote in The Conversation that lozenges should be consumed with other remedies as they are unlikely to provide complete relief.
This conclusion was based off studies into the effectiveness of different lozenges, which found many unlikely to cure infection.
However he added that lozenges with anti-inflammatory or local anaesthetic ingredients were the most effective.
Simple linctus without pholcodine
The withdrawal of cough syrups from shelves may leave you feeling as though you can’t reach for any the next time you have a sore throat.
But there are cough syrups that don’t contain pholcodine – the ingredient thought to cause allergic reaction.
Simple linctus cough syrups, which can be used by adults and children over the age of 12, contain citric acid which helps to reduce inflammation.
These syrups therefore can help to gently relieve and soothe mild coughs.
They can also help make it easier to cough up phlegm – mucus from your lungs and lower airways that protects against germs and foreign contaminants.