J Collis Browne's mixture (Morphine, peppermint oil)
How does it work?
J Collis Browne's mixture contains two active ingredients, anhydrous morphine and peppermint oil.
Morphine hydrochloride is a type of medicine called an opioid. In high doses it is a strong painkiller, but it also has cough suppressant and anti-diarrhoeal actions. This medicine contains a low dose of morphine that is not a painkiller and is used purely for its anti-diarrhoeal or cough suppressant effect.
In treating cough, morphine works by reducing the nerve signals sent from a part of the brain called the coughing centre to the muscles that produce coughing. Coughing is a reflex response to irritation of the airways. It is useful for clearing mucus, dust and other particles from the throat and lungs. It is important because it reduces the amount of mucus, dust and bacteria in the airways that would otherwise make breathing difficult. However, sometimes, coughing can become overstimulated even when there is no mucus to clear from the lungs or throat. In this situation coughing serves no purpose and can become painful and frustrating. This medicine can be used to block the cough reflex in situations where the cough serves no purpose, ie when no plegm is being coughed up.
In treating diarrhoea, morphine works by acting on opioid receptors that are found in the muscles lining the walls of the intestines. This reduces the muscular contractions of the intestine (called peristalsis) that move food and faecal matter through the gut. The speed at which the gut contents are pushed through the intestines is therefore reduced, allowing more time for water and electrolytes to be reabsorbed from the gut contents back into the body. This results in firmer stools that are passed less frequently.
Peppermint oil acts directly on the smooth muscle in the bowel wall, causing it to relax. By relaxing the gut, painful spasms in the bowel are reduced.
What is it used for?
- Dry, irritating, unproductive cough.
- If you have any of the following symptoms with a cough you should not take this medicine and consult your doctor so that the cough can be investigated further: coughing up phlegm that is green, rusty brown, yellow, blood-stained or foul smelling; shortness of breath, wheezing or difficulty breathing; chest pain; pain and swelling in the calf; sudden weight loss; recurrent night-time cough; or a long-term persistent cough.
- If any of the following apply to your diarrhoea you should not take this medicine and consult a doctor instead: if your diarrhoea started either during or after taking a course of antibiotics, if the diarrhoea contains yellow or greenish mucus or blood, or if you also have a fever.
- Acute diarrhoea makes you lose more fluids and salt than you usually would and can make you dehydrated. This medicine only treats the diarrhoea symptoms and so will not rehydrate you. You should ensure that you drink plenty of fluids, and you may also want to take an oral rehydration therapy, which is a soluble powder containing sugars and salts, to help rehydrate you. This is particularly important for frail and elderly people and children. Rehydration salts can be bought from pharmacies.
- This medicine may cause drowsiness. If affected do not drive or operate machinery. Alcohol should be avoided.
- Do not exceed the recommended dose of this medicine, which will be stated in the product packaging or information leaflet supplied with the medicine.
- If symptoms persist after 48 hours of treatment seek medical advice from your doctor or pharmacist.
- With prolonged use, the body may become dependent on the morphine in this medicine. As a result, when you then stop taking the medicine you may get withdrawal symptoms such as restlessness and irritability. If you find you need to use this medicine all the time you should consult your doctor for advice.
- Travellers wanting to take this medicine abroad may require a doctor's letter explaining why the medicine is necessary.
Use with caution in
- Elderly or weak people.
- Decreased kidney function.
- Decreased liver function.
- Chronic obstructive pulmonary disease (COPD).
- Condition called bronchiectasis, in which there is persistent widening of the airways as a result of lung disease, eg infection, inflammation, tumours or cystic fibrosis.
- Enlarged prostate gland (prostatic hypertrophy).
- Underactive thyroid gland (hypothyroidism).
- Low blood pressure (hypotension).
- Biliary tract disorders, eg recent surgery on the biliary tract.
- History of drug abuse or dependence.
Not to be used in
- Children under six years of age.
- Diarrhoea caused by inflammation of the bowel associated with antibiotic use (antibiotic-associated colitis).
- Diarrhoea associated with acute attacks of ulcerative colitis.
- Conditions where preventing gut movement should be avoided, such as constipation, obstruction of the intestines (ileus) or when abdominal swelling (distension) develops.
- Paralysis or inactivity in the intestines that prevents material moving through the gut (paralytic ileus).
- Slow, shallow breathing (respiratory depression).
- People having an asthma attack.
- Alcohol intoxication (acute alcoholism).
- People with raised pressure inside the skull (intracranial pressure).
- People with a head injury.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine for use during pregnancy and breastfeeding has not been established. If you are pregnant or breastfeeding you should seek medical advice from your doctor before taking this medicine. It should only be used with caution, and only if the expected benefit to the mother outweighs any potential risk to the infant.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
- Nausea and vomiting.
- Difficulty passing urine.
- Dry mouth.
- Facial flushing.
- Sensation of spinning.
- Skin rashes.
- Changes in heart rate.
- Awareness of your heartbeat (palpitations).
- Low blood pressure (hypotension).
- Contracted (pinpoint) pupils.
- Changes in mood.
- False perceptions of things that are not really there (hallucinations).
- Decreased sex drive.
- Dependence on the medicine if used for prolonged amounts of time.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you take this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
This medicine should not be used by people who are currently taking a monoamine oxidase inhibitor antidepressant (MAOI), eg phenelzine, tranylcypromine, isocarboxazid or moclobemide, or who have taken one of these medicines in the last 14 days.
This medicine may cause drowsiness. If this occurs, it may be made worse if the medicine is taken in combination with any of the following, which can also cause drowsiness:
- antipsychotics, eg haloperidol, chlorpromazine
- barbiturates, eg phenobarbital, amobarbital
- benzodiazepines, eg temazepam, diazepam
- opioid painkillers, eg dihydrocodeine, codeine, morphine
- sedating antihistamines, eg chlorphenamine, promethazine, triprolidine, hydroxyzine (some of these may be found in non-prescription cough and cold or hayfever remedies)
- sleeping tablets, eg zopiclone
- tricyclic antidepressants, eg amitriptyline.
Morphine can reduce the muscular activity in the gut and so may oppose the effect of the following medicines on the gut:
There may be an increased risk of breathing difficulties if cimetidine is taken with morphine.
Other medicines containing the same active ingredients
There are currently no other medicines available in the UK that contain this combination of active ingredients.