Atrioventricular block following overdose of decongestant cold medication

Burton, Brent T.; Rice, Murray D.; Schmertzler, Les E.

doi:10.1016/0736-4679(85)90250-1

Cited by 14 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, OTC cough and cold medications are associated with potentially serious side effects. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] In 1997, the American Academy of Pediatrics (AAP) issued a statement on the use of codeine-and dextromethorphan-containing cough remedies in children, concluding that physicians should clearly educate parents about the known risks and lack of benefits of these medications. 6 We chose to report these cases because they represent the range of severity of adverse outcomes that can be seen with OTC cough and cold preparations.…”

Section: Discussionmentioning

confidence: 99%

“…10,13-14 Dysrhythmias, myocardial infarction, and ischemic bowel infarction have also been reported. 9,11,12,16,17 A comprehensive review of Ͼ100 case reports of adverse drug effects involving PPA described 24 cases of intracranial hemorrhage-8 with seizures and 8 fatalities-between 1965 and 1990. 11 PPA toxicity may present with agitation, psychosis, seizures, chest pain, or headache.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Toxicity of Over-the-Counter Cough and Cold Medications

Gunn¹,

Taha²,

Liebelt³

et al. 2001

Pediatrics

133

View full text Add to dashboard Cite

ABSTRACT. Over-the-counter (OTC) cough and cold medications are marketed widely for relief of common cold symptoms, and yet studies have failed to demonstrate a benefit of these medications for young children. In addition, OTC medications can be associated with significant morbidity and even mortality in both acute overdoses and when administered in correct doses for chronic periods of time. Physicians often do not inquire about OTC medication use, and parents (or other caregivers) often do not perceive OTCs as medications. We present 3 cases of adverse outcomes over a 13-month period-including 1 death-as a result of OTC cough and cold medication use. We explore the toxicities of OTC cough and cold medications, discuss mechanisms of dosing errors, and suggest why physicians should be more vigilant in specifically inquiring about OTCs when evaluating an ill child. Pediatrics 2001;108(3). URL: http://www.pediatrics.org/cgi/content/full/108/3/e52; over-the-counter medications, cough and cold preparations, morbidity, mortality, phenylpropanolamine.ABBREVIATIONS. OTC, over-the-counter; PPA, phenylpropanolamine; ED, emergency department; PICU, pediatric intensive care unit; CBC, complete blood (cell) count; WBC, white blood cell (count); bpm, beats per minute; AAP, American Academy of Pediatrics; CNS, central nervous system; FDA, Food and Drug Administration. C olds, coughs, and upper respiratory infections are common childhood illnesses. The average child suffers from 6 to 10 colds per year, and each cold can last from 10 to 14 days, providing several days and nights of discomfort for the child as well as for his/her caregiver. 1 Many times parents will turn to one of many hundreds of cough and cold preparations for relief. However, over-the-counter (OTC) cough and cold preparations-although generally safe-have no demonstrated benefit. No studies have proven the efficacy of cough and cold preparations in facilitating recovery from these illnesses, 2-6 and most children will eventually improve on their own. However, a small number of children may suffer significant adverse effects from the administration of the very cough and cold formulations they were given in an attempt to relieve their symptoms. For example, the Food and Drug Administration recently issued an advisory to remove phenylpropanolamine (PPA)-a common constituent of OTC decongestants-from those products because of concern for increased risk of hemorrhagic stroke. 7,8 We present 3 cases of children who suffered significant morbidity from OTC cough and cold preparations requiring admission and treatment in a tertiary care hospital during a 13-month period; they ranged from a self-limited reaction requiring an intensive care unit admission to death in 1 patient. Because no cases of death or heart failure attributable to OTC cough and cold preparations have been reported in recent literature, these cases are presented to serve as points for additional discussion on the risks of OTC cough and cold preparations in children. CASE REPORTS Case 1A 36-month-old b...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Toxicity of Over-the-Counter Cough and Cold Medications

Gunn¹,

Taha²,

Liebelt³

et al. 2001

Pediatrics

133

View full text Add to dashboard Cite

show abstract

“… Elis et al [ 9 ] 10 mg Normotensive volunteers ( n = 4), concurrent MOA inhibitors Significant ↑ in BP 20 mmHg ↑ in BP after 10 mg phenylephrine dose following 11 days on tranylcypromine Elis et al [ 9 ] Unclear—?10 mg 74-year-old women with comorbidities, concurrent MOA inhibitors Significant ↑ in BP (hypertensive crisis—BP up to 230/120 mmHg) Combination of phenylephrine from an over-the-counter preparation, terbutaline and taloxatone. Lefebvre et al [ 10 ] Unclear—overdose 24-year-old otherwise healthy male Significant ↑ in BP (196/100 mmHg, ↓ in HR (40 bpm), third-degree atrioventricular block Ingestion of 30–40 tablets each containing 40 mg phenylpropanolamine, 10 mg phenylephrine, 5 mg chlorpheniramine and 15 mg phenyltoloxamine Burton et al [ 46 ] Unclear—up to 60 mg/day for 4 days 59-year-old otherwise healthy female ICH, SAH Took cold and flu medications containing PE, paracetamol, dextromethorphan and chlorpheniramine for 4 days before hospitalization Tark et al [ 36 ] Topical (eye drops, nasal packs, nasal sprays) 2.5 or 10 % single eye drop Cataract surgery—normotensive and hypertensive patients ( n = 89) ↑ BP following both 2.5 and 10 % eye drop in both normotensive and hypertensive patients. 4/30 patients in 10 % group and 1/29 patients in the 2.5 % group developed severe hypertension which required intravenous hypotensive agents for management—all patients who developed severe hypertension had baseline hypertension.…”

Section: Methodsmentioning

confidence: 99%

Potential cardiovascular adverse events when phenylephrine is combined with paracetamol: simulation and narrative review

Atkinson

Potts

Anderson

2015

Eur J Clin Pharmacol

View full text Add to dashboard Cite

BackgroundIncreased bioavailability of phenylephrine is reported when combined with paracetamol in over-the-counter formulations for the symptomatic treatment of the common cold and influenza. Such formulations could increase phenylephrine-related cardiovascular adverse events particularly in susceptible individuals. Quantification of the effect of phenylephrine concentration on blood pressure allows simulation of potential adverse combination therapy effects.MethodsMEDLINE and EMBASE databases were searched for papers discussing or describing any adverse effect, hypersensitivity or safety concerns related to phenylephrine alone or in combination with other drugs.The pharmacodynamic relationship between plasma phenylephrine concentration and mean arterial blood pressure was characterized using published observations of blood pressure changes after ophthalmic eye drops. The resulting pharmacokinetic and pharmacodynamic parameters were then used to predict mean arterial blood pressure (MAP) changes in that population if given an oral combination of phenylephrine and paracetamol.ResultsThere were 1172 papers identified for examination. Forty-seven reports fulfilled the inclusion criteria. Increases in blood pressure and decreases in heart rate have been reported with doses over 15 mg. It has been estimated that a 20-mmHg increase in systolic blood pressure would occur with an oral dose of 45 mg phenylephrine in normotensive healthy people. Those taking monoamine oxidase inhibitors report increased systolic blood pressure of greater than 60 mmHg. Blood pressure and heart rate changes are potentiated in patients with underlying hypertension. Simulation showed a modest increase in MAP when phenylephrine 10 mg was co-administered with paracetamol 1 g (4.2 vs 12.3 mmHg).ConclusionsCombination paracetamol phenylephrine oral therapy has potential to increase blood pressure more than phenylephrine alone in those with cardiovascular compromise.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-015-1876-1) contains supplementary material, which is available to authorized users.

show abstract