Cold Medicines Containing Opioids

The U.S Food and Drug Administration expanded restrictions in January 2018 announcing prescription cough medicines which contained either hydrocodone or codeine can only be labeled for use in adults 18 years of age and older due to risks of opioid products outweighing any potential benefits, this Pen State College study supports the decision.

The study stems from a larger safety surveillance project from the Rocky Mountain Poison and Drug Center Denver which was investigating adverse events associated with over the counter cold and cough medications. The surveillance system project detected serious side effects, especially among children who ingested prescription cold and cough medications that combined over the counter ingredients with opioid medications. Despite public attention to codeine medications many of adverse events were more likely to be linked to prescriptions containing hydrocodone, which led researchers to conduct the investigation.

Using surveillance data researchers analyzed adverse events that were associated with cold and cough medications including opioid and over the counter ingredients, data included 98 cases potentially related to hydrocodone or codeine, in most cases drugs were ingested without supervision or were prescribed. Sedative properties were frequently reported, but more common with hydrocodone. Lethargy, drowsiness, and respiratory depression was reported in 86% of hydrocodone cases and 61% of codeine cases. 3 deaths were reported that were associated with combining hydrocodone with an antihistamine.

Data from this adverse event profile of hydrocodone cold and cough medication appears more concerning than that of codeine, and healthcare providers should reevaluate prescriptions before giving any, especially to children. Supportive measures such as ibuprofen and acetaminophen are often enough to get through an illness combined with honey, lemon, garlic and vitamin C and D supplements, vapor rubs, humidifiers, rest, and nasal saline. Most people usually don’t need prescription medications for colds and should be encouraged to go a more natural route and help stop the prevalence of antibiotic drug resistance, and adverse opioid side effects.