Cough and cold medicines don’t work

Health authorities are reporting that commonly-used cough and cold medications are not safe and are not effective. Since colds are so common and affect all of our children at least a few times a year, parents ask me every day about the new guidelines, and about the safest ways to help their children feel better.

First, some details. The medications that are commonly suggested to relieve the symptoms of the common cold fall into just a few groups. Within each group, the available choices are all essentially the same. Often, medications from several groups are combined to make what is optimistically sold as a “multisymptom cold reliever.”

Decongestants include products with the active ingredients pseudoephedrine and phenylephrine. They are supposed to work by shrinking the lining of the nose and decreasing nasal mucus secretions. Decongestants also raise a child’s heart rate and blood pressure, and may cause hyperactivity, agitation, and sleeplessness. Good studies have never shown decongestants to be effective in children, and even in adults their clinical effect is probably very small.

Cough suppressants are another group of medications purchased to help with the symptoms of the common cold. The most widely used over-the-counter product, dextromethorphan, has become a drug of abuse among young adults. Good studies have never shown that dextromethorphan is effective in stopping a cough; in fact, a recent study showed that in children, honey may be just as good or better than this medication. There are some prescription-strength cough suppressants as well. These are usually narcotics with strong sedating effects and some potential for abuse and addiction. Even these potent drugs, with all of their side effects, are very effective at actually helping a child who has a cough.

Antihistamines can certainly help with symptoms of nasal allergy, and are often used for colds as well. If you’re not sure if your child has allergies or a cold, a safe dose of an antihistamine may be worth trying. But it won’t help if your child’s runny nose is caused by a cold. Some families may find that the sedating effect of antihistamines can allow better sleep, at least for the parents. Newer, non-sedating antihistamines like Claritin and Zyrtec are expensive and offer no benefit whatsoever to children with the common cold.

Expectorant medications include those with the active ingredient “guaifenesin”, sold under the brand name Robitussin. These are supposed to thin secretions and help clear mucus. Unfortunately, no studies have ever shown that these medications actually work; and the liquid forms taste horrible. Among the medications reviewed so far, expectorants are the least likely to cause any side effects. Even though they’re unlikely to be effective, at least they’re safe enough to be worth trying in some cases.

The medicines reviewed so far—decongestants, cough suppressants, antihistamines, and expectorants—are collectively called “cold medicines.” They’re combined in all sorts of ways in products marketed to children, including common brands like Dimetapp, Triaminic, Pediacare, and many others. These are the medications that have generated some increased controversy over the last years because of questions of their safety and effectiveness, and the way they’re marketed to children.

In 2004 and 2005, about 1500 children less than two years of age were treated for adverse events triggered by cold medications. While many of these reactions were mild, more serious reactions including seizures, stroke, and death have occurred. Though industry representatives feel confident that these more severe reactions are not possible if the medications are dosed correctly, safe doses of these medications are not well-established or agreed upon by pharmacists and pediatricians.

In August, 2007 an FDA advisory panel recommended that cold medications not be used under age six, citing both a lack of evidence that they work and concerns about their safety under age two. Shortly after that, several large manufacturers of these products voluntarily recalled cold medications that were packaged for use in babies and toddlers. In January, 2008, the FDA formally announced that they advised against the use of these products under age two, and that later this year they will make recommendations for older children.

So what can a parent do to help the miserable symptoms of the common cold in a child? First, several non-medicine approaches can really help. Frequent use of non-medicated saltwater (also called saline) drops can help clear mucus from the nose and is safe at any age. You can buy these drops over-the-counter, or mix them up inexpensively yourself. Other methods to keep nasal secretions runny and loose will also help. Encourage a child to drink more fluids, use a humidifier, and sit together in a steamy bathroom. Honey can be used safely in children past their first birthday to help settle a child’s cough. (Honey should never be given to infants less than one year of age.) Though these are many other alternative or “natural” medicines that are marketed for children with cold symptoms, many of these have unknown safety and effectiveness. If you’re interested, we can cover more details about these products in a future post.

Medicines that reduce fever and relieve aches and pains are safe and effective, and can help with some of the symptoms of a cold. These include acetaminophen (found in Tylenol, and safe at any age), and ibuprofen (found in Motrin and Advil, and safe for use in babies six months and up.) Confirm the correct dose for these based on your child’s weight with your pediatrician.

In summary, many of the medications commonly sold to reduce symptoms of the common cold just don’t work, and they can be unsafe especially if used under age two. To help your child feel better, rely on simple home remedies that thin secretions and help clear out stuffy noses. If you do want to use a medication, follow the dosing guidelines of your pediatrician or pharmacist closely, and always keep medicine bottles away from children. As miserable as it can be, a cold is going to get better all on its own. It’s not worth it to use approaches that might lead to far more serious consequences than a cold itself.

© 2008 Roy Benaroch, MD from www.PediatricInsider.com

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Tags: cold, common cold, cough, decongestant, expectorant, medicine, suppressant, symtoms, upper respiratory infection, uri

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