Revised: 6 June 2013

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Reminder: Cough and Cold Medicines in Children

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Prescriber Update 34(2):16
June 2013

As the winter season gets underway, healthcare professionals are reminded that the majority of cough and cold medicines are contraindicated in children less than six years of age.

In August 2009, the Cough and Cold Review Group recommended that all oral medicines indicated for the treatment of the symptoms of the common cold containing the substances in Table 1 be contraindicated for use in children less than six years of age¹. In Australia, similar recommendations were made last year².

Table 1: Medicines containing the following substances are contraindicated in children less than six years of age

Substances
Guaifenesin	Ipecacuanha
Dextromethorphan	Pholcodine
Oral phenylephrine	Pseudoephedrine
Brompheniramine	Chlorphenamine
Diphenhydramine	Doxylamine
Promethazine	Triprolidine

The Cough and Cold Review Group considered that these medicines lacked efficacy in children, were associated with serious adverse reactions and there was a risk of accidental overdose³. Serious adverse reactions reported internationally and in New Zealand include convulsions, increased heart rate, decreased level of consciousness, allergic reactions, abnormal heart rhythms and hallucinations³.

Healthcare professionals are also reminded that all cough and cold medicines are contraindicated in children less than two years of age.

Coughs and colds are self-limiting conditions that will usually resolve without pharmacological treatment⁴. Cough and cold medicines are designed to treat the symptoms of the common cold. They do not cure the infection. In addition, there is evidence that infection with the common cold affects children and adults differently.

As a result of the recommendations of the Cough and Cold Review Group, warning statements are now included on the packaging of these products. Label requirements for any medicine can be found on the Medsafe website (www.medsafe.govt.nz/regulatory/labelling.asp).

As for any medicine, should you find the packaging does not comply with the labelling statements required by Medsafe, please contact the Medsafe Compliance Management Team (recalls@health.govt.nz).

References

1. Medsafe. 2009. Use of cough and cold medicines in children — New Advice. URL: www.medsafe.govt.nz/hot/alerts/coughandcold/infooct2009.asp (accessed 8 May 2013).
2. Therapeutic Goods Administration. 2012. Changes to over-the-counter cough and cold medicines for children. Medicines Safety Update 35(6). URL: www.tga.gov.au/pdf/msu-2012-06.pdf (accessed 8 May 2013).
3. Medsafe. 2009. Questions and Answers on over-the-counter cough and cold medicines. URL: www.medsafe.govt.nz/hot/alerts/coughandcold/QandAOct2009.asp (accessed 8 May 2013).
4. Best Practice Advocacy Centre. 2013. Cold season in primary care: Advice is the best medicine. Best Practice Journal 52: 26–33. URL: www.bpac.org.nz/BPJ/BPJ.aspx (accessed 10 May 2013).