Cough and Cold Remedies: Emerging Trends in Unsupervised Exposures

Cough and cold remedies are some of the more common OTC medications that can lead to unsupervised exposures requiring trips to the emergency department.

Liquid and solid OTC medications account for 12.4% and 22.3% of unsupervised medication exposures necessitating a visit to the emergency room, respectively.

Cough and cold remedies, acetaminophen, ibuprofen, and diphenhydramine make up more than 90% of liquid OTC exposures.

Specifically, cough and cold remedies were implicated in 27.5% of OTC liquid exposure visits, followed by ibuprofen and diphenhydramine. Acetaminophen, meanwhile, was implicated in 32.9% of OTC liquid exposure visits.

One in every 5 children seen in the emergency department for accidental medication exposure needs to be admitted.

The journal Pediatrics recently published a study connecting adoption of child-resistant packaging and fewer pediatric unsupervised medication exposures.

Emergency department visits for unsupervised medication exposures increased by 5.7% annually on average from 2004 to 2010 and then decreased by 6.7% over the next 3 years.

The decrease in overall emergency department visits trended with the adoption of child-resistant packaging for liquids.

Most pediatric exposures to liquids involved pediatric products. After age 2, children are able to disable the predominant form of child-resistant packaging (safety caps) if caregivers fail to fully re-secure the cap after each use.

Many manufacturers have adopted flow restrictors and unit dosing for liquid products, which are additional barriers to overdose.

The FDA recommends expanding use of flow restrictors and safety packaging to limit pediatric exposures to all OTC pediatric liquid acetaminophen-containing products.

Child-resistant packaging is rare for solid products intended for adults, and exposures to solid medications lacking child-resistant packaging have increased.

Ten solid medications account for one-third of unsupervised medication exposures, but the remaining two-thirds of exposures have been linked to 260 other solid medications. Selecting interventions for such a wide range of products is challenging.

Attempts to increase the safety of solid medications are often foiled by older adults’ tendency to place pills in unsecured weekly pill organizers.

The study authors found that 80% of prescription solid exposure visits involved children younger than 2 years, and 42% were younger than 1. Children under the age of 2 are highly unlikely to undermine existing safety mechanisms.

The public-private partnership PRevention of Overdoses and Treatment Errors in Children Taskforce (PROTECT) initiative aims to develop new safety mechanisms, educate caregivers on prevention, and balance efficacy and feasibility of safety mechanisms.