"Inaccurate Dosing Dangers"
Also available as an audiocast.

Peter Dicpinigaitis, MD, pulmonary and critical care specialist at the Montefiore Medical Center, Bronx, NY, and Director of the Montefiore Cough Center

Cough and cold season is approaching, and with it, the annual surge of patients seeking relief from a bothersome cough. But what is the safest, most effective treatment? Physicians must consider the potential for over- or under-dosing with liquid medicines before prescribing medication.

Patients are seeking cough relief

Cough is among the most common reasons patients see a physician. In 2005 alone, patients made 32.5 million office visits for cough,¹ and consumers spend billions of dollars on cough and cold products annually.² Yet mitigating cough symptoms is important to more than just patient comfort: the Centers for Disease Control and Prevention warns that many serious respiratory illnesses can be spread through coughing.³

Dosing difficulties

Relieving severe cough often involves prescription cough syrup, but measuring liquid medications accurately has been shown to be difficult for patients and caregivers alike—leading to potential safety risks.

• A 2008 study in the Annals of Pharmacotherapy found that 85% of caregivers measured an excessive dose of liquid medication when using a dosing cup. Yet a dosing cup was the most commonly used dosing method for 49% of the adult prescription cough syrup users surveyed.⁴
• Prompted by reports of death and life-threatening side effects due to inaccurate dosing, the US Food and Drug Administration issued a 2008 public health advisory on the safe and accurate use of a prescription liquid cough medicine containing hydrocodone and chlorpheniramine.⁵
• A 2007 Harris Interactive poll of 932 adult prescription cough syrup users found that 35% drank a dose of syrup directly from the bottle without measuring.⁶

Addressing concerns, providing relief

Excessive dosing of prescription cough syrup can result in respiratory depression, and has even been linked to patient deaths.⁷ To help patients treat their cold-related cough while reducing risks associated with inaccurate dosing, doctors can recommend more effective measurement tools, or medications that avoid liquid altogether.

In a recent study, measuring cups with etched markings were shown to produce more accurate dosing: roughly half of parents measured accurate liquid doses for their children using a cup with etched markings, but only one-third of parents measured accurately with a dosing cup with printed markings.⁸

Additionally, new oral capsule formulations offer precise, consistent dosing to relieve cough symptoms, without the potential for inaccurate measurement. Medications like these can provide physicians with a reliable alternative to liquid medications—potentially improving patient safety without sacrificing patient relief.

When it comes to administering prescription cough medication, the data show the safety risks surrounding inaccurate dose measurement. Through patient education and new medication alternatives, doctors can help close the gap between the doctor's office and the home medicine cabinet.