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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; 15:243-255. [PMID: 39011322 PMCID: PMC11249067 DOI: 10.2147/phmt.s468314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024] Open
Abstract
Cough and cold symptoms (CCS) are common pediatric conditions often treated with over-the-counter (OTC) medications. However, the available knowledge regarding the safety and toxicity of these medications in children is inadequate. Therefore, understanding their clinical toxicology is crucial for safeguarding children's well-being. This narrative review highlights the importance of clinical toxicology in evaluating the safety and toxicity profile of OTC medications for treating CCS in pediatric patients. The pharmacology, clinical features, and adverse effects of various drug classes commonly found in cough and cold medications are briefly discussed. Pharmacokinetic and pharmacodynamic parameters are also examined to understand the interactions between these drugs and the body. OTC cough and cold medications often contain active ingredients such as antihistamines, decongestants, antitussives, expectorants, and analgesics-antipyretics. The combination of multiple ingredients in these products significantly increases the risk of adverse effects and unintentional overdoses. Several case studies have reported significant toxicity and even fatalities associated with the use of these medications in children. This review underscores the critical importance of clinical toxicology in evaluating the safety and toxicity profile of OTC medications employed for treating CCS in pediatric patients. The findings highlight the significance of informed clinical practice and public health policies to ensure the well-being of children using OTC cough and cold medications.
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Affiliation(s)
- Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran. University, Sumedang, West Java, 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Mohammed Alfaqeeh
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Lanny Indah Permatasari
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Mirna Nurfitriani
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Lela Durotulailah
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Wening Wulandari
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Truly Deti Rose Sitorus
- Department of Pharmacology and Therapy, Faculty of Medicine, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Gofarana Wilar
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran. University, Sumedang, West Java, 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Jutti Levita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran. University, Sumedang, West Java, 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
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Gill PJ, Onakpoya IJ, Buchanan F, Birnie KA, Van den Bruel A. Treatments for cough and common cold in children. BMJ 2024; 384:e075306. [PMID: 38272497 DOI: 10.1136/bmj-2023-075306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Peter J Gill
- The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Igho J Onakpoya
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary
- Alberta Children's Hospital Research Institute, Calgary
| | - Ann Van den Bruel
- Academic Centre for Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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Lovegrove MC, Weidle NJ, Geller AI, Lind JN, Rose KO, Goring SK, Budnitz DS. Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures. Am J Prev Med 2023; 64:834-843. [PMID: 37210158 PMCID: PMC10935594 DOI: 10.1016/j.amepre.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Emergency department visits and hospitalizations for unsupervised medication exposures among young children increased in the early 2000s. Prevention efforts were initiated in response. METHODS Nationally representative data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project collected from 2009 to 2020 were analyzed in 2022 to assess overall and medication-specific trends in emergency department visits for unsupervised exposures among children aged ≤5 years. RESULTS From 2009 to 2020, there were an estimated 677,968 (95% CI=550,089, 805,846) emergency department visits for unsupervised medication exposures among children aged ≤5 years in the U.S. Most visits involved children aged 1-2 years (2009-2012 [70.3%], 2017-2020 [67.4%]), and nearly one half involved prescription solid medications (2009-2012 [49.4%], 2017-2020 [48.1%]). The largest declines in estimated numbers of annual visits from 2009-2012 to 2017-2020 were for exposures involving prescription solid benzodiazepines (-2,636 visits, -72.0%) and opioids (-2,596 visits, -53.6%) and over-the-counter liquid cough and cold medications (-1,954 visits, -71.6%) and acetaminophen (-1,418 visits, -53.4%). The estimated number of annual visits increased for exposures involving over-the-counter solid herbal/alternative remedies (+1,028 visits, +65.6%), with the largest increase for melatonin exposures (+1,440 visits, +421.1%). Overall, the estimated number of visits for unsupervised medication exposures decreased from 66,416 in 2009 to 36,564 in 2020 (annual percentage change= -6.0%). Emergent hospitalizations for unsupervised exposures also declined (annual percentage change= -4.5%). CONCLUSIONS Declines in estimated emergency department visits and hospitalizations for unsupervised medication exposures from 2009 to 2020 coincided with renewed prevention efforts. Targeted approaches may be needed to achieve continued declines in unsupervised medication exposures among young children.
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Affiliation(s)
- Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Nina J Weidle
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Eagle Global Scientific, LLC, Atlanta, Georgia
| | - Andrew I Geller
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer N Lind
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen O Rose
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Chenega Enterprise Systems and Solutions, Atlanta, Georgia
| | - Sandra K Goring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Chenega Enterprise Systems and Solutions, Atlanta, Georgia
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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