Morning Report

March 30, 2011

OTC Cough and Cold Medications
 More than 800 cough/cold preparations sold in the US
 Include antihistamines, decongestants, antitussives,
expectorants, analgesics or combinations
 Effectiveness for symptom relief has not been
demonstrated in children
 Doses for children under 24 months are not provided
 Combination medications allow for accidental overdose
Antihistamines
 First generation: diphenhydramine, hydroxyzine,
chlorpheniramine, brompheniramine and clemastine
 Second generation: terfenadine, astemizole, loratatine and
cetirizine
 Adverse Effects
 Sedation
 Paradoxic excitability
 Respiratory depression
 Hallucinations
 Tachycardia, heart block, arrhythmia
 Dry mouth, urinary retention, blurred vision
Decongestants
 Pseudoephedrine, phenylephrine and oxymetazoline
 PPA was associated with intracranial hemorrhage and
cardiomyopathy
 Adverse Effects
 Irritability
 Agitation
 Tachycardia, palpitations, dysrhythmias
 Dystonic reactions
 Seizures
Antitussives
 Narcotic and nonnarcotic cough medications
 No benefit over placebo in cough suppression
 Adverse Effects
 Apnea
 Nausea
 Vomiting
 Dizziness
 Palpitations
References
 Gunn et al. Toxicity of Over-the-Counter Cough and Cold
Medications. Pediatrics. 2001; 108: E52.
 Kelly, Leslee. Pediatric Cough and Cold Preparations.
Pediatr. Rev. 2004;25:115-123.
 Paul et al. Effect of Dextromethorphan, Diphenhydramine
and Placebo on Nocturnal Cough and Sleep Quality for
Cough Children and Their Parents. Pediatrics.
2004;114:85-90.