Drugs List

Therapeutic Indications

Uses

Cough with viscous sputum

Contraindications

Children under 6 years

Precautions and Warnings

Children 6 to 12 years
Alcoholism
Asthma
Breastfeeding
Diabetes mellitus
Epileptic disorder
Excessive bronchial secretions
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
Pregnancy
Severe hepatic impairment
Severe renal impairment

Exclude chronic, persistent cough such as occurs with asthma or emphysema
Not all available brands are licensed for all age groups
Oral solution with maltitol unsuitable in hereditary fructose intolerance
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Some formulations contain fructose
Some formulations contain glucose
Some formulations contain Ponceau 4R (E124)-may cause allergic reactions
Some formulations contain propylene glycol
Some formulations contain sucrose
Some formulations may contain alcohol
Some formulations may contain sugar
May affect results of some laboratory tests
Should not be taken with other cough or cold medicine
Advise patient not to exceed stated dose
Advise patient to seek medical advice if symptoms persist for > 5 days

Guaifenesin is considered to be possibly porphyrinogenic and therefore, it should be used only when no safer alternative is available.

MHRA/CHM advice (February 2009)

Cough and cold remedies containing diphenhydramine and pholcodine should no longer be used in children under 6 as the balance of benefits and risk has not been shown to be favourable.

However, the MHRA/CHM also lists a number of combination products which are being phased out from the market for use in children under 12 years. This product is included on this list, therefore, it is not recommended for children up to the age of 12 years.

MHRA/CHM advice (March 2008)

Children should not be given more than one cough or cold preparation at a time because different brands may contain the same active ingredient; care should be taken to give the correct dose.

Pregnancy and Lactation

Pregnancy

Use guaifenesin with caution in pregnancy.

There is no data to support an association between guaifenesin and congenital defects.

Some formulations contain alcohol. The ethanol content should be taken into account in pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use guaifenesin with caution in breastfeeding.

At the time of writing, there is no published experience concerning the use of guaifenesin during breast feeding.

Some formulations contain alcohol. The ethanol content should be taken into account in breastfeeding women.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal discomfort
Anaphylactic reaction
Angioedema
Dizziness
Drowsiness
Hypersensitivity reactions
Nausea
Rash
Urticaria
Vomiting

Presentation

Oral formulations of guaifenesin

Drugs List

Therapeutic Indications

Uses

Cough with viscous sputum

Dosage

Adults

Elderly

Children

Contraindications

Children under 6 years

Precautions and Warnings

Children 6 to 12 years
Alcoholism
Asthma
Breastfeeding
Diabetes mellitus
Epileptic disorder
Excessive bronchial secretions
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
Pregnancy
Severe hepatic impairment
Severe renal impairment

Exclude chronic, persistent cough such as occurs with asthma or emphysema
Not all available brands are licensed for all age groups
Oral solution with maltitol unsuitable in hereditary fructose intolerance
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Some formulations contain fructose
Some formulations contain glucose
Some formulations contain Ponceau 4R (E124)-may cause allergic reactions
Some formulations contain propylene glycol
Some formulations contain sucrose
Some formulations may contain alcohol
Some formulations may contain sugar
May affect results of some laboratory tests
Should not be taken with other cough or cold medicine
Advise patient not to exceed stated dose
Advise patient to seek medical advice if symptoms persist for > 5 days

Guaifenesin is considered to be possibly porphyrinogenic and therefore, it should be used only when no safer alternative is available.

MHRA/CHM advice (February 2009)

Cough and cold remedies containing diphenhydramine and pholcodine should no longer be used in children under 6 as the balance of benefits and risk has not been shown to be favourable.

However, the MHRA/CHM also lists a number of combination products which are being phased out from the market for use in children under 12 years. This product is included on this list, therefore, it is not recommended for children up to the age of 12 years.

MHRA/CHM advice (March 2008)

Children should not be given more than one cough or cold preparation at a time because different brands may contain the same active ingredient; care should be taken to give the correct dose.

Pregnancy and Lactation

Pregnancy

Use guaifenesin with caution in pregnancy.

There is no data to support an association between guaifenesin and congenital defects.

Some formulations contain alcohol. The ethanol content should be taken into account in pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use guaifenesin with caution in breastfeeding.

At the time of writing, there is no published experience concerning the use of guaifenesin during breast feeding.

Some formulations contain alcohol. The ethanol content should be taken into account in breastfeeding women.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal discomfort
Anaphylactic reaction
Angioedema
Dizziness
Drowsiness
Hypersensitivity reactions
Nausea
Rash
Urticaria
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org

Further Information

Last Full Review Date: January 2016.

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Benylin Children's Chesty Coughs. McNeil Products Ltd. Revised May 2016.

Summary of Product Characteristics: Benylin Mucus Cough Menthol oral solution. McNeil Products Ltd. Revised September 2016.

Summary of Product Characteristics: Covonia Chesty Cough Sugar Free Syrup. Thornton & Ross Limited. Revised April 2015.

Summary of Product Characteristics: Hills Balsam Chesty Cough liquid. Boston Healthcare Ltd. Revised April 2014.

Summary of Product Characteristics: Lemsip Cough Chesty. Reckitt Benckiser. Revised September 2016.

Summary of Product Characteristics: Liqufruta Garlic Cough Medicine. Alston Garrard & Co Ltd. Revised September 2016.

Summary of Product Characteristics: Robitussin Chesty Cough Medicine. Pfizer Consumer Healthcare. Revised January 2014.

Summary of Product Characteristics: Tixylix Chesty Cough linctus. Novartis Consumer Health. Revised July 2013.

Summary of Product Characteristics: Veno's Expectorant. Forest Laboratories UK Ltd. Revised September 2015.

Dear Healthcare Professional Letter. Medicines and Healthcare products Regulatory Agency. 28th February 2009.
https://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=CON038904&RevisionSelectionMethod=LatestReleased
Last accessed: 18 January 2017.