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| Cough and cold medications are commonly used for children, but limited awareness of their safety risks highlights the need for better understanding. |
| Pediatric poisoning, often from OTC drugs like diphenhydramine and dextromethorphan, is most prevalent in children under 2 years due to caregiver administration errors. |
| Drug interactions, such as those involving dextromethorphan with MAOIs and SSRIs, can also increase toxicity. Understanding these risks is essential for ensuring the safe use of these medications in young patients. |
| Common OTC Medications for CCS |
| The medications like paracetamol, pseudoephedrine, dextromethorphan, CTM, phenylephrine, PPA, guaifenesin, and bromhexine are commonly used for CCS treatment. |
| In many cases, these ingredients are combined into a single medication, with the goal of providing comprehensive relief for multiple symptoms. However, this combination approach can significantly increase the risk of adverse effects, especially if the medication is not used correctly or if a child accidentally ingests a higher dose than recommended. |
| Pediatric Dose and Toxicity Summary |
| Drug |
Usual Pediatric Dose |
Toxic Dose |
Half Life (T ½) |
Toxidromes |
| Acetaminophen |
10–15 mg/kg every 4–6 hrs; max. 75 mg/kg/day |
>200 mg/kg acutely or >150 mg/kg/day for 2 days |
2.6–2.8 hours |
Acute: Hepatic necrosis, metabolic acidosis. Chronic: Nausea, glutathione depletion. |
| Pseudoephedrine |
3–5 mg/kg |
4–5× therapeutic dose |
~3 hours |
Tachycardia, hypertension, psychosis, seizures, intracranial hemorrhage. |
| Dextromethorphan |
5–20 mg every 4 hrs (age-dependent); max. 6 doses/day |
>10 mg/kg |
4.9–6.41 hours |
CNS depression, hallucinations, respiratory failure, serotonin syndrome. |
| CTM |
1–4 mg every 4–6 hrs (age-dependent); max. 24 mg/day |
>10–60 mg/kg |
13.1 hours |
Anticholinergic toxicity: Delirium, hyperthermia, rhabdomyolysis, convulsions. |
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| Key Risk Factors and Recommendations for Safety |
| To minimize the risk of toxicity, healthcare professionals are recommended: |
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Use of single-agent medications over combination products for more accurate dosing |
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Educate parents and caregivers about correct dosing, using calibrated dispensing instruments, and avoiding the use of adult formulations for children. |
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Remind caregivers to avoid combining different medications without professional guidance, as this can lead to unintentional overdoses due to overlapping active ingredients. |
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Monitoring the long-term safety of these medications can help to detect rare or delayed side effects. |
| Conclusion |
| While OTC medications for cough and cold symptoms are commonly used and can provide significant relief, they carry inherent risks that must be carefully managed. The toxicity of these medications, especially in children, requires close attention from healthcare professionals, parents, and caregivers alike. By improving awareness, education, and safety protocols, and by advancing research into safer treatments, we can better protect children from the potential dangers of OTC medications. |
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| LMRC |
| For the use of a Registered Medical Practitioner, Hospital or Laboratory only. |
| Reference: |
| Diantini A, Alfaqeeh M, Permatasari LI, Nurfitriani M, Durotulailah L, Wulandari W, Sitorus TDR, Wilar G, Levita J. Clinical Toxicology of OTC Cough and Cold Pediatric Medications: A Narrative Review. Pediatric Health Med Ther. 2024 Jul 11;15:243-255. doi: 10.2147/PHMT.S468314. PMID: 39011322; PMCID: PMC11249067. Click here to view the original article |
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