The public has been told to stop taking 20 common cough and cold medicines over safety fears. 

The remedies - including capsules of Day Nurse and Night Nurse, as well as a host of medicines manufactured by Boots and other brands - are being immediately withdrawn from the market on the orders of drug regulators. 

The Medicines and Healthcare products Regulatory Agency (MHRA) stressed the danger relates to a “very rare” risk of anaphylaxis, particularly among those who later undergo surgery, and require medicines which are used alongside anaesthetics. 

The concerns relate to products containing pholcodine, a cough suppressant. 

Patients are being told to check the labels of cough medicines at home, and to seek advice from pharmacists about using alternative remedies if required. 

Experts last night said most coughs would clear up on their own within a couple of weeks. 

Anyone undergoing surgery is being urged to tell their anaesthetist if they think they have taken a medicine containing pholcodine. 

Watchdogs said their review had found that pholcodine use -  particularly in the 12 months before general anaesthesia backed with muscle relaxants - is a risk factor for developing an anaphylactic reaction.

Such agents are used in about half of operations involving a general anaesthetic. 

The Commission on Human Medicines, which advised the MHRA, said the absolute risk of anaphylaxis following neuromuscular blocking agents is “very small” at less than 1 case per 10,000 procedures overall. 

The MHRA considered a recent study, which showed that use of pholcodine during the 12 months preceding anaesthesia was “significantly associated” with a four-fold increase in risk. 

Treatment of symptoms of cold and flu

Data on the risk beyond 12 months was not available, but an early study in Norway suggests that a “very small increased risk may persist for up to three years.”

The European Medicines Agency recently recommended the withdrawal of such products, which are used in adults and children to treat non-productive (dry) cough and, in combination with other active substances, for the treatment of symptoms of cold and flu.

In the UK recall notice, the MHRA said: “The available data has demonstrated that pholcodine use, particularly in the 12 months before general anaesthesia with NMBAs, is a risk factor for developing an anaphylactic reaction to NMBAs.”

It added: “Given the advice of the CHM and the lack of identifiable effective measures to minimise the increased risk of anaphylactic reactions to NMBAs, pholcodine-containing medicines are being withdrawn from the UK market and will therefore no longer be available in pharmacies.”

The MHRA said that all pholcodine-containing medicines are “pharmacy-only medicines” which means they will have only been sold or dispensed under the supervision of a suitably trained healthcare professional.

‘Check to see if any contain pholcodine’

Healthcare workers have been told to stop supplying the products “immediately” and return stocks to the manufacturer.

Prof Penny Ward, independent pharmaceutical physician, and Visiting Professor in Pharmaceutical Medicine at King’s College London, said: “Anyone that has any cough or cold remedies in their medicine cupboard should check to see if any contain pholcodine and if so get rid of them.  

“Anyone that has taken a cough or cold remedy recently and is going to have a general anaesthetic should tell the doctor/nurse that they might have taken pholcodine – this also applies if the cough medicine was taken anytime within 12 months prior to an anaesthetic procedure in the future.”

“Although pholcodine is effective in suppressing cough, most illnesses causing coughs will recover, even if not treated, within one to two weeks and other medicines which can soothe a cough are available if needed.” 

Professor Claire Anderson, Royal Pharmaceutical President said: “All products containing the cough suppressant pholcodine have been withdrawn due to concerns of its potential to cause a severe allergic reaction in some people having general anaesthesia for surgery.

“If you are taking a cough medicine (including tablets and syrups), check the packaging, label or Patient Information Leaflet to see if pholcodine is a listed ingredient – if it is, and you have any questions, you can talk to your pharmacist who can suggest a different medicine suitable for you.”

‘Range of alternative products available’

She added:  “A cough usually clears up within three to four weeks. You can treat it with other cough medicines or hot lemon and honey (not suitable for babies under one year old). Rest up if possible and you can try paracetamol or ibuprofen, if suitable, to treat any pain. If your cough persists for longer than three to four weeks seek advice from a healthcare professional.”

Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said: “Pharmacies across the UK take patient safety very seriously and will be assisting with the recall of these products. Patients with coughs and colds should contact their local pharmacy for the best advice about the range of alternative products available.”

Michelle Riddalls, chief executive of the Proprietary Association of Great Britain (PAGB), the trade association for manufacturers of over-the-counter medicines, said: “We and our members put an absolute priority on patient safety. The risk in people who have used pholcodine is extremely small and the MHRA has taken this decision as a precaution.

“This precautionary measure is an example of the robust safety measures that we have in place in the UK working effectively.

“Pholcodine-containing products have only been available for purchase in pharmacies and if people have any questions pharmacists are well placed to give advice and recommend alternative products.”

Dr Russell Perkins, Vice President of the Royal College of Anaesthetists, said medics would try to avoid use of muscle relaxants on patients with a history of taking pholcodine, but said they would have to “balance the risks and benefits”.

Some procedures - particularly emergency abdominal operations - require the use of relaxants. 

The MHRA is already reviewing the safety of another group of over-the-counter medicines, including Sudafed and Day Nurse, which contain pseudoephedrine, amid concern about links to rare brain disorders.

It came after the European Medicines Agency (EMA) launched a review, following concerns over the risk of two conditions that affect blood vessels in the brain and can cause major and life-threatening complications.

Medicines with pseudoephedrine, which are taken orally, are used to treat nasal congestion resulting from a cold, flu or allergy and work by stimulating nerve endings to release noradrenaline, which causes the blood vessels to constrict.

The drug is contained in a host of over-the-counter medicines, including Sudafed, Day Nurse, Nurofen Cold and Flu and some Benylin products.

The medicines are known to increase the risk of heart conditions and strokes, with restrictions and warnings already included in the medicines’ product information.