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- Jennifer A. Lowry, MD*
- J. Steven Leeder, PharmD, PhD†
- *Section of Clinical Toxicology, Division of Clinical Pharmacology, Toxicology and Therapeutic Innovations, Children’s Mercy Hospital, Department of Pediatrics, University of Missouri – School of Medicine, Kansas City, MO.
- †Pediatric Clinical Pharmacology, Division of Clinical Pharmacology, Toxicology and Therapeutic Innovations, Children’s Mercy Hospital, Departments of Pediatrics and Pharmacology, University of Missouri-Kansas City, Kansas City, MO.
AUTHOR DISCLOSURE
Drs Lowry and Leeder have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Practice Gap
Although there are benefits to the availability of over-the-counter products (eg, rapid access to effective medications, decreased utilization of the health care system, and patient autonomy), there also are risks to their use that clinicians should know and discuss with their patients and families. These include delay in seeking advice from a health care professional, increased drug-drug interactions, potential for misuse and abuse, and increased adverse effects when not used properly.
Objectives
After completing this article, readers should be able to:
Recognize that over-the-counter (OTC) cough and cold preparations have not been adequately studied in children younger than 6 years of age and that they are not recommended for treating the common cold.
Recognize the systemic effects of oral decongestants and antihistamines in infants and young children.
Recognize the signs and symptoms of acetaminophen and aspirin toxicity and know the management of overdose of these agents.
Be aware of potentially harmful additives in OTC medications.
Introduction
Over-the-counter (OTC) medications are widely marketed and frequently used to treat most health problems in adults and children. The use of symptomatic treatments, such as OTC medications for the common cold, is controversial. Children often receive analgesics, decongestants, antihistamines, expectorants, and cough suppressants during the course of their illnesses. However, these OTC products have not been proven to be safe and effective in young children. In addition, their common use puts children at risk for poisonings. Published data show no efficacy (no benefit) of OTC cough and cold preparations when compared to placebo for most ingredients in these products. After much review, the U.S. Food and Drug Administration (FDA) and the Consumer Healthcare Products Association issued …
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