It is very easy to buy medication over the counter at your pharmacy. These medications are as potentially dangerous as any prescription medication so it is important to know what you are buying. It is most important to understand that over the counter (OTC) medications are for symptomatic relief, meaning that they treat the symptoms and not the cause of the illness.
Three medications are used most frequently to achieve relief from congestion and coughing and these have significant side effects especially when used in young children and when given in the incorrect dose. They are: dextromethorphan, pseudoephedrine and antihistamines.
It is important to note that the doses of these medications have not been accurately studied in children. The side effects of some medications have led to a global warning about the safety of products that contain these preparations. All medications containing these preparations must not be used in children under 2 years of age and their use in children from 2 to 6 years of age is discouraged.
While bearing this warning in mind, here are some symptoms and the medications that are commonly available for treating them.
- Dextromethorphan in cough suppressant syrups.
- Respiratory depression (breathing difficulties)
- Pseudoephedrine in decongestants
- Heart rhythm changes
- High blood pressure
- Antihistamines in both decongestants and cough suppressants
- Drowsiness, loss of consciousness
- Heart rhythm changes
Pain and fever
Panado, Calpol, Tylenol
- Use: fever control, mild to moderate pain.
- Dose: maximum and most effective dose: 2mg per kilogram per dose and this can be given 6 hourly. The syrups are available in concentrations of 120mg per 5ml.
- Safe for: all ages but must be avoided in children with liver or kidney disease.
- Available in syrup, drops, tablets and suppositories. Syrups allow more flexibility in dosing but suppositories are well tolerated and are better for vomiting children.
- Paracetamol does not sedate a child.
Paracetamol and combination medications for pain and fever
Stopayne, Lentogesic, Stilpane, Painagon
- Use: combination medications are specifically designed for pain relief. They have no advantage over paracetamol for the relief of fever.
- Dose: 2.5ml per 6kg of body weight.
- Safe for: Only children over the age of 2 years.
- These medications are a combination of paracetamol, codeine phosphate and promethazine. Promethazine is an antihistamine that sedates the child and has an effect on relieving cramps. Codeine phosphate is a cough suppressant as well as a pain reliever and is similar to dextromethorphan.
- Common side effects: sedation, constipation, dizziness and at very high doses, could cause difficulty in breathing.
Lotem (combination of paracetamol and ibuprofen)
- Use: anti-inflammatory agent, pain relief, fever.
- Dose: 2.5ml per 10kg body weight- given 8 hourly.
- Safe for: Only children over the age of 2 years.
- Not to be used in dehydrated children or children with vomiting and diarrhoea.
- Must be taken with food and must not be taken for more than 48 hours without speaking to your doctor.
- Common side effects: tummy ache, diarrhoea, prolonged use can cause bleeding in the stomach.
Myprodol (combination of paracetamol, codeine phosphate and ibuprofen with indications as per each individual ingredients)
- Use: anti-inflammatory, excellent pain relieving properties, lowers fever.
- Dose: 1 to 3mg per kilogram per day divided into three doses- 12.5mg suppository given every 8 to 12 hours.
- Safe for: only children over the age of 2 years without a doctor's authorisation.
- Not for children with asthma, bleeding tendencies, dehydration, vomiting and diarrhoea.
- Must be taken with food.
- Common side effects: tummy ache and possibly bleeding in the stomach if used for long periods.
Treating coughs, colds and flu
Medications for mucus (snotty nose or wet cough)
Bromhexine- Bisolvon, Bronkese
Carbocisteine- Mucosirop, Flemex
- These products are used to thin out or liquify mucus or phlegm in the chest and upper airway to allow easier coughing.
- The medications will not stop the cough, but will cause more coughing until the mucus is cleared.
- The preparations are generally safe for children over two years of age and are typically used for coughs and colds.
- Follow the manufacturer's package insert for the correct dose.
Cough suppressants (dry cough)
Dextromethorphan (Benylin Dry cough)
- It is hardly ever necessary to suppress a cough. Coughing is the body's protective reflex that protects the lungs be expelling mucus. A persistent dry cough, such as the coughing from whooping cough, may respond to cough suppressants.
- These medications are safe for children and registered for use in children older than 6 years of age. Not to be taken more than 8 hourly. They may cause drowsiness and tummy upsets.
b2 Agonists (Ventolin, Berotec)
- Bronchodilators relax the smooth muscle surrounding the airways and therefore relieve a tight chest. They are known as asthma pumps or inhalers but are also available in syrup form, which should only be prescribed if the child is unable to use the inhalers. The oral formulations are more concentrated than the pumps and cause more side effects, and their onset of action is slower, although the duration of action is longer.
- Common side effects are tremors, nervousness, rapid pulse, dizziness and nausea. Overdose will cause abnormal heartbeats.
- Dosage of the oral medication depends on the weight of the child. The inhalers are a standard dose and can safely be used 6 hourly during attacks of tight chest. The inhalers must be used with a spacer and mask in young children.
Theophylline (Nuelin, Alcophyllin, Solphyllin)
- These medications exert their action by causing bronchodilation.
- The side effects of rapid heart rate and feeling jittery and tremulous are greater than for the above group.
- They should not be given with antibiotics belonging to the macrolide group (Erythromycin, Klacid, Zithromax). This group of medications should only be used under instruction of a doctor.
Decongestants (wet, runny nose and wet, mucusy cough)
- The listed medications are either pseudoephedrine alone or in combination with antihistamines. They dry up secretions and allow clearer nasal passages during infections like a common cold. These medications interact with anaethetic gases (halothane) and heart medication (digoxin, beta-blockers). If used in the correctdose they are safe but overuse can result in high blood pressure, rapid heart rate, restlessness and tremors.
- The dose is age and weight dependent, so check the package insert for the correct dose. Pseudoephderine must not be used as an agent on its own. In combination with other medications in a syrup it must not be used in children under 2.
Oxymetazoline (Iliadin, Drixine)
- Used for the short-term symptomatic relief of nasal congestion and for treatment of the common cold.
- The side effects are potentially the same as for pseudoephedrine if used in patients potentially the same as for pseudoephedrine if used in patients with heart disease, but they are generally extremely safe.
- During use, the lining of the nose dries out and this gives relief from nasal blockage.
- If used for longer than one week, they can potentially cause a rebound blockage of the nose when the therapy is stopped.
- If this is associated with a fever it is probably an ear infection. Oral medications for pain and fever must be used. ear drops can be used but won't treat the infection. They are for pain and must contain local anaesthetic such as Convocaine or Auralgen.
- Ear pain caused by irritation or infection of the ear canal (otitis externa) should be treated with anti-inflammatory drops like Spfradex, Betnesol and Covomycin.
Allergic reactions (itchy skin rashes, stings, hives)
- These new generation antihistamines don't generally cause sedation and are safe for long-term use and use in children from 1 year. The dose is 2.5ml daily for children under 6 and 5ml daily for children over 6.
- Side effects are minimal but may cause irritability, sedation, constipation or difficulty passing urine.
- Allergex is the most common antihistamine dispensed. It causes drowsiness and has potentially serious side effects in young children. It should not be used in children under 2 years of age.
Medication for vomiting
- This is used to stop vomiting and to treat motion sickness and dizziness.
- It must not be used in children under 2 years of age and I suggest that use in children under 6 years must be under direction of a doctor.
- The medication causes drowsiness, lethargy, dry mouth, blurred vision and nervous system reactions.
- The paediatric suppositories (50mg) must only be used in children over 6 years of age.
- This medication must only be used on prescription.
- It is very effective in stopping vomiting but can cause serious reactions in the nervous system.
- We do not use medication to stop vomiting in children who have viral gastroenteritis.
Antispasmodics (tummy cramps)
Buscopan (Hyoscine butylbromide)
- Buscopan is derived from belladonna and causes relaxation of the gut, the bile ducts and the urinary system.
- It is poorly absorbed from the gut and it has very few side effects at recommended doses.
- It is safe for children from one month of age.
- It can cause drowsiness and should not be used in conditions causing obstruction of the gut.
- It's available in syrup (5mg per 5ml) and the dose depends on the age. See the package insert.
- The most common cause of diarrhoea is gastroenteritis and the diarrhoea in this condition can persist for up to ten days.
- This medication slows down the movement of the gut and therefore stool is passed less frequently.
- This medication will not decrease the length of the illness and probably will not decrease the quantity of diarrhoea, but may reduce the number of stools per day.
- We generally do not use antidiarrhoeals to treat the diarrhoea in viral gastroenteritis.
Osmotic laxatives (Lactulose)
- Very safe for long term use. No effect on the lining or muscles of the intestine.
- Starting dose is 1ml per kilogram per day.
- Safe for any age.
- Safe for any age.
- Use for short periods of three days.