Panamax 240 Elixir 200ml Shopping Cart is Empty

CONTRAINDICATIONS Panamax is contraindicated in patients who are hypersensitive to paracetamol or to any other component of the Panamax formulations. It must not be used in patients with known glucose-6-phosphate-dehydrogenase deficiency or pre-existing respiratory depression. Panamax must not be used in patients with impaired liver function. PRECAUTIONS Panamax should not be administered to patients with hepatic or renal dysfunction (see CONTRAINDICATIONS). This medication may be dangerous when used in large amounts or for long periods. Hepatotoxicity may occur with paracetamol even at therapeutic doses, after short treatment duration and in patients without pre-existing liver dysfunction. Hepatotoxicity may develop following as little as 10 to 15g of paracetamol and hepatic failure is known to occur occasionally with the long term use of paracetamol. Patients with known analgesic intolerance or known bronchial asthma must only use Panamax after having consulted a physician (hypersensitivity reactions including bronchospasm possible). Caution is advised in patients with underlying sensitivity to aspirin and/or to non-steroidal anti-inflammatory drugs (NSAIDs).* Severe cutaneous adverse reactions (SCARs): Life threatening cutaneous reactions Stevens-Johnson syndrome (SJS), and Toxic epidermal necrolysis (TEN) have been reported with the use of paracetamol. Patients should be advised of the signs and symptoms and monitored closely for skin reactions. If symptoms or signs of SJS and TEN (e.g. progressive skin rash often with blisters or mucosal lesions) occur, patients should stop paracetamol treatment immediately and seek medical advice. Use in pregnancy Category A - Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed. Paracetamol can cross the placenta; however, no teratogenic effects have been observed in rats or mice, after doses of up to 250 mg/kg. A woman in the third trimester of pregnancy ingested 22.5 g paracetamol. Early treatment with oral acetylcysteine resulted in good outcome for both mother and foetus. Use in lactation Paracetamol is excreted in breast milk. The amount available for ingestion by the infant has been reported variously as less than 0.1% of a single 500 mg dose and as 0.04 to 0.23% of a single 650 mg dose. Maternal ingestion of paracetamol in usual analgesic doses does not appear to present a risk to the nursing infant.Panamax PI GLUv3 Piv8 18 Feb 14 INTERACTIONS WITH OTHER MEDICINES Paracetamol may increase the risk of bleeding in patients taking warfarin and other antivitamin K. Anticoagulant dosage may require reduction and patients should be monitored for appropriate coagulation and bleeding complications. Paracetamol absorption is increased by drugs which increase gastric emptying e.g. metoclopramide and decreased by drugs which decrease gastric emptying e.g. propantheline, antidepressants with anticholinergic properties, narcotic analgesics. Paracetamol may increase chloramphenicol concentrations by slowing down excretion, entailing the risk of increased toxicity. The risk of paracetamol toxicity may be increased in patients receiving other potentially hepatotoxic drugs or drugs that induce liver microsomal enzymes, such as antiepileptics (such as phenobarbital, phenytoin, carbamazepine, topiramate), barbiturates, hypnotics, rifampicin and alcohol. Paracetamol excretion may be affected and plasma concentrations altered when given probenecid. Colestyramine reduces the absorption of paracetamol if given within 1 hour of paracetamol. Co-administration of flucloxacillin with paracetamol may lead to metabolic acidosis, particularly in patients presenting risk factors of glutathione depletion, such as sepsis, malnutrition or chronic alcoholism. When used concurrently with zidovudine, an increased tendency for neutropenia may develop. Combination of Panamax and zidovudine should be avoided. ADVERSE REACTIONS Reports of adverse reactions are rare. Although the following reactions have been reported: dyspepsia, sweating, erythema, urticaria, anaphylactic shock, angioneurotic oedema, difficulty breathing, drop in blood pressure, nausea, allergic reactions such as skin rashes, hypersensitivity reactions and haematological reactions, including thrombocytopenia, leukopenia, neutropenia agranulocytosis and pancytopenia. Bronchospasm may be triggered in patients having a tendency of analgesic asthma. Toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), acute generalised exanthematous pustulosis, fixed drug eruption (see PRECAUTIONS) and cytolytic hepatitis, which may lead to acute hepatic failure, have also been reported. Overdosage with paracetamol if left untreated can result in severe, sometimes fatal liver damage and rarely, acute renal tubular necrosis. Haemolytic anaemia in patients with underlying glucose 6-phosphate-dehydrogenase deficiency has been reported. Kounis syndrome and bronchospasm have also been reported.