Over the Counter Medication

By Adrienne Harmel, CPNP

The heat is officially on at home, which reminds us that we are entering cold and flu season. This is a time of year when all people, but particularly children, frequently come down with runny nose and cough. Most of these illnesses are due to viruses, and we know that healthy children can get 8-12 viral infections every year. Because these illnesses are often viral, they do not respond to antibiotics. So parents often wonder what to do for their child to help him or her feel better. Over the counter cough and cold medications are readily available in any pharmacy, and the instinct is to reach for one or several of these medications to treat the cold symptoms. But is that the best course of action?

Parents may have been told by their health care provider not to use these medications in children below a certain age but many may not have been told why.

Here is a review of what types of medications are available, and how they work, and some of the potential effects of taking too high a dose.

Cough suppressants

(examples: dextromethorphan, benzonatate, codeine)

  • Work by suppressing the cough reflex
  • Symptoms associated with overdose: lethargy, loss of coordination, coma

Decongestants

(examples: pseudoephedrine, phenylephrine, phenylpropanolamine)

  • Work by decreasing swelling in the nasal passages to allow easier breathing
  • Symptoms associated with overdose: high blood pressure, elevated heart rate, reflex low heart rate, seizure, stroke, intracranial bleeding

Antihistamines

(examples: diphenhydramine, chlorpheniramine, cetirizine, loratadine)

  • Work by suppressing histamine reaction
  • Symptoms associated with overdose: sedation, dry mouth, altered mental status, vision problems, hyperactivity, psychosis, seizures

Expectorants

(example: guaifenesin)

  • Symptoms associated with overdose: minimal concern for toxicity with this medication, side effects include nausea or vomiting.

Alternative medications

  • Zarbees: includes vitamin C, melatonin, zinc, honey, ivy leaf extract
  • Zarbees baby: ivy leaf extract and agave nectar

The big questions are: Do these medications work? And are they safe?

The FDA is responsible to approving medications for use in this country. They are charged with deciding if medications are “generally recognized as safe and effective.”

There is very little research that has been done looking at these medications when given to children. The recommended doses were developed back in 1976, and based on adult research, not on any studies done in children.

Since 1976 the FDA has not conducted or presented any review of evidence on safety or efficacy date for cough and cold medications in young children. Guidelines for dosing in children under 2 still do not exist, hence the instruction to “consult your doctor for dosing under the age of 2” on these medications’ labels.

There have been several studies done in the past 20 years looking at efficacy of these medications in children and none of the studies have shown any benefit. So the bottom line is that we have little to no research in children that says that they are helpful. But some parents may feel that they do in fact help their child. So the next question is…are they safe?

There are serious safety concerns associated with these medications. These drugs are very commonly associated with misuse and incorrect dosing, in part because clear dosing guidelines have not been developed due to lack of research. Over 7000 patients under the age of 12 years go to ER’s in this country every year due to adverse effects related to these medications.