Cough syrups, especially those made by Indian pharma firms, are in the news.
In 2022, The Gambia reported that 70 children died allegedly because of cough syrup made by Haryana-based Maiden Pharma.
A few weeks later, Uzbekistan reported that 18 children died allegedly because of cough syrup made by another Indian pharma brand, Noida-based Marion Biotech.
So now arises the question: How safe are cough syrups really?
And then there are the questions parents need to be asking too. “Are all cough syrups the same?” “What are the different types of cough syrups?” “Should we consult a doctor before giving our child cough syrup or is it okay to buy them over the counter?
Today, there’s a cough syrup for every type of cough — wet cough, dry cough, paroxysmal cough (violent coughing fit), croup cough (barking-like cough) — and there are hundreds of combinations of drugs that make up these various cough syrups.
Chlorpheniramine, phenylephrine, dextromethorphan, codeine, levosalbutamol, salbutamol, terbutaline, deriphyllin, ambroxol, guaifenesin, cetirizine, montelukast, levocetirizine, diphenhydramine and so on — the list of drugs to treat a cough is nearly endless.
Is cough syrup necessary for children?
To answer this question (and many others), South First spoke to two paediatricians who have probably seen a gazillion coughing children in their careers.
“Strictly no cough syrup should be given to infants and toddlers; in fact, it shouldn’t be given to anyone under six year of age. Try home remedies instead, like honey or a drop of lemon,” advised Dr Sindhura Munukuntla, consultant paediatrician, Yashoda Hospitals, Hyderabad.
Chennai-based Dr Binu Ninan, head of the Pediatrics & Neonatology Department at MGM Healthcare, said, “Many parents give cough syrup as the solution for cough, but these syrups never cure the problem. It is only a symptomatic treatment, not a curative one.”
A tad too late
Based on the experience of both paediatricians, most parents tend to make a visit to the doctor’s office only after having given their child cough syrup for a few days.
“Parents often give the same medication that was previously prescribed for the child. What they don’t realise is that the symptoms are not always exactly the same as before. So they try previous medication first and if it doesn’t subside, then they come to the paediatrician,” said Dr Munukuntla.
And then there are parents who buy over-the-counter (OTC) cough syrups at the pharmacy. “The child may have been prescribed cough syrup in the past. The parents will just go across the counter and keep buying the same one. They just self-medicate, which is very dangerous, especially in children,” said Dr Ninan.
“Different coughs require different modalities of treatment, depending on the type of cough,” stated Dr Munukuntla, adding that parents often tend to assume that noisy breathing or spitting up of mucous is a sign of a cough and cold.
Wrong drug, wrong outcome
Various drugs work against different mechanisms that produce cough. Some break down the mucous, some decrease the secretions, some control the allergies, some open up the airways, and some suppress the cough.
Paediatricians prescribe cough syrups as per the cause of the cough. The consumption of different kinds of cough syrups or too much of cough syrup can lead to several complications.
“These kids may experience nausea, vomiting, drowsiness, constipation, irritability, breathlessness — it may even impact the heart and kidneys, increases the heart rate and do so much more damage to their small bodies,” said Dr Munukuntla.
“Many of these cough syrups contain an antihistamine, which is known to make children sleepy and cranky,” said Dr Ninan.
When is cough syrup needed?
The paediatricians caution that cough is most often only a symptom of a cold and that it helps the body clear the mucous out of the airway to protect the lungs.
“Cough works as a protective mechanism. Whenever something enters our body, we cough and remove it outside our body. If we don’t cough, the particle may go into the lungs, increasing the risk of a lung problem,” said Dr Munukuntla.
Dr Ninan went as far as to say that a cough actually protects the child. “All coughs don’t need treatment. Most usually go away in a week or two.” he said.
So when should parents worry about a cough?
“Chronic cough — this is when there is coughing for more than three weeks. In such cases, parents should visit the doctor, who may prescribe a cough syrup,” said Dr Ninan.
He added that 85 percent of the time, a cough syrup works as a placebo effect. Parents feel the need to do something and so they pressurise doctors to write a cough syrup prescription. When the child gets better, usually on their own, parents chalk it up to the effect of the cough syrup.
But scientifically speaking, “If you are looking at the controlled trial and effectiveness of it, none of it has worked. In 90 percent of cases of children with cough are because of a viral infection or fever, and we prescribe medication for fever,” said Dr Ninan.
Both the paediatricians agreed that one of the most effective treatments for a cough is honey. “Honey and lime are better than many of the cough syrups in the market today,” stated Dr Ninan.
Then which cough syrup to take?
The paediatricians added that cough syrups act as a sedative and most of them are cough suppressants. Parents feel good when the child isn’t coughing anymore, but this isn’t good as the cough is still inside the body.
They provided a quick guide to understand the role some drugs play in treating coughs:
- Antihistamines: Paediatricians may prescribe an antihistamine if it is an allergic cough. These work on the brain and reduce the cough reflex.
- Expectorants: Paediatricians may prescribe this when there is an increase in mucous production. These drugs make it easier to expel the mucous.
- Mucolytics: Paediatricians may prescribe this when the mucous is thick. These drugs break down the mucous and thin it out, making it less thick and sticky and easier to cough up.
Google for information, not medication
Google is not a doctor’s friend as the amount of information found on it is vast and sometimes incorrect. It’s important to source information, especially regarding health, from verified websites. But even then, Google should never be used for medication, said Dr Munukuntla.
Dr Ninan listed his advice to parents, “First thing, inform parents that cough is a symptom, not a disease. Second, all cough syrups are not the same — it may work for one type of cough but not for another. Third, OTC medicines are always dangerous for children. Fourth, get a prescription from a doctor — and remember, these are for one time only.”