Review of Day Nurse Alternatives

Day Nurse alternative: The Best Medicines

“Day Nurse” is an over-the-counter medication commonly used in the UK for the relief of cold and flu symptoms. It is formulated to help alleviate various symptoms during the day without causing drowsiness. Recently, Day Nurse was discontinued, which spiked the search and demand for Day Nurse alternative medicines for the symptomatic management of colds and flu.

What are Day Nurse’s active ingredients?

The typical ingredients in Day Nurse include:

  • Paracetamol: An analgesic and antipyretic, it helps in reducing pain (such as headache, sore throat pain) and fever.
  • Pseudoephedrine: A decongestant that helps to relieve nasal congestion or a blocked nose.
  • Pholcodine: Used to reduce coughing (cough suppressant).

Day Nurse is designed for daytime use as it does not contain ingredients that cause drowsiness, unlike its counterpart “Night Nurse” which is formulated to help patients rest during the night while relieving cold and flu symptoms.

Is Day Nurse discontinued?

Day Nurse and other cold and flu products and cough medicines were withdrawn from the UK market following a review by the Medicines and Healthcare Products Regulatory Agency (MHRA). This decision was based on the findings that the benefits of these medicines did not outweigh the increased risk of a very rare, but severe allergic reaction known as anaphylaxis. This risk is specifically related to neuromuscular blocking agents (NMBA), which are used in general anaesthesia. Studies identified a link between pholcodine and an increased risk of anaphylaxis to these muscle relaxants during surgery.
Since the withdrawal of pholcodine-containing products from UK pharmacies, Day Nurse capsules and liquid and Day & Night Nurse Capsules (combination pack) were discontinued.

Pholcodine which is included in the formulation of Day Nurse may be replaced with another active ingredient in the future, however, this is just a speculation.

Day Nurse alternative medicines

Since pholcodine was withdrawn from the market, first we will look at combination medicines containing the other two active ingredients found in Day Nurse, paracetamol and pseudoephedrine.

Day Nurse alternative medicines containing paracetamol and pseudoephedrine

In the UK, there are specific restrictions on the sale of medicines containing pseudoephedrine and ephedrine, which are commonly used in nasal decongestants. These restrictions, which came into effect on April 1, 2008, include:

Limit on Quantity: It is illegal to sell or supply any product that contains more than 720 mg of pseudoephedrine or 180 mg of ephedrine without a prescription. Additionally, selling or supplying a combination of products that collectively contain more than these specified amounts of pseudoephedrine or ephedrine is also illegal without a prescription.

Combination Sales Prohibited: It is illegal to sell or supply a product containing pseudoephedrine along with a product containing ephedrine in a single transaction.

Pharmacist Supervision Required: The sale and supply of products containing pseudoephedrine or ephedrine must be done by a pharmacist or suitably trained pharmacy staff under the supervision of a pharmacist.

1. Sinutab (Non-drowsy) as an alternative to Day Nurse

Is Sinutab the best Day Nurse alternative?
Sinutab is an over-the-counter medication primarily used to relieve symptoms associated with cold and flu and other related conditions like sinusitis. Sinutab is used to alleviate symptoms like nasal congestion, sinus pressure, headaches, and minor aches and pains that can come with sinus problems.
Sinutab tablets contain paracetamol and pseudoephedrine which are found in Day Nurse.
Each Sinutab tablet contains 30 mg Pseudoephedrine hydrochloride and 500 mg Paracetamol.

Where can you buy Sinutab tablets?

Sinutab tablets are pharmacy-only medication (P), which means that their sale is restricted to pharmacies only. P-medicines are kept behind the pharmacy counter, away from the public.

2. Day Nurse alternative: Contact tablets

Contact contains paracetamol and pseudoephedrine which can be used as Day Nurse alternative

Another on the list of Day Nurse alternative medicines is Contact tablets. Contact tablets have the same combination of active ingredients as previously discussed Sinutab tablets.

Each Contact tablet contains Paracetamol 500 mg and Pseudoephedrine Hydrochloride 30 mg.
Contact tablets are pharmacy-only medications.

3. Lemsip Max Flu Lemon

Lemsip is a brand of cold and flu remedies popular in the UK. The original and most well-known product in the Lemsip line is a lemon-flavored hot drink.

Lemsip Max Flu lemon comes in the form of powder which is mixed with hot water.
Each Lemsip Max Flu lemon sachet contains: 1000mg of paracetamol and 60mg of pseudoephedrine.

Day Nurse alternative: a combination of ibuprofen and pseudoephedrine

Slightly less relevant, but still popular is a medicine containing ibuprofen and pseudoephedrine. Unlike paracetamol, ibuprofen is used in conditions involving inflammation in addition to pain. It can also be used to reduce fever.

4. Nurofen Cold and Flu tablets

Nurofen Cold and Flu contains ibuprofen and paracetamol

Nurofen Cold and Flu tablets have two active ingredients: pseudoephedrine and ibuprofen. Although not the same, Nurofen Cold and Flu tablets can be considered as Day Nurse alternative, since both active ingredients elevate symptoms of a common cold and flu.

Day Nurse alternatives: other combination products

So far we discussed Day Nurse alternative medicines containing two main active ingredients found I Day Nurse. Plenty of combination products are available which are licensed for the management of cold and flu symptoms. Most cold and flu products come in the form of tablets, however, a noticeable amount of medicines are also available in the form of liquids.

5. Is Actifed Multi-Action Dry Coughs best Day Nurse alternative?

Is Actifed The Best Day Nurse alternative medication?

Actifed Multi-Action Dry Coughs liquid is a great Day Nurse alternative, however, the combination of active ingredients found in this medication can cause drowsiness. Nevertheless, Actifed Multi-Action Dry Coughs liquid aims to control the main symptoms of cold and flu.

Active ingredients found in Actifed Multi-Action Dry Coughs liquid:

  • 1.25 mg triprolidine hydrochloride
  • 30 mg pseudoephedrine hydrochloride and
  • 10 mg dextromethorphan hydrobromide
    in each 5 ml of the medication.

Dextromethorphan is commonly used in cold and flu products as a cough suppressant. It works by affecting the signals in the brain that trigger the cough reflex. This makes it useful for treating a dry cough that doesn’t produce mucus, which is often a symptom associated with the common cold and flu.
Dextromethorphan is a great alternative to pholcodine found in Day Nurse.

Triprolidine is used in cold and flu products primarily for its antihistamine properties. Antihistamines like triprolidine are effective in relieving allergy symptoms, they can also help treat symptoms associated with the common cold and flu.

Triprolidine helps by blocking the effects of histamine, which can reduce symptoms like runny nose, sneezing, and watery eyes. Many first-generation antihistamines, including triprolidine, have sedative properties. This can be beneficial in cold and flu products as it can help a person rest and sleep, which is important for recovery.

Actifed Multi-Action Dry Coughs tablets and liquid do not contain paracetamol, however, paracetamol can be taken alongside.

Actifed Multi-Action Dry Coughs liquid and tablets are pharmacy-only medicines.

Plenty of over the counter combination medicines contain phenylephrine. Phenylephrine and pseudoephedrine are both decongestants used to relieve nasal congestion. Studies have shown that pseudoephedrine is generally more effective than phenylephrine at relieving nasal congestion. However, individual responses can vary.

Some medicines which can be considered as Day Nurse alternative:

6. Lemsip Max All in One sachets

Lemsip Max All-in-One sachets contain paracetamol, phenylephrine hydrochloride and guaifenesin. Unlike Day Nurse, L emsip Max All in One sachets contain guaifenesin, which is used to manage symptoms of chesty coughs. Guaifenesin,” which is a medication commonly used as an expectorant. Guaifenesin is used to treat coughs and congestion caused by the common cold, bronchitis, and other breathing illnesses.
Guaifenesin works by thinning and loosening mucus in the airways, clearing congestion, and making breathing easier. By reducing the thickness of bronchial secretions, it helps in the removal of mucus through coughing.

7. Beechams All-In-One Tablets

BEECHAMS All in One for colds and flu

Beechams All-In-One Tablets contain the same combination of active ingredients which are found in Lemsip Max All-in-One sachets: guaifenesin, paracetamol, phenylephrine hydrochloride. The role of all active ingredients in the management of cold and flu symptoms was already discussed. Beechams All-In-One tablets are another option to consider, despite not having the same active ingredients which are found in Day Nurse.

Conclusion

In conclusion, Day Nurse, an over-the-counter medication in the UK for cold and flu symptoms, has been withdrawn from the market following MHRA’s review linking pholcodine (one of its ingredients) to an increased risk of anaphylaxis.

For those seeking similar relief, options like Sinutab, Contact tablets, and Lemsip Max Flu Lemon offer a combination of paracetamol and pseudoephedrine. These products are effective for symptoms like nasal congestion, headaches, and minor aches, but vary in form from tablets to powders.

Nurofen Cold and Flu tablets, though slightly different, serve as another alternative to pseudoephedrine and ibuprofen, addressing pain and inflammation alongside cold and flu symptoms.
For a broader approach, Actifed Multi-Action Dry Coughs (liquid and tablets) include triprolidine, pseudoephedrine, and dextromethorphan, offering antihistamine and cough suppressant properties but with potential drowsiness.

Additionally, Lemsip Max All-in-One sachets and Beechams All-In-One Tablets provide an alternative with guaifenesin, phenylephrine hydrochloride, and paracetamol, targeting chest congestion and other cold symptoms.

These alternatives, while not identical to Day Nurse, offer diverse options for managing cold and flu symptoms, with consideration for individual preferences and symptom profiles. Customers need to be aware of the active ingredients and choose accordingly, especially in light of regulatory changes and individual health needs.

I am a qualified pharmacist working in an independent pharmacy in the UK.
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