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The Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children
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There is numerous prescription and nonprescription medications currently available for suppression of cough symptoms in children.  There is also reported adverse effects and over dosage associated with giving cough and cold preparations to children.  Patients and parents need to learn about the “lack” of proven antitussive effects and the potential risks of these products.

What is a cough?

•    It is a reflex response to mechanical, chemical, or inflammatory irritation
•    The cough is a physiologic function to clear airways of obstructive or irritating material or to warn of noxious substances breathed in from the air.

In diseases such as asthma, bronchopulmonary dysplasia, cystic fibrosis and a variety of inflammatory conditions, excessive and/or abnormal airway secretions may occur.  The cough reflex helps maintain airway potency by clearing out these secretions.  The clearing of these secretions is essential and may be helped along by chest physiotherapy.  Therefore, cough suppression may adversely affect patients with conditions such as asthma, bronchopulmonary dysplasia and cystic fibrosis by creating a build up of secretions, airway obstruction, secondary infection and hypoxemia.  In other words, the cough is a necessary function for getting rid of excess secretions in some conditions and should not be suppressed with a cough remedy.

Many of the common respiratory conditions in which a cough is present last only a few days.  A cough may also be an expression of airway reactivity or asthma.  These types of cough symptoms can be satisfactorily managed with fluids and increased ambient humidity.  If a cough continues for many days and is persistent, it is usually due to a secondary infection, allergy (including asthma), environmental irritants (cigarette smoke, dust particles) or a foreign body.  The cause of this type of cough should be determined by a health care professional for a long lasting benefit and remedy to the patient.

Antitussive Formulas

Most cough suppressants are mixtures of dextromethorphan or codeine with antihistamines, decongestants, expectorants, and or antipyretics.  Some nonprescription cough medicines substitute diphenhydramine or eucalyptus oil in the place of codeine or dextromethorphan.  Prescription cough medicines may substitute other narcotic agents such as hydrocodone or hydromorphone for codeine and may be more addictive than codeine.  Many of the cough products are also elixirs that contain up to 25% alcohol by volume.

Codeine and dextromethorphan are effective cough suppressants in adults, but similar effectiveness has not been demonstrated in children.  Because there are numerous cough and cold preparations readily available over-the-counter, many people think the medications are safe and effective for their children.  Studies have shown antitussive preparations given to children is not effective and may even be potentially harmful.  

Decongestant (sympathomimetic) components of these mixtures given to children have been associated with:

•    Irritability
•    Restlessness
•    Lethargy
•    Hallucination
•    Hypertension
•    Dystonic reactions

The above reactions may vary with age and disease state.

Why is it possible for these symptoms to occur in children?  

•    The hepatic enzyme system that metabolizes drugs in young children is relatively immature; therefore, the risk of an adverse effect when using these medicines, especially in infants younger than 6 months is greater.  
•    When the decongestant mixtures are combined with other drugs such as acetaminophen, the metabolism and/or toxicity may also be changed and cause the child problems.  
•    In addition, the dosing guidelines for these agents are based on extrapolation from adult data without consideration of a child’s potentially unique metabolism and disposition.

Based upon the studies given us at this time, antitussive preparations provide few positive effects when given to children and may even be potentially harmful.  Indications for their use in children have not been established.

Suppression of cough reflex in many pulmonary airway diseases may be hazardous and contraindicated.  Parents should realize that coughs due to acute viral airway infections are short-lived.  Treatment consists of fluids and humidity.  If you give your child a cough suppressant during this time you may be inviting more serious problems rather than helping the child get rid of a cough.  A cough that last longer than a few days warrants a health care provider evaluation to determine the underlying cause.

Source:  American Academy of Pediatrics

Disclaimer:  These statements have not been evaluated by the Food and Drug Administration.  The information in this article is not intended to diagnose, treat, cure or prevent any disease.  All health concerns should be addressed by a qualified health care professional.

By Connie Limon
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