How serious are you on OTC cough products for young kids?

RxPal said:

I am a relatively new pharmacist, so when FDA recommends against self-treatment with OTC cough products for patients under 4 years of age I conveyed that message to my patients. But an older pharmacist who I work with does not follow that recommendation at all. When a mother complains to him about her one-year-old having cough, the pharmacist would recommend Robitussin and come up with a dosing schedule for the patient. And that's even after the mother has told the pharmacist that her doctor warned her against using OTC cough medicine in a kid this young.

Do you still recommend OTC products for patients younger than four years of age for cough relief?

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Honestly, I am not a pharmacist so take this with a grain a salt. But, that being said, I personally would rely less on what the FDA says and more on what the AAP (Academy of Pediatrics) says. They would have more current and better reviewed studies than the FDA. Plus, they do not try to be experts on everything in medicine, just peds.

By the way, the AAP does not recommend it either. I have already had this discussion with both my regular pediatrician and the developmental ped at the med school here. (I have a daughter with recurring low grade infections because of some sinus problems occuring after a premie birth).

RxPal said:

I am a relatively new pharmacist, so when FDA recommends against self-treatment with OTC cough products for patients under 4 years of age I conveyed that message to my patients. But an older pharmacist who I work with does not follow that recommendation at all. When a mother complains to him about her one-year-old having cough, the pharmacist would recommend Robitussin and come up with a dosing schedule for the patient. And that's even after the mother has told the pharmacist that her doctor warned her against using OTC cough medicine in a kid this young.

Do you still recommend OTC products for patients younger than four years of age for cough relief?

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you have to keep in mind that that not long ago that it was 2 years of age instead of 4. The main reason why the age was raised was because bad things happen when parents don't follow dosing instructions. A 2 years old is alot easier to over dose than a 4.

If I'm retail, I would be comfortable with still giving it to the parents WITH good counseling. Now if they come in looking they are drunk, on something, or just doesn't look like they are reliable, I probably wouldn't.

The only value of OTC cough medications is in getting people out of my store.

I have told parents to avoid them. Most of the studies/reviews out there that I've read tend to agree you see very little efficacy in peds and enough of the ADRs to make them not worthwhile. Add that the dosing is extrapolated from adult dosing without testing in peds that it's generally not a good idea to recommend them.

I do recommend humidifiers, honey (over 1 year of age), vaporub on occasion, and water.

They don't work. They have adverse reactions, why in God's name would you recommend them?

over 1 year, less than 4 i say "honey is very good, it'll stop the cough and sooth the throat and it takes good"

if the parent really wants it, i just tell the dose to use. usually its just 1/2 a teaspoon instead of 5 ml, thats it really

theres plenty of dosing info on lexi for infants and children, just follow that

why do i recommend them somtimes? cuz we still have bromfed dm available and mds still prescribe it for little kids.. so why not.. no need to be super anal about all this stuff

farmadiazepine said:

over 1 year, less than 4 i say "honey is very good, it'll stop the cough and sooth the throat and it takes good"

if the parent really wants it, i just tell the dose to use. usually its just 1/2 a teaspoon instead of 5 ml, thats it really

theres plenty of dosing info on lexi for infants and children, just follow that

why do i recommend them somtimes? cuz we still have bromfed dm available and mds still prescribe it for little kids.. so why not.. no need to be super anal about all this stuff

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So you are willing to recommended products that can lead to hospitalization and that have no proof efficacy? Any special reason?

Annually, an estimated 7091 patients aged <12 years were treated in emergency departments for adverse drug events from cough and cold medications, accounting for 5.7% of emergency department visits for all medications in this age group. Most visits were for children aged 2 to 5 years (64%). Unsupervised ingestions accounted for 66% of estimated emergency department visits, which was significantly higher than unsupervised ingestions of other medications (47%), and most of these ingestions involved children aged 2 to 5 years (77%). Most children did not require admission or extended observation (93%).

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http://pediatrics.aappublications.org/content/121/4/783.full

does the article mention if the children admitted were taking cold/cough products due to physician/pharmacist/healthcare worker recommendation, or were parents just giving whatever meds to their kids without asking for advice.

these articles are a joke bro, take with a grain of salt, not all variables are accounted for, so many things are missed.

didn't this article just say most of it was due to unsupervised ingestion? how about mommy and daddy keep the robitussin dm all the way on the top counter instead of the bottom .. keep the cookies on the bottom

farmadiazepine said:

does the article mention if the children admitted were taking cold/cough products due to physician/pharmacist/healthcare worker recommendation, or were parents just giving whatever meds to their kids without asking for advice.

these articles are a joke bro, take with a grain of salt, not all variables are accounted for, so many things are missed.

didn't this article just say most of it was due to unsupervised ingestion? how about mommy and daddy keep the robitussin dm all the way on the top counter instead of the bottom .. keep the cookies on the bottom

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It's really simple. You are willing to give products with zero proof of efficacy and I do mean zero. There is no proof they work. These products have real side effects. So explain the upside to me. I just don't get it. Why would you do it?. Not only that, you leave yourself open to huge liability as they should only bu used under the supervision of a physician, which rules out you and me.

tomato, tomatoe, thats it

farmadiazepine said:

tomato, tomatoe, thats it

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No, you are willing to risk harming your patients with proof of helping them. Think snake oil.... Honey and a vaporizer work just as well and nobody gets sick.... Did you really care about what the science says or do just go by anecdotal (read non-existent) evidence.

I have a very reputable peds office that will dose bromfed dm to anyone 6 months and older. I've spoken to them as well as the parents using it and they claim excellent results. The FDA recommendation is based on self-treatment. When prescribed under the supervision with a healthcare professional, I don't see a problem with it.

This is what I find myself doing at work:
Zyrtec, Zyrtec, Claritin, Zyrtec, Claritin, Claritin, Zyrtec... Runny nose --> post nasal drip --> cough --> Zyrtec, Zyrtec,
Claritin, Zyrtec, Claritin, Claritin, Zyrtec... Cough --> post nasal drip --> Zyrtec, Zyrtec, Claritin, Zyrtec, Claritin, Claritin...

PharmD RPh said:

I have a very reputable peds office that will dose bromfed dm to anyone 6 months and older. I've spoken to them as well as the parents using it and they claim excellent results. The FDA recommendation is based on self-treatment. When prescribed under the supervision with a healthcare professional, I don't see a problem with it.

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Under the supervision of a physician, not a pharmacist. More anecdotal evidence.

farmadiazepine said:

does the article mention if the children admitted were taking cold/cough products due to physician/pharmacist/healthcare worker recommendation, or were parents just giving whatever meds to their kids without asking for advice.

these articles are a joke bro, take with a grain of salt, not all variables are accounted for, so many things are missed.

didn't this article just say most of it was due to unsupervised ingestion? how about mommy and daddy keep the robitussin dm all the way on the top counter instead of the bottom .. keep the cookies on the bottom

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Both the FDA and AAP disagree with you. I will stick with the AAP. When they recommend these products, so will I.

Old Timer said:

Both the FDA and AAP disagree with you. I will stick with the AAP. When they recommend these products, so will I.

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Good to hear. That is why these other organizations exist. To ensure proper education for all people regardless of their chosen speciality or lack thereof.

i'm the same with Old Timer, I do not recommend products outside the dosing range. If the pediatrician says okay, then I'll show you where they are in the store. Thats as far as I go. Efficacy is questionable, adverse events are real and if a kid gets hurt, ill or injured, your ass will be on the line, its not like something happening to an adult. When a kid gets hurt they throw the book at you.

[YOUTUBE]http://www.youtube.com/watch?v=wd-EBG3a7jU[/YOUTUBE]

asthma, cancer, broken leg...tussin

RxPal said:

I am a relatively new pharmacist, so when FDA recommends against self-treatment with OTC cough products for patients under 4 years of age I conveyed that message to my patients. But an older pharmacist who I work with does not follow that recommendation at all. When a mother complains to him about her one-year-old having cough, the pharmacist would recommend Robitussin and come up with a dosing schedule for the patient. And that's even after the mother has told the pharmacist that her doctor warned her against using OTC cough medicine in a kid this young.

Do you still recommend OTC products for patients younger than four years of age for cough relief?

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This pharmacist is an idiot. Probably doesn't remember chit from pharmacy school and darn sure nothing new.

The guidlines are there for a reason. I absolutly go by them with customers as well as with my own children.

Kansas Pharmer said:

Honestly, I am not a pharmacist so take this with a grain a salt. But, that being said, I personally would....

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Best quote ever on SDN and our second addition to the SDN hall of shame in the last 24 hours!!!! Is this kind of like staying at a Holiday Inn? I have a question about my medication. Oh so your a Pharmacist? Nope, but I did sleep at a Holiday Inn last night.

I love SDN! A Pharmacist asks a question of other Pharmacists and the first reply is from a Pre-Pharmacy student. Great comedy here on SDN!

MountainPharmD said:

Best quote ever on SDN and our second addition to the SDN hall of shame in the last 24 hours!!!! Is this kind of like staying at a Holiday Inn? I have a question about my medication. Oh so your a Pharmacist? Nope, but I did sleep at a Holiday Inn last night.

I love SDN! A Pharmacist asks a question of other Pharmacists and the first reply is from a Pre-Pharmacy student. Great comedy here on SDN!

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All bow to the almighty Mountain!!! I notice you gave the same exact advice I did. YET, I have not spent 6 years and $150k in school yet. Hmmm... Looks like your education was well spent.

Kansas Pharmer said:

All bow to the almighty Mountain!!! I notice you gave the same exact advice I did. YET, I have not spent 6 years and $150k in school yet. Hmmm... Looks like your education was well spent.

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"gave the same exact advice I did"

"follow the guidelines"

Wow, you shouldn't even bother with pharmacy school, you're so smart already. Since you came up with the same conclusion, you clearly have all the knowledge Mountain does.

Ackj said:

"gave the same exact advice I did"

"follow the guidelines"

Wow, you shouldn't even bother with pharmacy school, you're so smart already. Since you came up with the same conclusion, you clearly have all the knowledge Mountain does.

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Oh, I (unlike you or Mountain) dont have an ego too large to not know what I dont know. I still have many years of learning to complete and even more years of experience after that.

The point of my post is if there are any questions about advice to give a client, there are resources much more learned that we are/will be. Any kind of specialty population should be referenced with said specialty's board organization.

Additionally, there is absolutely no reason to be condescending. I thought the point of this board was the free exchange of ideas and helping each other out. Instead, people such as yourself and Mountain seem to think that you are better than other people. You two must be compensating for lack of something else...

owlegrad said:

That line really did crack me up. I am going to use that and soon.

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Just make sure you use a grammar/spelling nazi first. Spell-check doesn't catch homophone errors.

Farmercyst said:

Just make sure you use a grammar/spelling nazi first. Spell-check doesn't catch homophone errors.

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What did you just call me?!?!

owlegrad said:

Did I make such a mistake? Am I at risk for making such a mistake?

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Not to make you self-conscious, but it happens quite frequently. In this case, I was referring to Mountain. You just happened to quote Mountain. Since you said you'd use the quote in the future, I thought you might want to correct the spelling before you used it.

It should be you're (you are) not your (it belongs to you).

Farmercyst said:

Not to make you self-conscious, but it happens quite frequently. In this case, I was referring to Mountain. You just happened to quote Mountain. Since you said you'd use the quote in the future, I thought you might want to correct the spelling before you used it.

It should be you're (you are) not your (it belongs to you).

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Mountain's terrible with "too", too. He always misspells it as "to" instead of "too".

Its very confusing to. I cant follow what hes sayin and then what your sayin to.

MountainPharmD said:

What did you just call me?!?!

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He said you can't type or spell or string together a grammatically correct sentence for chit.
Homophone

Old Timer said:

He said you can't type or spell or string together a grammatically correct sentence for chit.
Homophone

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Yeah dude I know. I was just making a joke.

7th grade Unified Studies in Junior High is where it all went wrong for me. I had a terrible teacher who I did not get along with. She made us do this horrible sentence diagramming which I refused to do or learn. I have suffered ever since.

Seriously? Give me a break. I know the proper usage of to, too, your, you're, there, and their. I get to typing fast and make a mistake sometimes. I didn't know we had a bunch of sentence diagramming geniuses on here. Maybe I should revisit 7th grade. Oh and who ever knew what a homophone was without looking it up is a total nerd. Mrs. Barr in my 7th grade class would be proud of you...NERD!!!!

MountainPharmD said:

Yeah dude I know. I was just making a joke.

7th grade Unified Studies in Junior High is where it all went wrong for me. I had a terrible teacher who I did not get along with. She made us do this horrible sentence diagramming which I refused to do or learn. I have suffered ever since.

Seriously? Give me a break. I know the proper usage of to, too, your, you're, there, and their. I get to typing fast and make a mistake sometimes. I didn’t know we had a bunch of sentence diagramming geniuses on here. Maybe I should revisit 7th grade. Oh and who ever knew what a homophone was without looking it up is a total nerd. Mrs. Barr in my 7th grade class would be proud of you...NERD!!!!

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It takes two minutes to learn. It's not too difficult. Now you try.

http://www.studygs.net/vocab/too.htm

I spend a lot of time in the OTC aisle, and believe it or not , I get a lot of patients coming to me from their pediatrician with information about what active ingredients to take. In that case I usually explain what the product is and how it works, give safety tips, etc. If there is no ped recommendation, I restrict recommendations for children under 4 to a very small list of products, ibuprofen and apap usually, and give nonpharmacologic recommendations. There is occasionally a rare situation where I will recommend DM to the parent of a child in the 3-4 ish range, if they are INSISTENT, and will not settle for anything less, however I always follow it up with some disclaimers, and a hefty dose of education.

I would under no circumstances recommend a "combo" product, pseudoephedrine, or antihistamines for use in children under 4, except with specific written pediatrician instructions, as clearly their risks outweigh their benefits.

Most peds rec situations I run across are for apap/ibuprofen, (also some dextromethorphan) specific dosing regimens. I usually just help the parent figure out how to make up the dose.

Imho it's a clinical judgement call on each and every one of these. I don't have much experience to make clinical judgements at this point, so I trust the FDA, and clearly "risks outweigh benefits" on cough and cold products in children < 4, for the general population, so that's the rule i go by 99% of the time. I dont think pharmacists should be black and white in their thinking, but, they should listen to common sense at the same time.

DYSF777 said:

It takes two minutes to learn. It's not too difficult. Now you try.

http://www.studygs.net/vocab/too.htm

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I love your signature. AboveLessWorthy was a classic troll poster. I laugh everytime I read your sig!

I Missed two on on the quiz. That was cool I actually learned something. I am telling ya 7th grade Unified Studies is where it all went wrong for me (in the grammer department that is!).

MountainPharmD said:

(in the grammer department that is!).

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You mean grammar, right?

pharaday said:

You mean grammar, right?

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Oh crap I suck!

DYSF777 said:

It takes two minutes to learn. It's not too difficult. Now you try.

http://www.studygs.net/vocab/too.htm

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Thanks, after further review of this website I have a freaking headache. Dependent clauses, restrictive appositives, misplaced/dangling modifiers, what the hell! I really should have paid more attention in grade school.

There are many different types of nouns. In fact, grammarians have developed a whole series of noun types, including the proper noun, the common noun, the concrete noun, the abstract noun, the countable noun (also called the count noun), the non-countable noun (also called the mass noun), and the collective noun. You should note that a noun will belong to more than one type: it will be proper or common, abstract or concrete, and countable or non-countable or collective.

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Reading this I want to cry. I am having flashbacks to one of the most awkward times in my life......7th grade. Is it to late for me to learn all this? I think i need to pull a Billy Madison and go back.

MountainPharmD said:

Reading this I want to cry. I am having flashbacks to one of the most awkward times in my life......7th grade. Is it to late for me to learn all this? I think i need to pull a Billy Madison and go back.

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7th grade we were diagramming sentences. I forget how to do most of it anymore. Vertical line between subject and predicate line angled downward (I think) for prepositions, objects of prepositions on a line horizontal extending from the preposition. All sorts of useless stuff.

You really want to go against the FDA on a stupid gamble like this? All I can say is that I hope you have good liability insurance.

Kansas Pharmer said:

I thought the point of this board was the free exchange of ideas and helping each other out.

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Boy, did you get on the wrong f---ing message board you treehugging pansy.