Published: 2 June 2016

Publications

Reminder: Using Cough and Cold Medicines in Children is Inappropriate

Prescriber Update 37(2): 18
June 2016

Key Messages

  • All oral cough and cold medicines are contraindicated in children less than six years of age. Some cough and cold medicines, including codeine-containing products, are contraindicated in children less than 12 years of age.
  • Coughs and colds are self-limiting illnesses and do not require pharmacological interventions.


As the winter months approach, healthcare professionals are reminded that oral cough and cold medicines, including bromhexine, should only be used in adults and children six years of age and over. Products containing codeine used to relieve cough and cold symptoms should only be used in adults and children 12 years of age and over.

The Medicines Adverse Reactions Committee (MARC) reviewed the use of both bromhexine and codeine-containing cough and cold medicines in December 2014. These reviews were triggered by:

  • reports of allergic reactions, including anaphylaxis, with the use of ambroxol (a metabolite of bromhexine)
  • morphine-induced respiratory depression, with the use of codeine (codeine is metabolised to morphine).

The MARC concluded that for these medicines, the risks of harm outweighed the benefits of relieving the symptoms of coughs and colds in younger age groups1. Further information is available on the Medsafe website (www.medsafe.govt.nz/safety/EWS/2015/BromhexineOrCodeine.asp).

The package labelling for bromhexine-only containing products has been updated, but a limited amount of stock may still display the previous age restrictions.

Coughs and colds are self-limiting and do not require pharmacological interventions, which only relieve the symptoms2. Children with coughs and colds should be allowed to rest, be made comfortable and be given plenty of fluids. Simple analgesics such as paracetamol may be considered for symptomatic treatment of associated pain or fever, and saline drops or spray may be used for nasal congestion2.

References
  1. Medsafe. 2014. Minutes of the 160th Medicines Adverse Reactions Committee Meeting 4 December 2014. URL: www.medsafe.govt.nz/profs/adverse/Minutes160.htm (accessed 12 April 2016).
  2. Best Practice Advocacy Centre New Zealand. 2010. Do cough & cold preparations work in children? Best Practice Journal 29: 32-39. URL: www.bpac.org.nz/BPJ/2010/July/docs/BPJ_29_cough_meds_pages_32-39.pdf (accessed 12 April 2016).
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