Behind the Label: Lemsip Max

By Pat Thomas, 01/02/07 Articles

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As doctors can tell you, the best remedy for colds and flu is the traditional one: rest, warmth, fluids – and time. Drug manufacturers want you to believe otherwise. But, as Pat Thomas reports, pharmaceutical ‘cures’ may be more than just a waste of money

Most of believe there are only four seasons; but actually there is a fifth season that runs from November to February – the cold and flu season. Out of a UK population of 48 million adults aged 16 and older, around 33 million will suffer from at least one cold or a bout of flu annually, so the odds are that at some point you are going to catch a cold. For healthy individuals, the best medicine is rest, warmth and lots of liquids – this combination being the age-old remedy that best facilitates recovery from a cold or flu.

But convenience culture has become as prevalent in over-the-counter (OTC) medicines as it is in food and other
consumables. So, if you do succumb to a cold or flu this winter, there are now literally dozens of OTC remedies that claim to relieve cold and flu symptoms.

However, most have been found – through objective, scientific studies – to be useless. The most popular varieties use a scattergun approach, mixing several different types of ingredients. And the more ingredients, the greater the chance of a variety of side effects, which means that you may ultimately end up substituting one type of symptom for another.

Crucially, people who regularly purchase cold and flu remedies are usually ill when they make their purchases, and this phenomenon, known as the ‘distress factor’, is a real boon to manufacturers. Sick people don’t think, they simply want relief – immediately. They don’t care how it works and they don’t usually care how much it costs. The distress factor, along with continuing government policy that encourages self-medication wherever possible, means that commercial cold and flu remedies are finding happy homes for increased sales not just in pharmacies but also in supermarkets, newsagents, petrol station forecourts and 24-hour convenience stores.

In the UK, the ‘winter remedies’ market – comprised of cold treatments, cough liquids, decongestants and cough/throat lozenges – is worth around £200 million a year; and the Lemsip brand, made by Reckitt Benckiser, is the market leader, with a 12 per cent share of total sales.

Pushing too hard

So, in spite of the fact that nothing you can buy will cure your cold, a huge number of us have succumbed to the hit-it-hard-and-hit-it fast remedies such as the Lemsip ‘Max’ range, which predominate on the pharmacist’s shelves and promise that you can happily continue to work long hours and enjoy a full social life, even if your body is telling you to slow down. As medical and scientific studies have repeatedly shown, the best remedy for the common cold is rest and time; and when you reflexively reach for a product that temporarily suppresses a range of minor but irritating symptoms, you may only end up making things worse.

For instance, Lemsip’s active ingredients may produce quick effects, but in the long run have no real curative value. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, acetaminophen and ibuprofen can relieve pain and lower fever, but may actually increase nasal symptoms. While not strictly an NSAID, the paracetamol in Lemsip Max Cold & Flu Capsules also relieves pain and lowers fever.

The catch, according to a recent study in Nature Immunology, is that mild fevers actually disrupt the ability of viruses that thrive at body temperature to multiply. The influenza virus grows best at a temperature of 34-35°C but poorly, if at all, at temperatures greater than 37°C. So lowering fever with drugs may actually prolong the agony of a cold or flu.

Lemsip’s other active ingredient, phenylephrine hydrochloride, is what is known as a vasoconstrictor – a drug that narrows blood vessels and is associated with higher risk of hypertension (high blood pressure). Other potential side effects, according to the information leaflet, include headache, vomiting and palpitations.

Faking it with colours

Lemsip Max is also choc-full of artificial colours, which may make the product look impressive and give it a strong ‘identity’, but which have no therapeutic value at all.

There are currently more than 100 dyes and colouring agents approved for use in pharmaceutical preparations. This in spite of the fact that exposure to dyes and colorants in medications has been associated with a range of hypersensitivity reactions, including the classic triad of allergic symptoms – asthma, hives and, ironically, rhinitis (a runny nose). These can occur in anyone but can be particularly severe in some people – for instance, the two to 20 per cent of asthmatics who are also aspirin-intolerant. Many synthetic dyes are also potential human carcinogens.

Vegetarians and vegans should note that the so-called ‘inactive ingredients’ magnesium stearate (which has its own potential toxicity, see table opposite) and gelatine are derived from animals, and shellac is derived from insects.

Sidebar: The ingredients

Active ingredients: Paracetamol 500mg, phenylephrine hydrochloride 6.1mg and caffeine 25mg.

Inactive ingredients: starch, croscarmellose sodium, sodium lauryl sulphate, magnesium stearate, talc, gelatin, titanium dioxide (e171), quinoline yellow (e104), patent blue V (e131), erythrosin (e127), shellac, tartrazine (e102), aluminium hydroxide

Paracetamol

Painkiller (analgesic) Used in the treatment of mild to moderate pain and to reduce fever. Paracetamol is liver-toxic in high doses. By reducing fever, it also reduces the body’s ability to naturally fight off cold and flu viruses.