Day and Night Nurse is popular over the counter medication used for the management of cold and flu symptoms. In the last couple of months both Day and Night Nurse have been out of stock. European Medication Agency (EMA) recommended the withdrawal of pholcodine and pholcodine-containing products from the market putting a question mark on the future of Day Nurse availability. Is Day and Night Nurse discontinued as result?
Day and Nurse range and active ingredients
Day and Night Nurse range consists of Day Nurse capsules or liquid and Night Nurse capsules and liquid.
Active ingredients found in Day Nurse:
- Paracetamol
- Pseudoephedrine Hydrochloride
PholcodineActive ingredients found in Nigh Nurse:
- Dextromethorphan hydrobromide
- Paracetamol
- Promethazine hydrochloride
Day and Night nurse is available as a combination pack containing Day and Night capsules and separate products Day Nurse capsules and liquid and Night Nurse capsules and liquid.
Is Day and Night Nurse discontinued?
One of the active ingredients found in Day Nurse is pholcodine. Pholcodine is a drug used in the management of dry coughs (non-productive), commonly associated with episodes of cold and flu in adults and children.
In December 2022, European Medicines Agency (EMA) revoked marketing authorisation for pholcodine with the recommended withdrawal of pholcodine-containing products.
Additionally, EMA recommended the following:
- Pholcodine should not be prescribed or dispensed by healthcare professionals
- Patients should be advised to stop using pholcodine
- Patients who have general anaesthesia with NMBAs PLANNED should be asked whether they used pholcodine or pholcodine-containing products.
Why was pholcodine discontinued?
EMA’s decision on the withdrawal of pholcodine was based on post-marketing information and safety data (ALPHO study). It was found that the use of pholcodine in the 12 months before general anaesthesia with neuromuscular blocking agents (NMBA) increases the risk of developing a sudden anaphylactic reaction which can be a life-threatening reaction.
What about the UK?
Medicines and Healthcare products Regulatory Agency (MHRA) is performing its own investigation regarding the possible use of pholcodine and the risk of severe allergic reactions when NMBAs are used in general anaesthesia.
Is Night Nurse discontinued?
GSK, the marketing authorisation holder for Day and Night Nurse range has not issued any statements since EMA recommended the withdrawal of pholcodine and pholcodine-containing products from the European market. As of today no official statement on the possible discontinuation of Day or Night Nurse was issued.
Night Nurse does not contain pholcodine, however, there have been ongoing supply issues with Night Nurse since before Christmas. One possible explanation is ongoing supply issues with one of the active ingredients found in Nigh Nurse, dextromethorphan hydrobromide. Other over the counter products containing dextromethorphan, for example, Benylin Dry Cough Syrup have been out of stock for a few months.
Supply problems of cough syrups are part of the national shortage of cold medicines in the UK.
Is Day and Night Nurse discontinued – what next?
Day and Night Nurse is a well-recognised brand of cold and flu medicines. Day and Night Nurse have not been discontinued. Possible supply problems with Day Nurse may be explained with the ongoing investigation by MHRA into possible risks described in the previous paragraphs.
Are there any Day and Night alternative medicines?
Some pharmacies, noticeably Boots Pharmacy sell their own brands of Day and Night Cold and Flu relief medicines. Boots Day Cold and Flu Relief Oral Solution and Boots Night Cold and Flu Relief Oral Solution, for example, contain the same active ingredients which are found in Day and Night Nurse.
Plenty of other cough and cold medicines contain a similar combination of active ingredients, and many of them are currently out of stock. A detailed review of Day and Night Nurse alternative medicines will follow.
References
EMA (2022). EMA recommends withdrawal of pholcodine medicines from EU market. Available at: https://www.ema.europa.eu/en/news/ema-recommends-withdrawal-pholcodine-medicines-eu-market Accessed on 04/02/2023
