Expectorantsare claimed to promote expulsion of bronchial
secretions, but there is no evidence that any drug can
specifically facilitate expectoration.
Compound cough preparationsfor children are on sale
to the public but should not be used in children under
6 years; the rationale for some is dubious. Care should be
taken to give the correct dose and to not use more than one
preparation at a time.MHRA/CHM advice (March 2008 and February 2009)
Children under 6 years should not be given over-the-counter
cough and cold medicines containing the following
ingredients:
.brompheniramine, chlorphenamine maleate p. 178 ,
diphenhydramine, doxylamine, promethazine, or
triprolidine (antihistamines);
.dextromethorphan or pholcodine (cough suppressants);
.guaifenesin or ipecacuanha (expectorants);
.Phenylephrine hydrochloride p. 125 , pseudoephedrine
hydrochloride p. 696 , ephedrine hydrochloride p. 695 ,
oxymetazoline, or xylometazoline hydrochloride p. 696
(decongestants).
Over-the-counter cough and cold medicines can be
considered for children aged 6 – 12 years after basic principles
of best care have been tried, but treatment should be
restricted tofive days or less. Children should not be given
more than 1 cough or cold preparation at a time because
different brands may contain the same active ingredient;
care should be taken to give the correct dose.Nasal decongestants, systemic
Nasal congestion in children due to allergic or vasomotor
rhinitis should be treated with oral antihistamines, topical
nasal preparations containing corticosteroids, or topical
decongestants.
There is little evidence to support the use of systemic
decongestants in children.
Pseudoephedrine hydrochloride has few sympathomimetic
effects, and is commonly combined with other ingredients
(including antihistamines) in preparations intended for the
relief of cough and cold symptoms.COUGH AND COLD PREPARATIONS›COUGH
SUPPRESSANTSPholcodine
lINDICATIONS AND DOSE
Dry cough
▶BY MOUTH USING LINCTUS
▶Child 6–11 years: 2 – 5 mg 3 – 4 times a day
▶Child 12–17 years: 5 – 10 mg 3 – 4 times a dayIMPORTANT SAFETY INFORMATION
MHRA/CHM ADVICE (MARCH 2008 AND FEBRUARY 2009) OVER-
THE-COUNTER COUGH AND COLD MEDICINES FOR CHILDREN
Children under 6 years should not be given over-the-
counter cough and cold medicines containing
pholcodine (cough suppressant).
Over-the-counter cough and cold medicines can be
considered for children aged 6 – 12 years after basic
principles of best care have been tried, but treatment
should be restricted to 5 days or less. Children should
not be given more than 1 cough or cold preparation at a
time because different brands may contain the same
active ingredient; care should be taken to give the
correct dose.lCONTRA-INDICATIONSBronchiectasis.bronchiolitis.
chronic bronchitis.patients at risk of respiratory failurelCAUTIONSAsthma.chronic cough.persistent cough.
productive cough
lINTERACTIONS→Appendix 1 : pholcodine
lSIDE-EFFECTSAgitation.confusion.constipation.
dizziness.drowsiness.gastrointestinal disorder.nausea.
skin reactions.sputum retention.vomiting
lPREGNANCYManufacturer advises avoid unless potential
benefit outweighs risk.
lBREAST FEEDINGManufacturer advises avoid unless
potential benefit outweighs risk—no information
available.
lHEPATIC IMPAIRMENTAvoid in hepatic impairment.
lRENAL IMPAIRMENTUse with caution in renal impairment.
Avoid in severe renal impairment.
lPRESCRIBING AND DISPENSING INFORMATIONPholcodine
is not generally recommended for children.
Flavours of oral liquid formulations may include orange.
When prepared extemporaneously, the BP states
Pholcodine Linctus, BP consists of pholcodine 5 mg/ 5 mL
in a suitableflavoured vehicle, containing citric acid
monohydrate 1 % and Pholcodine Linctus, Strong, BP
consists of pholcodine 10 mg/ 5 mL in a suitableflavoured
vehicle, containing citric acid monohydrate 2 %lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Oral solution
▶Pholcodine (Non-proprietary)
Pholcodine 1 mg per 1 mlPholcodine 5 mg/ 5 ml linctus| 200 mlp
£ 1. 23 – £ 1. 32 DT = £ 1. 32 m
Pholcodine 5 mg/ 5 ml linctus sugar free sugar-free| 200 mlp£ 1. 34
DT = £ 1. 34 msugar-free| 2000 mlp£ 13. 40 m
Pholcodine 2 mg per 1 mlPholcodine 10 mg/ 5 ml linctus strong sugar
free sugar-free| 2000 mlp£ 9. 88 DT = £ 9. 88 m
Pholcodine 10 mg/ 5 ml linctus strong| 200 mlp£ 1. 67 m
▶Covonia Dry Cough(Thornton & Ross Ltd)
Pholcodine 1 mg per 1 mlCovonia Dry Cough Sugar Free Formula
5 mg/ 5 ml oral solution sugar-free| 150 mlp£ 3. 30 m
▶Galenphol(Thornton & Ross Ltd)
Pholcodine 1 mg per 1 mlGalenphol 5 mg/ 5 ml linctus sugar-free|
2000 mlp£ 8. 50 m
Pholcodine 2 mg per 1 mlGalenphol Strong 10 mg/ 5 ml linctus sugar-
free| 2000 mlp£ 9. 88 DT = £ 9. 88 m
▶Pavacol-D(Alliance Pharmaceuticals Ltd)
Pholcodine 1 mg per 1 mlPavacol-D 5 mg/ 5 ml mixture sugar-free|
150 mlp£ 1. 69 msugar-free| 300 mlp£ 2. 55 mCOUGH AND COLD PREPARATIONS›OTHER
Citric acid
(Formulated as Simple Linctus)
lINDICATIONS AND DOSE
Cough
▶BY MOUTH
▶Child 1 month–11 years: 5 – 10 mL 3 – 4 times a day, this
dose is for Simple Linctus, Paediatric, BP ( 0. 625 %)
Cough
▶BY MOUTH
▶Child 12–17 years: 5 mL 3 – 4 times a day, this dose is for
Simple Linctus, BP ( 2. 5 %)lPRESCRIBING AND DISPENSING INFORMATIONFlavours of
oral liquid formulations may include anise.
When prepared extemporaneously, the BP states Simple
Linctus, Paediatric, BP consists of citric acid monohydrate
0. 625 % and Simple Linctus, BP consists of citric acid
monohydrate 2. 5 %, both in a suitable vehicle with an anise
flavour.188 Cough and congestion BNFC 2018 – 2019
Respiratory system3