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08-16-2004, 11:03 PM
Ask Dr. H | Cold-product ingredient DM may do little for coughs
By Mitchell Hecht
Knight Ridder News Service
Question: My friend told me that a study just published by Penn State showed Robitussin DM cough syrup to be no better than sugar syrup. Can you tell me more?
A: Actually, the study showed that dextromethorphan (DM), the active ingredient in over-the-counter cold products, was no better than placebo in improving nighttime cough, specifically in children.
What you might not know is that although DM has been sold for 50 years as the safer, nonaddictive cousin of codeine, the evidence that it works better than placebo is weak, at best. Most of the early studies were not properly designed against a placebo or they used an artificially induced cough. Four studies, two each in the 1960s and 1990s, showed that DM was superior to placebo, although the latter studies were performed by Procter and Gamble, maker of the Vicks line of cold and cough formulas. Four more studies, all done in the 1990s, showed DM was no better than placebo.
So why is DM used when its benefit is inconsistent? First of all, there's a 50-year history of its recommendation by doctors and textbooks. Secondly, there's lots of direct-to-consumer advertising for cough and cold products. Lastly, what else does a parent have available to safely relieve a child's cough?
I haven't found DM to be nearly as effective as codeine or hydrocodone-based cough syrups. But I wouldn't recommend those medications for use in children, unless a pediatrician OKs it. Still, over-the-counter cough syrups usually include guaifenesin to loosen thickened mucus. One reason I've found for failure is that not enough cough syrup is being used. Every four hours as needed means exactly that.
Of course, another reason why you may continue to cough is the possible need for an antibiotic. So if you're running a fever, coughing up green/brown/bloody sputum, or getting short of breath, it's important to see your doctor. Let's be sure it's a cold and not bacterial bronchitis or pneumonia.
If you're under a doctor's supervision, codeine or hydrocodone-based cough syrup may be more effective if you're still coughing or you're having pain with coughing. It may be sedating, but that can help you get a good night's sleep. For those over age 10 who simply can't tolerate codeine or hydrocodone, continue taking Robitussin DM every four hours as needed and ask your doctor to consider Tessalon Perles. They're tiny yellow pearllike pills swallowed with a tall glass of water to numb the nerves that control the cough reflex.
Link: http://www.philly.com/mld/philly/living/he.../9410977.htm?1c (http://www.philly.com/mld/philly/living/health/9410977.htm?1c)
By Mitchell Hecht
Knight Ridder News Service
Question: My friend told me that a study just published by Penn State showed Robitussin DM cough syrup to be no better than sugar syrup. Can you tell me more?
A: Actually, the study showed that dextromethorphan (DM), the active ingredient in over-the-counter cold products, was no better than placebo in improving nighttime cough, specifically in children.
What you might not know is that although DM has been sold for 50 years as the safer, nonaddictive cousin of codeine, the evidence that it works better than placebo is weak, at best. Most of the early studies were not properly designed against a placebo or they used an artificially induced cough. Four studies, two each in the 1960s and 1990s, showed that DM was superior to placebo, although the latter studies were performed by Procter and Gamble, maker of the Vicks line of cold and cough formulas. Four more studies, all done in the 1990s, showed DM was no better than placebo.
So why is DM used when its benefit is inconsistent? First of all, there's a 50-year history of its recommendation by doctors and textbooks. Secondly, there's lots of direct-to-consumer advertising for cough and cold products. Lastly, what else does a parent have available to safely relieve a child's cough?
I haven't found DM to be nearly as effective as codeine or hydrocodone-based cough syrups. But I wouldn't recommend those medications for use in children, unless a pediatrician OKs it. Still, over-the-counter cough syrups usually include guaifenesin to loosen thickened mucus. One reason I've found for failure is that not enough cough syrup is being used. Every four hours as needed means exactly that.
Of course, another reason why you may continue to cough is the possible need for an antibiotic. So if you're running a fever, coughing up green/brown/bloody sputum, or getting short of breath, it's important to see your doctor. Let's be sure it's a cold and not bacterial bronchitis or pneumonia.
If you're under a doctor's supervision, codeine or hydrocodone-based cough syrup may be more effective if you're still coughing or you're having pain with coughing. It may be sedating, but that can help you get a good night's sleep. For those over age 10 who simply can't tolerate codeine or hydrocodone, continue taking Robitussin DM every four hours as needed and ask your doctor to consider Tessalon Perles. They're tiny yellow pearllike pills swallowed with a tall glass of water to numb the nerves that control the cough reflex.
Link: http://www.philly.com/mld/philly/living/he.../9410977.htm?1c (http://www.philly.com/mld/philly/living/health/9410977.htm?1c)