Behind the label: Lemsip Max Cold & Flu Capsules

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

INGREDIENTS: Paracetamol, sodium lauryl sulphate, croscarmelose sodium, titanium dioxide (E171), quinoline yelow (E104), patent blue V (E131), erythrosin (E127), tartrazine (E102), phenylephrine hydrochloride, magnesium stearate, caffeine, aluminium hydroxide

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.


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.

Sodium lauryl sulphate: Disintegrator, surfactant. Promotes the breakup of the capsule contents in the body. The same substance is commonly found in shampoos, foaming bath products and washing-up liquids. It has been shown to build up in the heart, liver and brain of experimental animals.

Croscarmelose sodium: Disintegrator. Promotes breakup of the capsule contents in the body and brings the ingredients into better contact with bodily fluids and improves their bioavailability. Widely used but poorly studied in respect of its cancer-causing, mutagenic, teratogenic or reproductive effects.

Titanium dioxide (E171), quinoline yelow (E104), patent blue V (E131), erythrosin (E127), tartrazine (E102): Synthetic colours. Tartrazine is known to provoke asthma attacks and skin rashes, altered states of perception and behaviour and hyperactivity. Quinoline yellow may cause asthma, rashes and hyperactivity. Aspirin-sensitive people should avoid it. Erythrosin is an iodine-containing dye linked with sensitivity to light and learning difficulties; it can increase thyroid hormone levels and lead to hyperthyroidism, and was shown to cause thyroid cancer in rats. Patent Blue V is linked with dermatitis and purpurea.

Phenylephrine hydrochloride: Nasal decongestant, vasoconstrictor. It works by triggering the contraction of blood vessels in the walls of the mucous membranes in the nose and sinuses. With less fluid travelling through the mucous membranes, the production of mucus is also reduced. Vasoconstrictors like this are associated with high blood pressure, angina and arrhythmias. They also affect the central nervous system, causing headache, excitability, restlessness and tremors. Phenylephrine may also induce skin rashes and is a potential reproductive toxin.

Magnesium stearate: Anti-caking substance. Frequently used in high-volume manufacturing processes to speed the flow of ingredients through the machinery. It is a hydrogenated fat that may impede the absorption of certain nutrients and can interfere with liver function and the body’s immune response.

Caffeine: Stimulant. Claimed to enhance the painkilling effects of paracetamol. It has no therapeutic value on its own. In high doses, caffeine is addictive, can reduce adrenal function and the body’s immune response. If taken close to bedtime it may interfere with sleep.

Aluminium hydroxide: Stabiliser, preservative. Can cause constipation and occasionally skin allergy. Leeches calcium and phosphorous from the body and interferes with absorption of folic acid. Neurotoxic. Used as a preservative in vaccines, aluminium hydroxide has been linked to symptoms associated with Parkinson's, amyotrophic lateral sclerosis (ALS), and Alzheimer’s Disease.

This article first appeared in the Ecologist April 2007

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