Unpacking OTC medicine for you

Before you medicate your baby be sure of the side effects and potential pitfalls, writes Dr Simon Strachan, a Joburg paediatrician

IT IS VERY EASY to buy medication over the counter (OTC) at your pharmacy. These medications are as potentially dangerous as any prescription medication, so it’s important to know what you are buying. It is most important to understand that 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

PAIN AND FEVER Use for fever control, mild to moderate pain

✓ Paracetamol – Panado,

Calpol, Tylenol

› Dose: Maximum and most effective dose – 20mg per kg per dose 6 hourly.

› The syrups are available in concentrations of 120mg per 5ml.

› Safe for all ages, must be avoided in children with liver or kidney disease.

› Available in syrup, drops, tablets and suppositories. Syrups allow more flexibility in dosing than the suppositories. The 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 › These medications are a combination of paracetamol, codeine phosphate and promethazine.

They are specifically designed for pain relief. They have no advantage over when given in the incorrect dose.

The doses of these medications have not been accurately studied in children. The side effects of these medications (see box below) 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 two years of age, and their use in children from two to six years of age is discouraged. While bearing this warning and precaution in mind, here are some symptoms and the medications that are commonly available for treating them. paracetamol for the relief of fever.

› Not to be used in children younger than two years of age.

› Dose: 2.5ml per 6kg of body weight Promethazine is an antihistamine that sedates the child and has an effect on relieving cramps.

Codeine phosphate is a cough suppressant and pain reliever and is similar to dextromethorphan.

› Common side effects will be sedation, constipation, dizziness and, at very high doses, could cause difficulty in breathing.

✓ Lotem: Lotem is a combination of paracetamol and ibuprofen. Ibuprofen is an anti-inflammatory agent that has excellent pain-relieving properties and lowers fever.

› Not indicated for children younger than two years of age. Not to be used in dehydrated children or children with vomiting and diarrhoea.

› Preferable to avoid for treating asthmatics and children with bleeding tendencies. › Dose: 2.5ml per 10kg of body weight.

› 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: This is a combination of paracetamol, codeine phosphate and ibuprofen. See above for the effects of the individual components.

✓ Voltaren: This is an anti-inflammatory that has excellent pain-relieving properties and lowers fever.

› Not for children under two years of age without a doctor’s authorisation. Available in drops, suppositories and tablets.

› Dose (children over two years of age): 1 to 3mg per kg per day divided into three doses. For example, 12 child – Voltaren 12.5mg suppository given every 8 to 12 hours.

› Not for children with asthma, bleeding tendencies, dehydration, vomiting and diarrhoea.

› Must be taken with food

› Side effects: tummy ache and possibly bleeding in the stomach if used for long periods.

› The suppositories will cause the stools to be loose.

TREATING COUGHS, COLDS AND FLU Medications for mucus (snotty nose or wet cough)

✓ Mucolytics: acetylcysteine – Solmucol | bromhexine – Bisolvon, Bronkese | carbocisteine – Mucosirop, Flemex, Mucospect

› 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 rather 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) | noscapine – Nitepax | pholcodine – Pholtex

› It is hardly ever necessary to suppress a cough. Coughing is the body’s protective reflex that protects the lungs by expelling mucous. 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 six years. Not to be taken more than 8 hourly. They may cause drowsiness and tummy upsets.

Wheezy chests

✓ Bronchodilators: b2 agonists – Ventolin, Berotec | hexoprenaline – Ipradol

› 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 bronchodilatation. 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, mucousy cough)

✓ Pseudoephedrine –

Sudafed, Actifed, Sinumed, Sinumax, Demazin, Coryx

› 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 anaesthetic gases (halothane) and heart medication (digoxin, beta-blockers).

› If used in the correct dose, 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. Pseudoephedrine 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 two years of age.

Nasal decongestants

✓ Oxymetazoline – Iliadin, Drixine | phenylephrine – Vibrocil

› 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 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 a week, they can potentially cause a rebound blockage of the nose when the therapy is stopped.

EARACHE

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 a 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 Sofradex, Betnesol and Covomycin.

ALLERGIC REACTIONS (ITCHY SKIN RASHES, STINGS, HIVES) ✓ Antihistamine – Clarityne,

Deselex, Zyrtec

› These new-generation antihistamines don’t generally cause sedation and are safe for long-term use and use in children from one year. The dose is 2.5ml daily for children under six years and

5ml daily for children over six years.

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 is not safe for long-term use. It falls into the firstgeneration antihistamines class and has potentially serious side effects in young children. It should not be used in children under two years of age. It’s much safer to use the new-generation antihistamines.

STOMACH AILMENTS Medication for vomiting

✓ Cyclizine – Valoid, Covamet, Emitex

› This is used to stop vomiting and to treat motion sickness and dizziness. It must not be used in children under two years of age, and I suggest that use in children under six 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 six years of age.

✓ Prochlorperazine – Stemetil

› 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.

✓ Antidiarrhoeals: Loperamide –

Imodium

› The commonest cause of diarrhoea is gastroenteritis, and the diarrhoea in this condition can persist for up to 10 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.

Constipation

✓ Osmotic laxatives – Lactulose | Duphalac, Senokot syrup, Lacson, Laxette › Very safe for long-term use. No effect on the lining or muscles of the intestine. Starting dose is 1ml per kg per day. Safe for any age.

Suppositories

✓ Glycerine | Dulcolax

› Safe for any age. Use for periods of no more than three days.