Managing Cold and Flu Presentations in Community Pharmacy: Supporting Symptom Relief Day and Night

Sponsored Editorial in association with BENYLIN®

Community pharmacy remains one of the first points of contact for patients seeking advice and treatment for cough, cold and flu symptoms. During peak seasonal periods, pharmacists are frequently asked to help differentiate symptoms, recommend appropriate treatment options and support patients in managing symptoms effectively while identifying when referral may be required.

For many patients, the challenge of cold and flu management extends beyond symptom control alone. Today’s busy lifestyles mean many people continue to work, care for families and maintain daily responsibilities while managing symptoms. Pharmacists therefore play an important role in helping patients select treatment options that fit both their symptom profile and lifestyle needs.

Understanding Common Presentations

While cold and flu symptoms frequently overlap, influenza often presents with a more sudden onset and greater severity. Common symptoms include:

  • Fever
  • Headache
  • Muscle aches
  • Fatigue
  • Nasal congestion
  • Sore throat
  • Cough

Cold symptoms are generally milder and often develop more gradually. Patients frequently seek pharmacy advice for symptom combinations rather than isolated complaints, creating a need for treatments that address multiple symptoms simultaneously.

A structured consultation remains essential. Approaches such as WWHAM help pharmacists assess:

  • Who the medicine is for
  • What symptoms are present
  • How long symptoms have persisted
  • Any action already taken
  • Current medications or medical conditions

This allows pharmacists to identify red flags, contraindications and determine whether self-care or referral is appropriate.

Tailoring Treatment to Daily Symptom Burden

Symptom severity often changes throughout the day. Nasal congestion and fever may impact concentration, productivity and routine activities during waking hours, while night-time symptoms can significantly disrupt sleep quality.

Sleep disturbance associated with cold and flu can contribute to fatigue and affect recovery. As a result, symptom management strategies that acknowledge differences between day and night symptoms may help improve patient comfort and support recovery.

Combination products can be particularly useful for patients experiencing multiple symptoms simultaneously and seeking practical symptom relief throughout the day and night.

BENYLIN® DAY & NIGHT Tablets are currently the only cold and flu remedy offering 24-hour relief with tablets specifically designed for both Day and Night use.

The dual formulation allows symptom management to be tailored according to the patient’s needs throughout the course of the day.

Day Tablets (White)

Each white tablet contains:

  • Paracetamol 500mg
  • Pseudoephedrine hydrochloride 60mg

The daytime formulation is designed to relieve fever and help decongest the nose, helping patients continue with their normal daily activities while managing symptoms.

Pseudoephedrine acts as a nasal decongestant by reducing swelling within nasal passages, while paracetamol provides analgesic and antipyretic effects.

Night Tablets (Blue)

Each blue tablet contains:

  • Paracetamol 500mg
  • Diphenhydramine hydrochloride 25mg

The night time formulation contain paracetamol and diphenhydramine hydrochloride (an antihistamine which helps clear catarrh and so aids sleep) and are for night time use only.

Each BENYLIN® DAY & NIGHT pack contains:

  • 12 Day tablets
  • 4 Night tablets

The colour-coded packaging provides a clear visual distinction between formulations, helping support correct patient use.

Supporting Appropriate Recommendations

As with all OTC cold and flu products, pharmacists should assess suitability carefully. Pseudoephedrine-containing products may not be suitable for all patients, particularly those with:

  • Hypertension
  • Cardiovascular disease
  • Hyperthyroidism
  • Certain concomitant medications

Similarly, sedating antihistamines such as diphenhydramine require counselling regarding drowsiness and avoidance of driving or operating machinery if affected.

Pharmacists should also reinforce the importance of avoiding duplication with other paracetamol-containing medicines.

Always review the full product label when considering any recommendation to ensure it is suitable for the specific patient.

The Role of Pharmacy in Self-Care

Community pharmacists continue to play a central role in supporting self-care and helping patients navigate a crowded OTC market. Effective consultations not only ensure appropriate product selection but also provide reassurance, education and advice regarding symptom expectations and when medical referral may be necessary.

For consumers seeking practical symptom relief that reflects the realities of modern life, treatment options that recognise differing daytime and night-time needs may offer additional convenience and support.

BENYLIN® DAY & NIGHT forms part of the wider BENYLIN® portfolio, including BENYLIN® Cough Range and BENYLIN® Cold & Flu Range, supporting pharmacists in delivering tailored recommendations across a variety of patient presentations.

Benylin Dry Coughs Syrup, Benylin Non-Drowsy Dry Coughs Syrup, Benylin Children’s’ Chesty Cough Syrup, Benylin Children’s Dry Cough Syrup, Benylin Mucus Cough Honey & Lemon Syrup, Benylin 4 Flu Tablets: MAH: JNTL Consumer Health I (Ireland) Ltd. Block 5, Hight Street, Tallaght, Dublin 24, Ireland. Full prescribing information available upon request. Products not subject to medical prescription. Supply through pharmacies only.

Benylin Non-Drowsy Chesty Coughs, Benylin Mucus Cough Syrup, Benylin Mucus Cough Menthol Oral Solution: MAH: JNTL Consumer Health I (Ireland) Ltd. Block 5, Hight Street, Tallaght, Dublin 24, Ireland. Full prescribing information available upon request. Products not subject to medical prescription. Supply through pharmacies and non-pharmacy outlets only

Benylin Day & Night Tablets, 500mg/60mg tablets and 500/25mg film-coated Tablets. Composition: Each white (day) tablet contains Paracetamol 500 mg, Pseudoephedrine Hydrochloride 60 mg. Each blue (night) tablet contains Paracetamol 500 mg Diphenhydramine Hydrochloride 25 mg. Indications: For the short-term symptomatic treatment of nasal and sinus congestion associated with daytime symptoms of cold and flu such as pain, headache and/or fever when in combination with bedtime symptoms which are causing difficulty in getting to sleep. Dosage: Adults and Adolescents over 15 years: Four tablets should be taken daily. One white tablet to be taken every 4 to 6 hours during the day (one tablet in the morning, at midday and in the afternoon). Do not take more than 3 white day-time tablets in 24 hours. One blue tablet to be taken at night. Do not take the night-time tablets during the day. Patients should consult their doctor or pharmacist if symptoms persist for more than 3 days or worsen. Children and adolescents under 15 years. Not recommended for children and adolescents under 15 years. Elderly: Experience has indicated that normal adult dosage is usually appropriate. However, in frail, immobile, elderly subjects or in elderly patients with renal or hepatic impairment, a reduction in the amount or frequency of dosing may be appropriate. The maximum daily dose should not exceed 60mg/kg/day (up to a maximum of 2g paracetamol per day) in the following situations, unless directed by a physician: Weight less than 50kg; Chronic alcoholism; Dehydration; Chronic malnutrition. Hepatic impairment: In patients with hepatic impairment or Gilbert’s Syndrome, the dose should be reduced or the dosing interval prolonged. The daily dose should not exceed 2g paracetamol/day unless directed by a physician. Renal impairment: Caution should be exercised when administering Benylin Day & Night to patients with mild to moderate renal impairment. It is recommended, when giving paracetamol to patients with renal impairment, to reduce the dose and to increase the minimum interval between each administration to at least 6 hours unless directed otherwise by a physician. Recommended Dose for Adults with Renal Impairment: Glomerular filtration rate10-50 ml/min: 500 mg every 6 hours. Glomerular filtration rate <10ml/min: 500 mg every 8 hours: Contraindications: contraindicated in patients with: Hypersensitivity to paracetamol, pseudoephedrine, diphenhydramine or any of the excipients. Concomitant use of other sympathomimetic decongestants, beta-blockers or monoamine oxidase inhibitors (MAOIs), or within 14 days of stopping MAOI treatment. The concomitant use of MAOIs may cause a rise in blood pressure and/or hypertensive crisis. Cardiovascular disease including hypertension. Diabetes mellitus. Phaeochromocytoma, Hyperthyroidism, Severe renal impairment, Urinary retention in patients at risk of developing respiratory failure, Severe acute or chronic kidney disease /renal failure. Special warnings and precautions for use: Paracetamol should be administered with caution under the following circumstances: Hepatic impairment; Chronic alcoholism; Renal impairment (GFR ≤ 50ml/min); Gilberts syndrome (familial non-haemolytic jaundice); Concomitant treatment with medicinal products affecting hepatic function; Glucose-6-phosphate dehydrogenase deficiency; Haemolytic anaemia; Glutathione deficiency; Dehydration; Chronic malnutrition; Weight less than 50kg; Elderly patients. Hepatotoxicity at therapeutic dose of paracetamol. Cases of paracetamol induced hepatotoxicity, including fatal cases, have been reported in patients taking paracetamol at doses within the therapeutic range. These cases were reported in patients with one or more risk factors for hepatotoxicity including low body weight (<50 Kg), renal and hepatic impairment, chronic alcoholism, concomitant intake of hepatotoxic drugs and in acute and chronic malnutrition (low reserves of hepatic glutathione). Paracetamol should be administered with caution to patients with these risk factors. Caution is also advised in patients on concomitant treatment with drugs that induce hepatic enzymes and in conditions which may predispose to glutathione deficiency. Doses of paracetamol should be reviewed at clinically appropriate intervals and patients should be monitored for emergence of new risk factors for hepatotoxicity which may warrant dosage adjustment. Prolonged or frequent use is discouraged. Paracetamol overdose warning: Taking more than the recommended dose (overdose) may result in severe liver damage. In case of overdose, medical help should be sought immediately. Urgent medical attention is critical for adults as well as for children even if you do not notice any signs or symptoms. Patients should be advised not to take other paracetamol-containing products concurrently. Taking multiple daily doses in one administration can severely damage the liver. In such cases, medical assistance should be sought immediately. Caution should be exercised when using the product in the presence of severe hepatic impairment or moderate to severe renal impairment (particularly if accompanied by cardiovascular disease). The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease. Patients with hepatic disease should consult a doctor before use. Alcohol Warning: Chronic alcohol users should ask their physician whether they should take paracetamol. In general, medicinal products contains paracetamol should be taken for only a few days without the advice of a physician or dentist and not at high doses. If high fever or signs of secondary infection occur or if symptoms persist for longer than 3 days, a physician should be consulted. Hypersensitivity reactions, including skin rashes, angioedema and anaphylaxis have been reported very rarely with paracetamol (see Section 4.8). Serious skin reactions such as acute generalised exanthematous pustulosis (AGEP), Stevens-Johnson syndrome (SJS), Toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) have been reported very rarely in patients receiving paracetamol. Patients should be informed about the signs of serious skin reactions and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Ischaemic colitis: Some cases of ischaemic colitis have been reported with pseudoephedrine. Pseudoephedrine should be discontinued and medical advice sought if sudden abdominal pain, rectal bleeding or other symptoms of ischaemic colitis develop. Severe skin reactions such as acute generalized exanthematous pustulosis (AGEP) may occur with pseudoephedrine-containing products. This acute pustular eruption may occur within the first 2 days of treatment, with fever, and numerous, small, mostly non-follicular pustules arising on a widespread oedematous erythema and mainly localized on the skin folds, trunk, and upper extremities. Patients should be carefully monitored. If signs and symptoms such as pyrexia, erythema, or many small pustules are observed, administration of this medicine should be discontinued and appropriate measures taken if needed. Ischaemic optic neuropathy: Cases of ischaemic opticneuropathy have been reported with pseudoephedrine. Pseudoephedrine should be discontinued if sudden loss of vision or decreased visual acuity such as scotoma occurs. Although pseudoephedrine has virtually no pressor effects in normotensive patients, this medicine should be used with caution in patients taking antihypertensive agents, tricyclic antidepressants or other sympathomimetic agents (such as appetite suppressants and amphetamine-like psychostimulants). The effects of a single dose on the blood pressure of these patients should be observed before recommending repeated or unsupervised treatment. Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). Cases of PRES and RCVS have been reported with the use of pseudoephedrine containing products. The risk is increased in patients with severe or uncontrolled hypertension, or with severe acute or chronic kidney disease/renal failure. Pseudoephedrine should be discontinued and immediate medical assistance sought if the following symptoms occur: sudden severe headache or thunderclap headache, nausea, vomiting, confusion, seizures and/or visual disturbances. Most reported cases of PRES and RCVS resolved following discontinuation and appropriate treatment. This product is contraindicated for use in patients with pre-existing cardiovascular disease, particularly those with coronary heart disease and hypertension (see section 4.3). This product is contraindicated for use in patients with thyroid disease, diabetes, glaucoma and, severe renal impairment. Patients with difficulty in urination and/or enlargement of the prostate, should be advised to consult a physician before using pseudoephedrine. This product may act as a cerebral stimulant giving rise to hyperpyrexia, tremor and epileptiform convulsions. Care should be taken when used in epileptic patients. If any of the following occur, this product should be stopped: Hallucinations; Restlessness; Sleep disturbances. Use with caution in occlusive vascular disease. Pseudoephedrine may induce positive results in certain anti-doping tests. Risks of abuse: Pseudoephedrine carries the risk of abuse. Increased doses may ultimately produce toxicity. Continuous use can lead to tolerance resulting in an increased risk of overdosing. The recommended maximum dose and treatment duration should not be exceeded. Diphenhydramine may enhance the sedative effects of central nervous system depressants including alcohol, sedatives, and tranquilizers. While taking this product, avoid alcoholic beverages and consult a healthcare professional prior to taking with central nervous system depressants. Patients with the following conditions should be advised to consult a physician before using diphenhydramine: a respiratory condition such as emphysema, chronic bronchitis, or acute or chronic bronchial asthma; prostate hyperplasia with urinary retention. Concomitant use of other products containing paracetamol or decongestants with Benylin Day & Night could lead to overdosage and should, therefore, be avoided. Night time tablets only: May cause drowsiness. Patients should be advised not to drive or operate machinery if affected. Alcoholic drink should be avoided. Night time tablets only: Patients should be advised not to use with any other product containing Diphenhydramine. The stated dose should not be exceeded. Use in patients with congenital long QT-syndrome should be avoided. The concurrent use of medicinal products, which also prolong the QT interval or result in hypokalemia should be avoided. Cases of high anion gap metabolic acidosis (HAGMA) due to pyroglutamic acidosis have been reported in patients with severe illness such as severe renal impairment and, sepsis, or in patients with malnutrition or other sources of glutathione deficiency (e.g. chronic alcoholism) who were treated with paracetamol at therapeutic dose for a prolonged period or combination of paracetamol and flucloxacillin. If HAGMA due to pyroglutamic acidosis is suspected, prompt discontinuation of paracetamol and close monitoring is recommended. The measurement of urinary 5-oxoproline may be useful to identify pyroglutamic acidosis as underlying cause of HAGMA in patients with multiple risk factors. Immediate medical advice should be sought in an event of an overdose, even if you feel well. Immediate medical advice should be sought in an event of an overdose, because of the risk of irreversible liver damage. Do not take with any other paracetamol containing products. Do not use with any other product containing diphenhydramine, even one used on skin. Use when only clearly necessary. This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially ‘sodium-free’. If symptoms persist or get worse, or if new symptoms occur, patients should stop use and consult a physician. Undesirable effects: Immune system disorders: Not known Anaphylactic reaction, hypersensitivity. Investigations: Not known Blood pressure increased; transaminases increased. Psychiatric disorders: Not known Anxiety, confusional state, euphoric mood, hallucination, hallucination visual, restlessness, irritability. Nervous system disorders: Not known: Agitation, coordination abnormal, convulsion, headache, paraesthesia, psychomotor hyperactivity, sedation, sleep disturbances, tremor, somnolence, Posterior Reversible Encephalopathy Syndrome, Reversible Cerebral Vasoconstriction Syndrome. Eye disorders: Not known Blurred vision, Ischaemic optic neuropathy. Ear and labyrinth disorders: Not known Tinnitus. Cardiac disorders: Not known Palpitations, tachycardia, arrhythmia, myocardial infarction. Vascular disorders: Not known Hypotension. Respiratory, thoracic and mediastinal disorders: Not known Chest discomfort, dry throat, nasal dryness, dyspnoea. Gastrointestinal disorders: Not known Abdominal pain, constipation, diarrhoea, dyspepsia, vomiting Ischaemic colitis. Skin and subcutaneous tissue disorders: Not known Rash, pruritus, rash pruritic, urticaria, Angiodema, Serious skin reactions, including acute generalised exanthematous pustulosis (AGEP). Renal and urinary disorders: Not known Urinary retention, dysuria. Blood and the lymphatic system disorders: Not known Blood disorders, blood dyscrasias such as thrombocytopenia and agranulocytosis have been reported following paracetamol use but were not necessarily causally related to the drug. Hepato-biliary disorders: Not known Liver dysfunction. Metabolism and nutrition disorders: Not known High anion gap metabolic acidosis. MAH: JNTL Consumer Health I (Ireland) Ltd. Block 5, High Street, Tallaght, Dublin 24, Ireland. MA Number: PA 23490/006/001. Date of revision of text: March 2025. Product not subject to medical prescription. Supply through pharmacies only. Full prescribing information available upon request