Learning scenario
Learning scenario
Emma asks for your advice. She has a headache and some neck tension that she tried taking a couple of ibuprofen for, but they don't seem to have helped. She has had a really busy day at work, and she feels like she has a tight band around her head. She isn't taking any other medication, and has no medical conditions. Think about what kind of headache she has, the advice you could give, and whether Syndol is appropriate to be recommended. Then click on the arrow for a suggested response.
It sounds like a tension headache, possibly caused by stress or posture at work.
Other causes may be dehydration or tiredness.
- You could recommend Syndol to help with the headache and the muscle tension
- Remind her that it is for short-term use only and she should only use it for a maximum of three days
- Advise her that it may cause drowsiness, and she shouldn't drink alcohol while she is taking it
- Advise her to carefully read the patient information leaflet before taking the medication
- Explain that if there is no improvement in three days, she should seek advice from her GP.
Syndol® Film-coated 5mg Tablets Product Information
Presentation: Film-coated tablets containing paracetamol 450mg, codeine phosphate 10mg, doxylamine succinate 5mg and caffeine 30mg. Indications: For the short-term treatment of acute moderate pain which is not relieved by paracetamol, ibuprofen or aspirin alone such as headache, tension headache, migraine, neuralgia, toothache, dysmenorrhoea, muscular and rheumatic aches and pains and post-operative analgesia following surgical or dental procedures. Dosage and administration: The duration of treatment should be limited to 3 days. Adults: One or two tablets every four to six hours up to a maximum of 8 tablets in 24 hours. Elderly and debilitated: Codeine should be used with caution in the elderly and debilitated patients as they may be more susceptible to the respiratory depressant effects. Children 16 to 18 years: One to two tablets every 6 hours up to a maximum of 8 tablets in 24 hours. Children 12 to 15 years: One tablet every 6 hours up to a maximum of 4 tablets in 24 hours. Contraindications: Hypersensitivity to paracetamol, codeine or other opioid analgesics, doxylamine succinate, caffeine, or any of the other constituents. Concomitant use with monoamine inhibitors (MAOIs) or within 14 days of stopping treatment with these medicines. Conditions where morphine and opioids are contraindicated. All paediatric patients (0-18 years) who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome due to an increased risk of developing serious and life-threatening adverse reactions. Patients who are CYP2D6 ultra-rapid metabolisers. Warnings and precautions: Not recommended for use in children under 12 years of age. Do not take concurrently with any other paracetamol or codeine containing medicines. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. E110 and E104 may cause allergic reaction. Concomitant use with alcohol is not recommended. Co-administration of enzyme-inducing antiepileptic medications may increase toxicity; doses should be reduced. Care is advised in patients with impaired kidney or liver function and in those with hypertension, hypothyroidism, adrenocortical insufficiency, prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, shock, obstructive bowel disorders, acute abdominal conditions (e.g. peptic ulcer), recent gastrointestinal surgery, gallstones, myasthenia gravis, a history of cardiac arrhythmias or convulsions, and in patients with a history of drug abuse or emotional instability. Codeine may induce faecal impaction, producing incontinence, spurious diarrhoea, abdominal pain and rarely colonic obstruction. Interactions: Syndol may enhance the sedative effects of CNS depressants such as alcohol, barbiturates, anaesthetics, hypnotics, other opioid analgesics, anxiolytic sedatives, antipsychotics, tricyclic antidepressants and phenothiazines, resulting in increased CNS depression. It may also have an additive antimuscarinic action with other drugs, such as atropine and some antidepressants. Pregnancy and lactation: Use during pregnancy and lactation should be avoided. Side effects: Doxylamine succinate: Common: drowsiness, paradoxical stimulation, headaches, psychomotor impairment, urinary retention, dry mouth, Pregnancy and lactation: Use during pregnancy and lactation should be avoided. Side effects: Doxylamine succinate: Common: drowsiness, paradoxical stimulation, headaches, psychomotor impairment, urinary retention, dry mouth, blurred vision, gastrointestinal disturbances, thickened respiratory tract secretions. Rare: hypotension, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, palpitation, arrhythmia hypersensitivity reactions, blood disorders and liver dysfunction. Paracetamol: Very rare: thrombocytopenia, serious skin reactions. Not known: agranulocytosis, anaphylactic shock, angioedema. Hypersensitivity including skin rash may occur. Codeine: constipation, drowsiness, nausea, vomiting, sweating, facial flushing, dry mouth, blurred or double vision, dizziness, orthostatic hypotension, malaise, tiredness, headache, anorexia, vertigo, bradycardia, palpitations, respiratory depression, dyspnoea, allergic reactions and difficulties in micturition. Rarely: convulsions, hallucinations, nightmares, uncontrolled muscle movements, muscle rigidity, mental depression and stomach cramps. Very rare: pancreatitis. Regular prolonged use of codeine is known to lead to addiction and symptoms of restlessness and irritability may result when treatment is stopped. Prolonged use of a painkiller for headaches can make them worse. RRP (ex VAT): 10 tablets £3.79, 30 tablets £8.99. Legal category: P. Product licence number: PL 04425/0690. Product licence holder: Sanofi, One Onslow Street, Guildford, Surrey, GU1 4YS, UK. Further information is available from Sanofi, One Onslow Street, Guildford, GU1 4YS.
Tel: 0845 372 7101, email: uk-medicalinformation@sanofi.com. Date of preparation: October 2018. Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov/yellowcard Adverse events should also be reported to the Sanofi drug safety department on 0800 0902314
References
1. Syndol SmPC.
2. Iqbal N et al. The effect of caffeine on the pharmacokinetics of acetaminophen in man. Biopharm Drug Dispos. 1995 Aug;16(6):481-7
3. https://www.nhs.uk/conditions/tension-headaches/
4. https://www.nhs.uk/conditions/migraine/symptoms/
5. Symptoms in the pharmacy. A Guide to the Management of Common Illness. Alison Blenkinsopp. Blackwell Publishing.
6. https://www.nice.org.uk/guidance/cg150/chapter/Recommendations#assessment
7. https://patient.info/health/headache-leaflet/tension-headache
8. https://www.nhs.uk/conditions/migraine/
All references last accessed January 2018