Cough Preparations Research Articles

The Prevalence of Dextromethorphan Abuse Among High School Students

To the Editor .— Dextromethorphan is the d-isomer of the codeine analog, levorphanol, and the active ingredient in >100 over-the-counter cough and cold preparations. Reports of dextromethorphan abuse date back to the 1960s.1,2 There is some evidence suggesting that when used inappropriately at very high doses (eg, 1500 mg/day), dextromethorphan can result in a dependence-like syndrome.2 Psychological symptoms of dextromethorphan intoxication can include euphoria, an altered sense of time, paranoia, and disorientation as well as tactile, visual, and auditory hallucinations. Physical symptoms include but are not limited to hyperexcitability, ataxia, and nystagmus.3 These symptoms bear a remarkable similarity to those seen with phencyclidine (PCP), a powerful dissociative anesthetic that has also been abused since the 1960s.4 Research on the pharmacology of dextromethorphan shows that it is metabolized by the liver enzyme CYP2D6 to dextrorphan, a metabolite with an affinity for N -methyl-D-aspartate receptors, which explains the PCP-like effects that can result from consuming higher-than-recommended doses of the drug.5,6 Earlier research suggested that dextromethorphan abuse was sporadic and declining7; however, recent case reports about its misuse have again …

Acute cough

An acute cough is defined as lasting less than 3 weeks. Unlike prolonged cough and chronic cough defined in the next chapter, the aetiology of acute cough in these guidelines includes diseases characterized by abnormal findings on physical examination and CXR. In general, acute cough is self-limiting, and many patients simply buy cough remedies over-the-counter without seeing a physician. Thus, more so than in chronic cough, the incidence of acute cough is unknown. However, based on sales of over-the-counter cold remedies and cough preparations, acute cough is a common symptom in many people. Figure 1.1 depicts changes in the incidence of the cause of coughing based on duration of symptoms. The most common cause of acute cough is infection, in particular, the so-called ‘common cold’ due to viral infection of the upper respiratory tract from the nasal passages to the larynx.1 In most cases, these resolve on their own without specific treatment. As duration of symptoms increases to a persistent or chronic cough, it is more likely that the cause is non-infectious. In the differential diagnosis of acute cough, however, it is essential not to miss a potentially life-threatening condition such as pulmonary embolism or acute cardiac failure. Therefore, a detailed history, physical examination, and if necessary, CXR should be performed. Another important point is that all prolonged and chronic coughs first start out as acute coughs, so when diagnosing an acute cough, the causes of persistent and chronic coughs must also be kept in mind. Figure 3.1 outlines the differential diagnosis of acute cough. In Table 3.1, the main causes of acute cough identified in these guidelines are shown. Outline of acute cough. ACE, angiotensin converting enzyme; GERD, gastro-oesophageal reflux disease.

Chronic Addiction to Dextromethorphan Cough Syrup: A Case Report

Serious drug abuse and addiction related to dextromethorphan-containing cough preparations has been a problem in the United States since the 1950s, but few physicians are aware of it. Physicians must be alert to the type of substances and quantities used and misused by patients in obtaining a thorough routine history of over-the-counter medication use. We describe the case of a 66-year-old clerical worker who ingested 4 to 16 oz of dextromethorphan on a regular basis over an 8-year period. We consulted with our local Poison Control Center and undertook a literature search to research previous reports of similar cases to identify the features that would aid physicians in recognition and management of this problem. Despite the availability of a substantial number of case reports in specialty journals, there are almost no reports in the primary care literature of chronic dextromethorphan addiction. Our case highlights the difficulties in making an appropriate diagnosis and in obtaining effective help for the patient.

Medication use for pediatric upper respiratory tract infections

The present study monitored medication prescribing patterns to patients treated for upper respiratory tract infections (URTIs) in the pediatric outpatient department (OPD) at Central Referral Hospital (CRH), Gangtok, Sikkim. A total of 562 URTI prescriptions of children, aged 0-12 years attending pediatric OPD at CRH, Sikkim were collected by a random once-weekly survey between May 2002 and April 2003. Males numbered 284 (50.5%), and females 278 (49.5%). Most of the patients in our study were aged 2-5 years (preschool children) (44.8%). The average number of medications prescribed per encounter was 2.37; 59.2% (789) of medicines were fixed-dose combination (FDC) products and two-thirds of FDCs were respiratory medicines (521). The most commonly prescribed medicines were respiratory medicines (47% of the total medicines prescribed). Others were antimicrobials (30.7%) and analgesic-antipyretics (18.8%). Among respiratory medicines, cough and cold preparations (prescribed in 13 different FDC products in 25 brand names) were prescribed most frequently (62%) followed by nasal preparations (21%) and beta(2) adrenergic agonist inhalers (9.2%). Ninety-eight percent of nasal preparations were isotonic saline drops (129). Antihistaminics (41.8%), non-opioid antitussives (13.5%), alpha agonist oral decongestants (42.3%), expectorants (32.2%), mucolytics (18.7%), paracetamol (14.7%), and beta(2) agonists (17.2%) were common ingredients of respiratory medicine combinations. Antihistamines (2.5%) and beta(2) agonists (9.2%) were used alone. The most commonly prescribed antimicrobial was amoxicillin with clavulanate (28.4%) followed by cefadroxil (20%), cotrimoxazole (9.5%) and amoxicillin alone (9.3%). Average number of antimicrobials prescribed was 0.7 (409/562). The most commonly prescribed analgesic-antipyretic was paracetamol (81.3%) followed by combination of ibuprofen and paracetamol (12.4%) and nimesulide (5.6%). Medication selection was rational in few cases. Various anomalies were observed in various aspects of drug use in children for URTI's. The main aim of the initiative is the need for more rational medicine use in URTIs in children for improvement of clinical effectiveness, cost effectiveness and reduction of potential useless risk of side effects.

Prevalence of Self-medication in Rural Areas of Portugal

To study the prevalence of self-medication among pharmacy customers in rural areas of Portugal, to assess possible predictors of self-medication and to find out whether there was a seasonal dependence in the purchase of drugs for self-medication. A cross-sectional study during four different periods of a year was conducted. Community pharmacies of rural areas of Portugal were invited to participate and pharmacists were asked to recruit one person every hour during the opening hours and administer a questionnaire. Drugs dispensed were classified according to the Anatomical Therapeutic Chemical Classification system up to the second level. Prevalence of self-medication is defined as the percentage of patients acquiring a medicine that was not prescribed (written) or recommended (orally) by a physician. The prevalence of self-medication was 21.5%. Main therapeutic groups acquired for self-medication were "other alimentary tract and metabolism products" (A16; proportion acquired for self-medication= 75.0%), "throat preparations" (R02; 74.7%), "antiemetics and antinauseants" (A04; 70.0%), "cough and cold preparations" (R05; 56.5%), and "nasal preparations" (R01; 50.0%). Variables found to be predictors of self-medication were age, type of health professional or person consulted when a mild health problem occurred, time elapsed since last visit to the physician and time waited between setting an appointment and the actual visit. Seasonality seemed to occur for only "cough and cold preparations", for "dermatologicals" and for "anti-inflammatory and anti-rheumatic products". In rural Portugal about one fifth of the pharmacy customers engaged in self-medication. However, further research should be made to address appropriateness of self-medication.

THE INFLUENCE OF DRUG INFORMATION ON DRUG SELECTION AND USAGE COUGH PREPARATION AT SELF MEDICATION IN GODEAN SUBDISTRICT

The influence of drug information on drug selection and usage cough preparation for self medication in Godean was investigated. The study was performed in Godean community by distributing questioner to respondences. Stratified random sampling followed by equal sampling were used to select subjects. Multiple regression and t-test were used to analyzed the result statistically. The result showed that drug information influences drug selection and usage (Z 1/2 = 0,050). Key words : Self medication, information, cough medicine

Simultaneous Determination of Some Active Ingredients in Cough and Cold Preparations by Gas Chromatography, and Method Validation

A simple and rapid gas chromatographic (GC) method has been developed for the simultaneous determination of combinations of acetaminophen, phenylpropanolamine hydrochloride, guaifenesin, pseudoephedrine hydrochloride, caffeine, chlorpheniramine maleate, and dextromethorphan hydrobromide in cough and cold tablets and syrups. After extraction of the analyte with alkaline ethyl acetate, 2 microL extract was injected (splitting ratio of 50:1) into a gas chromatograph equipped with a CBP1-M25-025 fused silica capillary column (25 m x 0.22 mm; film thickness, 0.25 microm). The column temperature was held at 150 degrees C for 5 min, increased to 175 degrees C at 3 degrees C/min, and increased to 270 degreesC at 10 degrees C/min. The temperatures of the flame ionization detector and injector were maintained at 300 degrees C. The GC method is inexpensive, rapid, accurate, and precise, and thus it can be used for routine analysis of tablet and syrup preparations in quality control laboratories of pharmaceutical companies.

Cough and cold preparation abuse

Cough and cold preparation abuse

Pediatric Cough and Cold Preparations

Pediatric Cough and Cold Preparations

Pediatric cough and cold preparations.

1. Leslee F. Kelly, MD* 1. *Pediatric Associates, PC, Phoenix, AZ After completing this article, readers should be able to: 1. Discuss how respiratory viruses that cause the common cold are transmitted and spread. 2. List the major categories of medicines found in most cough and cold preparations. 3. Describe the primary effect of antihistamines in treating the common cold. 4. Explain how decongestants decrease nasal congestion. 5. Explain why topical nasal decongestants may be especially dangerous in infants. There have been many definitions for the “common cold.” Studies conducted on outcomes of cold remedies often are not consistent in their definition of this illness, but it can be defined rather succinctly by a certain set of signs and symptoms (Table 1). Upper respiratory tract infection is another term used interchangeably in the literature, but this broad term can include both viral and bacterial causes as well as illnesses other than the common cold. The term “common cold” is understood to mean that the cause is viral. | | || Table 1. Signs and Symptoms of the Common Cold Cough and cold medicines contain pharmacologically active ingredients that alone or in combination are intended to relieve some or all of a patient’s symptoms. For both the parent and the practitioner, deciding which of the multitude of available products to use can be confusing and overwhelming. The intent of this article is to simplify this process by describing what these medicines are intended to do, discussing their efficacy as determined by available evidence, discussing safety issues, and relating these to the epidemiology and pathophysiology of the common cold. Colds are extremely common in infants and children and are becoming more prevalent as larger numbers of children participate in child care. The average number …

Prevalência da automedicação na população urbana portuguesa

Este estudo transversal teve como objetivo principal determinar a prevalência da automedicação em meio urbano. Decorreu nas cidades de Lisboa e Porto, respectivamente em 11 e 15 farmácias, no período de Novembro de 1995 a Setembro de 1996. A recolha de informação dividiu-se em 6 fases de 10 dias cada. A prevalência da automedicação encontrada foi de 26,2%. Encontraram-se diferenças estatisticamente significativas no que respeita às prevalências da automedicação por sexo, idade, nível educacional e atividade profissional. Em 50% dos casos, os voluntários que adquiriram medicamentos em automedicação fizeram-no sob aconselhamento do farmacêutico. Os grupos terapêuticos mais utilizados em automedicação foram as preparações nasais e sistêmicas para a constipação e tosse (23,0%) e os analgésicos (13,6%). Analisando cada um dos grupos terapêuticos individualmente foram encontradas diferenças estatisticamente significativas relativamente ao perfil do utilizador por sexo e grupo etário, de acordo com a variável automedicação.

Short-term associations between air pollution and respiratory drug sales

Study objective: This research was implemented to assess the effect of air pollution on anti-asthmatic, bronchodilator, and cough and cold preparation sales in the city of Rouen (France) based on the Upper Normandy Regional Union of Health Insurance Offices database and the Air Quality Monitoring Network database. Design: An ecological time-series analysis was performed for a period of 2 years (July 1998–June 2000). Generalized additive model yields to relative risks and 95% confidence interval (CI) estimates were also carried out. Main results: The 10-day cumulative effect of a 10-μg/m3 black smoke increase was significantly associated with a 6.2% (95% CI, 2.4–10.1%) increase in the sales of anti-asthmatics and bronchodilators and to a 9.2% (95% CI, 5.9–12.6%) increase in the sales of cough and cold preparation for children aged under 15 years. The cumulative effect of a 10-μg/m3 increase in SO2 was associated with an 11.8% (95% CI, 6.7–17.1%) increase in cough and cold preparation sales for children aged under 15 years. The cumulative effect of 10-μg/m3 increase in NO2 was associated with an 13.6% (95% CI, 8–18.3%) increase in cough and cold preparation sales for children under 15 years of age. Conclusions: The results of this study suggest that an increase in drugs sales was directly related to air pollutant concentration increases in the city of Rouen (France).

Determination of butamyrate citrate in cough preparations by derivative UV spectrophotometry and high performance liquid chromatography.

Derivative spectrophotometric procedures and an isocratic high performance liquid chromatographic method for the determination of butamyrate citrate (Sinecod, Safarol) in cough syrups have been developed. In the spectrophotometric method, direct measurement of the drug at its absorption maxima is impossible because of interference from different absorbing excipients. Extraction of butamyrate citrate was performed with n-pentane/isopropyl alcohol. Quantification was carried out through the use of 1D derivative at a trough depth of 253.6 nm where interferences from other coextracted compounds are negligible. The extraction efficiency expressed as a % recovery and precision were assessed by fortifying placebo syrup(s) with known amounts of the compound. Also, a reversed phase high performance liquid chromatographic method was used with a mobile phase containing 0.015 M aqueous tetraethylammonium hydrogen sulfate, methanol and acetonitrile 40:30:30 adjusted to pH 3.50 with ammonium hydroxide. The retention behavior of butamyrate citrate as a function of both pH and salt concentration in the aqueous portion of the mobile phase was investigated. Quantification was achieved with UV detection at 258 nm based on peak area. The HPLC method clearly separates the analyte from its degradation products derived after storage of samples under different stress conditions such as acid, alkaline, temperature, oxygen and light. The described methods were successfully applied to the determination of butamyrate citrate in commercial pharmaceutical products and in placebo syrups prepared in the laboratory with good accuracy and precision. The results of the present study show that the use of the derivatives and the HPLC procedure provide precise and sensitive methods for the determination of the compound in pharmaceutical formulations.

Review: lack of evidence exists for effectiveness of over the counter cough preparations for children with upper respiratory tract infections

(2002) Arch Dis Child 86, 170; Schroeder K, Fahey T. . Should we advise parents to administer over the counter cough medicines for acute cough? Systematic review of randomised controlled...

Review: Lack of evidence exists for effectiveness of over-the-counter cough preparations for children with URTI

Source Citation Schroeder K, Fahey T. Should we advise parents to administer over the counter cough medicines for acute cough? Systematic review of randomised controlled trials. Arch Dis Child. 2002 Mar;86:170-5. 21849658

Beyond our pages

Beyond our pages

Treatment of upper respiratory tract infections--a comparative study of dispensing and non-dispensing doctors.

The reported results are part of an overall evaluation of drug management by dispensing (DDs) and non-dispensing doctors (NDDs). This study focuses on appropriate prescription. Other studies assess good pharmacy practice. Whereas rationality of prescription has been studied based on simple indicators, appropriate prescription in relation to diagnoses and symptoms has not been assessed. To analyse prescriptions by DDs and NDDs for patients diagnosed with upper respiratory tract infection. Cohort study of 28 private sector DDs and 28 NDDs, using retrospective registry data from a mean of 14.5 and 16.0 patient records per practice, respectively. Drug choice, frequency of the drugs being used, use of antibiotics and dosages for respiratory infections where antibiotics are/are not justified. DDs were associated with a greater number of drugs per encounter (P < = 0.001), a greater number of injections (P = < 0.002), more use of analgesic drugs (P = < 0.001), cough and cold preparations (P < 0.001) and psycholeptics (P = < 0.03). The choice of antibiotics for upper respiratory tract infection (URTI) was assessed as rational, although different for the two practices, but both practices over-prescribe antibiotics frequently. Dispensing doctors frequently prescribe sub-curative dosages and fewer curative dosages (P = < 0.001), compared with NDDs. Irrational prescription for URTI is widespread by both dispensing doctors and to a lesser extent, by NDDs. Symptomatic treatments with 'a drug for each symptom' was common, particularly by the DDs. There was also over-prescription of antibiotics and use of sub-therapetitic dosages. This poly-pharmacy, poses a safety risk, a risk of development of resistance and, unnecessarily costly treatment.

Self-medication in a Portuguese urban population: a prevalence study.

To determine the prevalence of self-medication in a Portuguese urban population. To assess the feasibility of performing these studies in community pharmacies. A cross-sectional study was chosen to collect information about demography, use of health services and drug utilization in a sample of pharmacy user-purchasers in a pre-determined period of time. The proportion of pharmacies which participated in the study was 18.3% (11 from 60 invited) in Lisbon and 37.5% (15 of 40 invited) in Porto. Among the 3312 selected patients, only 2.6% (n = 114) refused to participate. The prevalence of self-medication was found to be 26.2%. The distribution of self-medication by gender was 28.4% for males and 25.2% for females. Use of self-medication was statistically significantly higher (p < 0.001) among individuals aged between 10 and 49 years. The main therapeutic groups used for self-medication, according to the ATC classification, were throat preparations, cough and cold preparations, stomatological preparations (antiinfectives and corticosteroides for local oral treatment), laxatives, analgesics, dermatological preparations, vitamins, mineral supplements and other alimentary tract and metabolism products. In the urban areas under study the overall prevalence of self-medication was 26.2%. Predictive factors for self-medication seem to be, a high level of education, professional status and length of waiting times for a medical consultation in cases of a severe health problem. Further research on this subject is needed to confirm the reproducibility of these results, since potential selection bias could have been introduced due to the method used for patient selection. Pharmacoepidemiologic research is feasible in Portuguese community pharmacies.

Should we advise parents to administer over the counter cough medicines for acute cough? Systematic review of randomised controlled trials

Aims: To determine the effectiveness of over the counter (OTC) cough medicines for acute cough in children. Methods: Systematic review of randomised controlled trials (RCTs). An all language search of...

Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults

Objectives: To determine whether over the counter cough medicines are effective for acute cough in adults.Design: Systematic review of randomised controlled trials.Data sources: Search of the Cochrane Acute Respiratory Infections...