Cough and Cold Preparation Toxicity Medication

  • Author: Laleh Gharahbaghian, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Aug 1, 2011
 

Antidotes

Class Summary

These agents are used in the management of poisoning and overdose, prevention of toxic effects, and metabolic disorders in which toxic substances accrue. Mechanisms of action vary (eg, antagonists, toxin transformation, altered metabolism, chelation, directed antibodies).

View full drug information

Physostigmine (Antilirium)

 

Use of physostigmine in antihistamine poisoning is extremely controversial, and it should not be given unless directed by a regional poison control center or in direct consultation with a toxicologist. Physostigmine, an anticholinesterase, may be indicated in the suspected anticholinergic poisoning for its therapeutic and diagnostic value.

View full drug information

Diphenhydramine (Benadryl)

 

DOC for initial treatment of acute dystonia or akathisia not caused by antihistamines. Use diazepam for treatment of acute dystonia secondary to antihistamines.

View full drug information

Diazepam (Valium)

 

For treatment of acute dystonic reactions caused by antihistamines. Also indicated for muscle activity and agitation associated with serotonin syndrome. Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

View full drug information

Lorazepam (Ativan)

 

Used to treat seizures. Sedative hypnotic with short onset of effects and relatively long half-life. By increasing the action of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. Important to monitor patient's blood pressure after administering dose. Adjust prn.

View full drug information

Naloxone (Narcan)

 

Used to treat opioid overdose. Prevents or reverses opioid effects (hypotension, respiratory depression, sedation), possibly by displacing opiates from their receptors. Possesses short onset of action (2 min), duration of action is 30-60 min, and half-life is 1 h. May also be administered via endotracheal tube at 2-2.5 times the IV dose.

Next

Decontamination agents

Class Summary

Consider activated charcoal decontamination in any patient who presents within 4 hours of ingestion.

View full drug information

Activated charcoal (Actidose-Aqua, Liqui-Char)

 

Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Laleh Gharahbaghian, MD  Co-Director, Emergency Ultrasound Fellowship, Associate Director, Emergency Ultrasound, Clinical Instructor, Division of Emergency Medicine, Stanford University Medical Center

Laleh Gharahbaghian, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Lopez, MD  Attending Physician, Department of Emergency Medicine, Queen of the Valley Medical Center, Sutter Solano Medical Center

Nicholas Lopez, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Jennifer A Oman, MD  Associate Clinical Professor, Department of Emergency Medicine, University of California, Irvine, School of Medicine

Jennifer A Oman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William T Zempsky, MD  Associate Director, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

William T Zempsky, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

  1. [Best Evidence] [Guideline] Bolser DC. Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):238S-249S. [Medline]. [Full Text].

  2. Sharfstein JM, North M, Serwint JR. Over the counter but no longer under the radar--pediatric cough and cold medications. N Engl J Med. Dec 6 2007;357(23):2321-4. [Medline].

  3. Revised product labels for pediatric over-the-counter cough and cold medicines. MMWR Morb Mortal Wkly Rep. Oct 31 2008;57(43):1180. [Medline]. [Full Text].

  4. Kernan WN, Viscoli CM, Brass LM, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med. Dec 21 2000;343(25):1826-32. [Medline].

  5. Bronstein AC, Spyker DA, Cantilena JR LR, et al. 2007 Annual Report of the American Association of Poison Control Centers National Poison Data System (NPDS): 25th Annual Report. AAPCC. Available at http://www.aapcc.org/DNN/Portals/0/NPDS%20reports/2008%20AAPCC%20Annual%20Report.pdf. Accessed May 20, 2009.

  6. Bryner JK, Wang UK, Hui JW, Bedodo M, MacDougall C, Anderson IB. Dextromethorphan abuse in adolescence: an increasing trend: 1999-2004. Arch Pediatr Adolesc Med. Dec 2006;160(12):1217-22. [Medline].

  7. [Guideline] Pediatric basic and advanced life support. In: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation 2005 Nov 29;112(22 Suppl):III73-90. [Full Text].

  8. American Academy of Pediatrics. Use of codeine- and dextromethorphan-containing cough remedies in children. American Academy of Pediatrics. Committee on Drugs. Pediatrics. Jun 1997;99(6):918-20. [Medline].

  9. Cardoni AA, Mofenson HC, George DJ. Toxicological management: dextromethorphan. In: Poisindex. 1998.

  10. Chien C, Marriott JL, Ashby K, Ozanne-Smith J. Unintentional ingestion of over the counter medications in children less than 5 years old. J Paediatr Child Health. May-Jun 2003;39(4):264-9. [Medline].

  11. Dart RC, Paul IM, Bond GR, Winston DC, Manoguerra AS, Palmer RB, et al. Pediatric fatalities associated with over the counter (nonprescription) cough and cold medications. Ann Emerg Med. Apr 2009;53(4):411-7. [Medline].

  12. Delorio NM. Cerebral infarcts in a pediatric patient secondary to phenylpropanolamine, a recalled medication. J Emerg Med. Apr 2004;26(3):305-7. [Medline].

  13. Fine JS. Pediatric Principles. 6th ed. 1995:1687-97.

  14. Gadomski A, Horton L. The need for rational therapeutics in the use of cough and cold medicine in infants. Pediatrics. Apr 1992;89(4 Pt 2):774-6. [Medline].

  15. Goetz CM, Lopez G, Dean BS, Krenzelok EP. Accidental childhood death from diphenhydramine overdosage. Am J Emerg Med. Jul 1990;8(4):321-2. [Medline].

  16. Gunn VL, Taha SH, Liebelt EL, Serwint JR. Toxicity of over-the-counter cough and cold medications. Pediatrics. Sep 2001;108(3):E52. [Medline].

  17. Hestand HE, Teske DW. Diphenhydramine hydrochloride intoxication. J Pediatr. Jun 1977;90(6):1017-8. [Medline].

  18. Hubel PI, Barlas D, Caraccio TR. Pediatric poisonings. In: Emergency Toxicology. 2nd ed. 1998:209-19.

  19. Huott MA, Storrow AB. A survey of adolescents' knowledge regarding toxicity of over-the-counter medications. Acad Emerg Med. Mar 1997;4(3):214-8. [Medline].

  20. Infant deaths associated with cough and cold medications--two states, 2005. MMWR Morb Mortal Wkly Rep. Jan 12 2007;56(1):1-4. [Medline]. [Full Text].

  21. Jones J, Dougherty J, Cannon L. Diphenhydramine-induced toxic psychosis. Am J Emerg Med. Jul 1986;4(4):369-71. [Medline].

  22. Katcher ML. Cold, cough, and allergy medications: uses and abuses. Pediatr Rev. Jan 1996;17(1):12-7. [Medline].

  23. Koppel C, Ibe K, Tenczer J. Clinical symptomatology of diphenhydramine overdose: an evaluation of 136 cases in 1982 to 1985. J Toxicol Clin Toxicol. 1987;25(1-2):53-70. [Medline].

  24. Lindsay CA, Williams GD, Levin DL. Fatal adult respiratory distress syndrome after diphenhydramine toxicity in a child: a case report. Crit Care Med. Apr 1995;23(4):777-81. [Medline].

  25. Miller SC. Coricidin HBP cough and cold addiction. J Am Acad Child Adolesc Psychiatry. Jun 2005;44(6):509-10. [Medline].

  26. Pruitt AW. Rational use of cold and cough preparations. Pediatr Ann. Apr 1985;14(4):289-91. [Medline].

  27. Roberge RJ, Hirani KH, Rowland PL 3rd, Berkeley R, Krenzelok EP. Dextromethorphan- and pseudoephedrine-induced agitated psychosis and ataxia: case report. J Emerg Med. Mar-Apr 1999;17(2):285-8. [Medline].

  28. Rumack BH, Normann SA. Toxicologic management: antihistamine/decongestant. In: Poisindex. 1997.

  29. Schwartz RH. Adolescent abuse of dextromethorphan. Clin Pediatr (Phila). Sep 2005;44(7):565-8. [Medline].

  30. Simon HK, Weinkle DA. Over-the-counter medications. Do parents give what they intend to give?. Arch Pediatr Adolesc Med. Jul 1997;151(7):654-6. [Medline].

  31. Tenenbein M. General management principles for poisoning. In: Pediatric Emergency Medicine: Concepts and Clinical Practice. 2nd ed. 1997:527-34.

  32. von Muhlendahl KE, Scherf-Rahne B, Krienke EG, Baukloh G. Codeine intoxication in childhood. Lancet. Aug 7 1976;2(7980):303-5. [Medline].

  33. Wasserman GS, Mydler TT, Sharma V. Specific toxins. In: Pediatric Emergency Medicine: Concepts and Clinical Practice. 2nd ed. 1997:535-567.

  34. Wyngaarden JB, Seevers MH. The toxic effects of antihistaminic drugs. J Am Med Assoc. Feb 3 1951;145(5):277-82. [Medline].

 
Previous
Next
 
Dextromethorphan.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.