​Cough syrup under scanner: Indian govt issues warning against Pholcodine; experts help you understand this​

Drugs Controller General of India (DCGI) has warned against the use of pholcodine-containing cold and cough drugs. The warning from the country's drug regulatory authority comes after the World Health Organisation (WHO) issued an alert.

On March 31, the WHO alerted health care professionals and authorities of the "risk of anaphylactic reactions in people who have taken pholcodine-containing products at least 12 months prior to surgical procedures involving the administration of general anaesthesia with neuromuscular blocking agents (NMBAs)."

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Pholcodine is an opioid cough suppressor and it helps with dry cough. Pholcodine works by suppressing the cough center of the brain. It is contraindicated in patients who have liver disease," says Dr. Shreya Dubey - Consultant - Neonatology & Pediatrics, CK Birla Hospital Gurugram.

Pholcodine is a common ingredient in over-the-counter tablets and syrups which are marketed globally to treat non-productive or dry coughs.

Dr Saurabh Khanna - Lead Consultant- Paediatrics & Neonatology, CK Birla Hospital Gurugram explains: It is harmful if it is used excessively in inappropriate doses at an age that is not at the age of recommendation. Ideally, it is recommended only for kids who are more than 6 years of age or adults who have severe cough episodes. It is being added to the cough syrup because it gives an added advantage to them by suppressing the cough center in the brain and that's how it acts. The use of antitussives should be restricted to only times when the cough is very severe, and it is not associated with any other risk factors.

The experts explain the crackdown on pholcodine by the WHO.

"The recent developments in terms of codeine and why the WHO is banned using pholcodine in various cough syrups is because it is known that pholcodine reacts with certain neuromuscular blockers, which leads to a severe anaphylactic reaction which is a severe allergic reaction. Its use has been quite prevalent in India. The bottom line is cough suppressants are only to be used in case of specific indications. Every cough should not be treated by using pholcodine because this is only symptomatic treatment, and it does not treat the root cause of the cough," he says.

"The administration of pholcodine causes production of some antibodies which increases the risk of severe allergic reaction or anaphylaxis by 300 times during anaethesia. These antibodies can take several years to clear," explains Dr Dubey.

It can lead to constipation, drowsiness, certain gastrointestinal disturbances, nausea, vomiting, and in very high doses, may even lead to respiratory depression, says Dr Khanna. It is used in most of the cough syrups available over the counter and one has to ensure that whenever buying a cough syrup, always you should get it done and written by a healthcare professional, a pediatrician, or an MD medicine person so that you give it in an appropriate dose only if it is required, he suggests.

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In view of the health complications associated with pholcodine-containing drugs, the WHO urges patients to ask the doctor to suggest an alternative treatment if they recommend medicines with pholcodine. "Check if any of your over-the-counter cold and flu medicines contain pholcodine. Pholcodine is particularly used in cough lozenge (tablet) or syrup products but can be found in other medicines," it has informed patients. "If you need general anaesthesia and have taken pholcodine in the past 12 months, tell your health professional prior to the procedure. It may help to show this safety alert to your doctor," it has warned them.