FDA safety announcement prompts doctors to discuss alternative therapies to cough, cold medicines

Alan Schwartzstein
Alan Schwartzstein

Two primary care physicians provided tips on alternative therapies to cold and cough medicines containing hydrocodone or codeine, in light of the FDA’s recent label change on prescription products that limits the use of such medicines in children younger than 18 years.

“I would recommend parents encourage their children to drink plenty of fluids when they have a cough, because the moister and looser the secretions are, the less irritating thecough,” Alan Schwartzstein, MD, a family medicine doctor practicing in Oregon, Wisconsin, told Healio Family Medicine in an interview.

“PCPs also advise parents to use the albuterol inhaler often prescribed for children with asthma, and they can also recommend parents humidify the air in the child’s room with a cool mist dehumidifier or a vaporizer. These small appliances are particularly helpful in winter, because when you turn the heat on, it tends to dry up the air,” he added.

Stanley Spinner, MD , chief medical officer of Texas Children's Pediatrics, provided a few more ideas.

Stanley Spinner
Stanley Spinner

“Patients can also take honey and lozenges. Dextromethorphan, at the appropriate dose, may also provide minimal cough relief, although many feel it is no more effective than placebo,” he said in an interview.

Schwartzstein noted another potential caveat when it comes to dextromethorphan, one of the active ingredients in such over the counter cough suppressants as Robitussin DM, Nyquil, and Delsym.

Two primary care physicians provided tips on alternative therapies to cold and cough medicines containing hydrocodone or codeine, in light of the FDA's recent label change on prescription products that limits the use of such medicines in children younger than 18 years.
Source: Shutterstock

Certain other medications should not be recommended to older children with coughs, Schwartzstein added.

“PCPs with patients who are 16 or 17 years old should try to limit antihistamine use or other medicines that can dry up the secretions in the passage ways. Antihistamines are good for allergies or if the patient’s doing a lot sneezing or has watery eyes, but if there’s a cough, you want to have those passageways as wet as possible.”

Schwartzstein also said PCPs should consider each patient’s treatment on a case-by-case basis.

“Family physicians need to look at each situation individually and weigh the risks of using these products vs. the benefits but also keep in mind that they can cause harms.”

Clinicians need to take the time to explain the change in recommendations and reasons for it to parents of their younger patients.

“PCPs should discuss the potential serious risks of opioid-containing cough and cold products for children and adolescents in light of the limited benefit these products can provide,” Spinner said, adding these risks include depression and death.

“Having medicines out in the open where a child can access them can be dangerous. These medicines need to be kept locked up,” Schwartzstein added . – by Janel Miller

Reference:

fda.gov. “Drug Safety Communication.”

https://www.fda.gov/Drugs/DrugSafety/ucm590435.htm?utm_campaign=New%20FDA%20Drug%20Safety%20Communication%20on%20prescription%20opioid%20cough%20and%20cold%20medicines&utm_medium=email&utm_source=Eloqua Accessed Jan. 26, 2018.

Disclosure: Neither Schwartzstein nor Spinner report any relevant financial disclosures.

Alan Schwartzstein
Alan Schwartzstein

Two primary care physicians provided tips on alternative therapies to cold and cough medicines containing hydrocodone or codeine, in light of the FDA’s recent label change on prescription products that limits the use of such medicines in children younger than 18 years.

“I would recommend parents encourage their children to drink plenty of fluids when they have a cough, because the moister and looser the secretions are, the less irritating thecough,” Alan Schwartzstein, MD, a family medicine doctor practicing in Oregon, Wisconsin, told Healio Family Medicine in an interview.

“PCPs also advise parents to use the albuterol inhaler often prescribed for children with asthma, and they can also recommend parents humidify the air in the child’s room with a cool mist dehumidifier or a vaporizer. These small appliances are particularly helpful in winter, because when you turn the heat on, it tends to dry up the air,” he added.

Stanley Spinner, MD , chief medical officer of Texas Children's Pediatrics, provided a few more ideas.

Stanley Spinner
Stanley Spinner

“Patients can also take honey and lozenges. Dextromethorphan, at the appropriate dose, may also provide minimal cough relief, although many feel it is no more effective than placebo,” he said in an interview.

Schwartzstein noted another potential caveat when it comes to dextromethorphan, one of the active ingredients in such over the counter cough suppressants as Robitussin DM, Nyquil, and Delsym.

“Some patients have been using more of it than necessary, or combining it with other medicine to get a high off of it,” he said. “We need to be a bit more cautious when recommending it.”

Two primary care physicians provided tips on alternative therapies to cold and cough medicines containing hydrocodone or codeine, in light of the FDA's recent label change on prescription products that limits the use of such medicines in children younger than 18 years.
Source: Shutterstock

Certain other medications should not be recommended to older children with coughs, Schwartzstein added.

“PCPs with patients who are 16 or 17 years old should try to limit antihistamine use or other medicines that can dry up the secretions in the passage ways. Antihistamines are good for allergies or if the patient’s doing a lot sneezing or has watery eyes, but if there’s a cough, you want to have those passageways as wet as possible.”

Schwartzstein also said PCPs should consider each patient’s treatment on a case-by-case basis.

“Family physicians need to look at each situation individually and weigh the risks of using these products vs. the benefits but also keep in mind that they can cause harms.”

Clinicians need to take the time to explain the change in recommendations and reasons for it to parents of their younger patients.

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“PCPs should discuss the potential serious risks of opioid-containing cough and cold products for children and adolescents in light of the limited benefit these products can provide,” Spinner said, adding these risks include depression and death.

“Having medicines out in the open where a child can access them can be dangerous. These medicines need to be kept locked up,” Schwartzstein added . – by Janel Miller

Reference:

fda.gov. “Drug Safety Communication.”

https://www.fda.gov/Drugs/DrugSafety/ucm590435.htm?utm_campaign=New%20FDA%20Drug%20Safety%20Communication%20on%20prescription%20opioid%20cough%20and%20cold%20medicines&utm_medium=email&utm_source=Eloqua Accessed Jan. 26, 2018.

Disclosure: Neither Schwartzstein nor Spinner report any relevant financial disclosures.