Using of codeine- and dextromethorphan-containing cough syrups in pediatrics

S. Segal, S. N. Cohen, J. Freeman

Research output: Contribution to journalArticlepeer-review


Data to establish dosages for the safe and effective use of codeine, dextromethorphan, and other antitussives in children - particularly in infants - are lacking, even though these agents are widely used and prescribed. Symptomatic treatment may mask serious underlying disease and may be hazardous, particularly in infants whose small airways can be easily plugged with tenacious mucus. Patients with chronic pulmonary disease (e.g., asthma and cystic fibrosis) who produce excessive and thickened secretions are at high risk for this potentially fatal effect of antitussives. The few available data suggest a relatively low therapeutic ratio for codeine in infants. Centrally active antitussive agents should rarely be prescribed for children less than 6 to 12 months old. Risk of overdosage is enhanced when medication is administered by parents for symptomatic relief. Packaging in a container with an integral, age-specific, calibrated dispenser would diminish this risk. Physicians caring for children should evaluate the risk/benefit ratio before prescribing or recommending one of the irrational mixtures such as the antitussive-expectorant (often plus an antihistamine and/or sympathomimetic) combinations currently in vogue. These products cannot be considered placebos because the ingredients are pharmacologically active, at least in the relatively large doses which may be administered to infants and young children. When a valid indication exists for antitussive therapy, such as a nonproductive cough that seriously disturbs sleep or school attendance, either codeine or dextromethorphan, which appear to be equiactive, should be recommended in the form of single-ingredient preparations. When either of these agents is prescribed, instruction should be given to the pharmacist to dispense the medication in a safety-capped container to prevent accidental poisoning. By educating patients and parents, the physician will aid in diminishing demands to prescribe antitussive drugs.

Original languageEnglish (US)
Pages (from-to)118-122
Number of pages5
Issue number1
StatePublished - Jan 1 1978

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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