Do not prescribe oral over-the-counter (OTC) decongestants for children with colds
Laura Hufford MD
What to Do – Take Action
OTC cough and cold medications are widely recommended and used throughout the United States by clinicians and patients, respectively. These medications often contain a combination of drugs, depending on the preparation. Pseudoephedrine, a decongestant, is a sympathomimetic agent, thought to reduce nasal congestion by causing vasoconstriction and, thus, decrease nasal and sinus edema. Antihistamines, such as diphenhydramine and brompheniramine, block histamine at the H1 receptor and reduce smooth muscle contraction. An antitussive, dextromethorphan, is an opioid narcotic and acts centrally to raise the threshold for coughing. An expectorant, guaifenesin, reduces stickiness of phlegm and should make secretions easier to cough up. Antipyretics, including acetaminophen and ibuprofen, are often added for fever and pain. Because each OTC preparation includes many of these medications, the parent is at greater risk for giving an overdose if they combine these medications.
In a recent study, 1,519 children were treated at emergency departments for adverse events related to cough and cold medications during 2004. Serious acute reactions included seizures, dysrhythmias, and ischemic cardiac and bowel events. Additionally, a review of coroner reports from two states in children younger than 12 months in 2005 revealed three deaths caused by these medications. The infants were age 1 to 6 months and had pseudoephedrine levels nine to 14 times the levels expected from administering recommended doses to children younger than age 2 years. Additionally, dextromethorphan was detected in the blood of two children and doxylamine in one child. It is unknown if the death was caused by an overdose, interaction of several medications, or related to underlying medical conditions not noted by the coroner.

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