Over-The-Counter Cold Medications

by Debbie Smith, MS, RN, CPNP

See the chart at the bottom of this page for recommendations on some specific brand names.

During flu and cold season parents may find themselves reaching for those readily available over-the-counter (OTC) cold remedies. But which ones are safe to give your child? It’s always a good idea to check with your liver team on which over-the-counter medications are recommended and which are not recommended for children with liver disease or children who are immunosuppressed. Remember, the best therapy for the common cold is fluids, humidity and time.

Here are some general guidelines on  ingredients commonly found in over-the-counter cold and cough remedies:

Antihistamines
Antihistamines can help relieve cold and allergy symptoms such as sneezing, itchy or watery eyes, and scratchy throat. Antihistamines can also slow down bile flow. If your child has reduced bile flow, it is recommended that you push fluids whenever giving antihistamines.

Decongestants
Pseudoephedrine hydrochloride (PH) is a decongestant that also elevates blood pressure and could potentially elevate the portal or liver blood pressure. A great many over-the-counter cold and sinus medications contain PH. For children with portal hypertension or those taking medication for high blood pressure these products are not recommended. Check with your doctor first if you are unsure about your child’s risk.

Nonsteroidal anti-inflammatories (NSAID’s)
Many over-the-counter cold remedies contain NSAID’s to help relieve aches and pains. Generic names include ibuprofen, naproxen, and ketoprofen. Brand names include Advil, Motrin IB, Nuprin, Medipren, Pediaprofen, Aleve, Orudis and others. Like aspirin, NSAID’s can be irritating to the stomach and may cause gastrointestinal bleeding. If your child has high blood pressure, portal hypertension or esophageal varices, this could be dangerous. NSAID’s can also be toxic to the liver.

NSAID’s can cause kidney dysfunction in patients who are taking cyclosporine or tacrolimus (Prograf). Occasional use of NSAID's for transplant patients may be permissible, but you should check with your transplant physician or nurse first.

Aspirin
Aspirin is not recommended for fever in children because of the possible risk of Reye’s syndrome. Aspirin can also be irritating to the stomach. (Under close supervision, many children take aspirin post-transplant to prevent clotting of the hepatic artery.)

Acetaminophen
For children with liver disease or transplant, acetaminophen (Tylenol) is recommended for fever. Do not exceed more than 4 doses per day and for no longer than 3 consecutive days. For high fever (over 102°) or fever that persists for more than 24 hours in children with biliary atresia or post transplant, your doctor or transplant coordinator should be notified.

The main thing to remember is that even over-the-counter medications can have harmful side effects or interactions with other medications your child is taking. Your liver specialist is always the best source of information regarding which over-the-counter medications are safe for your child.

Ms. Smith is a pediatric nurse practitioner at The Children’s Hospital Pediatric Liver Center and Pediatric Liver Transplantation in Denver, CO.

 
Reviewed on 02/23/2004