Combination of Caffeine + Cetirizine + Nimesulide + Paracetamol/Acetaminophen + Phenylephrine

The combination of five medicines:

Caffeine, Cetirizine, Nimesulide, Paracetamol and Phenylephrine, which relieves aches and fever associated with cold.

1. Caffeine is a stimulant which decreases sleepiness caused by Cetirizine. Cetirizine is an antiallergic which relieves allergy symptoms like runny nose, watery eyes and sneezing.

2. Nimesulide is a non-steroidal anti-inflammatory drug (NSAID). It works by blocking the release of certain chemical messengers that cause pain and inflammation (redness and swelling).

3. Paracetamol is an analgesic (pain reliever) and an antipyretic (fever reducer) which also blocks the release of certain chemical messengers in the brain that cause pain and fever.

4. Phenylephrine is a decongestant which narrows the small blood vessels providing relief from congestion or stuffiness in the nose.

COMMONSIDE EFFECTS:

Nausea, Diarrhea, Vomiting, Dryness in mouth, Insomnia (difficulty in sleeping), Allergic reaction, Restlessness, Fatigue, Dizziness, Sleepiness, Increased liver enzymes, Headache

PRECAUTIONS:

1. It is preferable to avoid medicines or food that also contain caffeine. Foods like coffee, tea, cola drinks and chocolate should be avoided as they may add to your total caffeine intake. Increased caffeine intake can cause difficulty in sleeping, may experience tremors and/or may have chest discomfort. Also, avoid drinking alcohol (beer, wine, etc) while taking this medicine.

2. Caffeine+Cetirizine+Nimesulide+Paracetamol/Acetaminophen+Phenylephrine may make you feel drowsy or may cause you to fall asleep during your daily activities. Avoid driving a car, operating machinery, working at heights or participating in potentially dangerous activities until you know how the medicine affects you. Inform your doctor if you experience such episodes while taking this medicine..

3. Taking a higher than the recommended dose may not be more effective, rather it may increase the chances of having some serious side effects and toxicity. If you experience increased severity of your symptoms, that are not relieved by the recommended doses, please consult your doctor for re-evaluation.

4. It is not recommended to use Caffeine+Cetirizine+Nimesulide+Paracetamol/Acetaminophen+Phenylephrine if have high blood pressure (hypertension), any underlying serious heart condition or cardio-vascular disorder, any history of stomach ulcers, overactive thyroid (hyperthyroidism). However, it can be taken if advised by the doctor. This medicine should not be used during pregnancy. 

5. The use of Caffeine+Cetirizine+Nimesulide+Paracetamol/Acetaminophen+Phenylephrine should also be avoided if you are taking antidepressant drugs. These drugs, called monoamine oxidase inhibitors (MAOIs), may include phenelzine and isocarboxazid or tricyclic antidepressants like imipramine and amitriptyline.

6. It is not advisable to breastfeed while using Caffeine+Cetirizine+Nimesulide+Paracetamol/Acetaminophen+Phenylephrine. This medicine contains cetirizine, an antihistamine, which can pass into the breast milk and may harm the baby. Inform your doctor that you are breastfeeding if you are advised to take this medicine.

7. Caffeine+Cetirizine+Nimesulide+Paracetamol/Acetaminophen+Phenylephrine contains Paracetamol and Nimesulide. These medicines are known to cause harm to the liver especially in the doses above the recommended level. Also, avoid drinking alcohol while taking this medicine, as it may further increase your risk of liver damage. Use of this medicine should preferably be avoided in patients with the underlying liver disease. Contact your doctor immediately if you notice any early signs and symptoms of liver damage. These symptoms may include fever, rash, loss of appetite, nausea, vomiting, fatigue, stomach pain, dark urine, yellow skin or eyes and abnormal liver enzymes.

8. Caffeine+Cetirizine+Nimesulide+Paracetamol/Acetaminophen+Phenylephrine contains Paracetamol and Nimesulide. These medicines are known to cause harm to the liver especially in the doses above the recommended level. Also, avoid drinking alcohol while taking this medicine, as it may further increase your risk of liver damage. Use of this medicine should preferably be avoided in patients with the underlying liver disease. Contact your doctor immediately if you notice any early signs and symptoms of liver damage. These symptoms may include fever, rash, loss of appetite, nausea, vomiting, fatigue, stomach pain, dark urine, yellow skin or eyes and abnormal liver enzymes.

However, apart from all these serious side effects with Caffeine+Cetirizine+Nimesulide+Paracetamol/Acetaminophen+Phenylephrine are uncommon and rare. Tell your doctor as soon as possible if you notice allergic reactions, skin rash or peeling, mouth ulcers, breathing problems, unexplained bleeding, recurrent fevers or infections, vision disturbances, fast or irregular heartbeat. These side effects are uncommon but may be serious and may need urgent medical attention.