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SafeMedicationUse Newsletter

Cough and Cold Preparations: Use with Care!


When we get a cough or cold, we often suffer through the symptoms, drink hot liquids, and try to get more rest. Sometimes, however, a bad cough prevents us from getting a good night's sleep. It can also lead to sore muscles in the chest and a sore throat. To ease our symptoms, we may reach for a cough and cold preparation from the medicine cabinet or buy something off the shelf at the pharmacy. Problem solved...or is it?

Not all cough and cold preparations are the same. To begin with, the form of these drugs can vary. Some are tablets, some are liquids or syrups, and others are lozenges. More importantly, cough and cold preparations may contain a variety of ingredients in different combinations. Two recent adult deaths in Quebec point to the need for care when selecting and taking cough and cold medicines. These deaths were linked to use of dextromethorphan (also known as DM), a cough suppressant commonly found in over-the-counter cough and cold medicines.

In one case, the Quebec coroner's office has determined that death was caused by an overdose of dextromethorphan. The man probably took more than the recommended dose of a cough syrup containing dextromethorphan. He may not have been aware of symptoms indicating that he was taking too much of this medicine. In the other case, a man who was taking the antidepressant Prozac (generic name, fluoxetine) began taking dextromethorphan for a cough and then obtained a prescription for the antibiotic Biaxin (generic name, clarithromycin). It is believed that interactions between these 3 medicines led to the man's death. The man did not go to his usual pharmacy to obtain the Biaxin, so the pharmacist who dispensed the Biaxin was not aware of the other drugs the man was taking. The Quebec coroner's office commented that possible interactions between these drugs are a serious safety concern, since all of the drugs are commonly used in Canada. The coroner also recommended that medicines containing dextromethorphan be placed behind the counter in pharmacies in Quebec, to ensure that consumers check with a pharmacist before purchasing a medicine containing this ingredient. Read more information on the report of the Quebec Coroner's Office (available in French only).

Some consumers may assume that any medicine available without a prescription is safe to use. They may not think to ask questions or consult with the pharmacist when they buy one of these products. But there are important things to be aware of when selecting and taking over-the-counter medicines, including medicines used to treat coughs and colds. has the following advice for consumers:

  • Make a list of all your medicines and carry it with you at all times. Show the list to your healthcare provider any time you receive care. Read more.
  • Try to use the same pharmacy for all your medication needs. Before taking any over-the-counter medicine, check with your pharmacist. Ask if the medicine interacts with any other medicines you are taking, including other over-the counter medicines or herbal remedies. You should also make sure the pharmacist knows about any medical conditions you may have. Some diseases or conditions can be affected by over-the-counter medicines. On the other hand, a disease or condition can affect how a particular over-the-counter medicine works. The pharmacist can help make sure that the product you are selecting is right for you.
  • It is very important to read and follow warnings and directions when taking ANY medicine. Do not take more than the recommended dose, and do not take a regular dose more often than directed. Be sure that you do not exceed the total recommended daily dose of a medicine. Remember that certain people, such as children, elderly people, and small or underweight people, may require a lower dose than the one used by a typical adult.
  • Avoid giving cough and cold medicines to children under 6 years of age. There is little evidence that cough and cold medicines are effective for children, and these medicines can cause serious side effects. Read more about over-the-counter medicines in children.
  • For liquid medicines, always use a proper measuring device (such as an oral syringe, a special measuring spoon, or a medicine cup). Read more.
  • Always carefully read the label and the information that comes with your over-the-counter medicine. Reading this information will help you to be informed about the medicine before you take it. It will also help you to become aware of the possible serious side effects of the medicine and what to do if you should experience any of them.
  • For more information about safe practices with medicine, read Safe Practices for Medication Use (Take Charge of Your Medicines!).
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