Recommendations for the Use of OTC Cough and Cold Medications in Children

Ann McMahon Wicker, PharmD, BCPS; Brice A. Labruzzo, PharmD


US Pharmacist. 2009;34(3):33-36. 

In This Article


Nasal decongestants are sympathomimetic amines that exert their vasoconstrictive action by affecting sympathetic tone in the nasal mucosa. Decongestants decrease enlarged blood vessels and alleviate mucosal edema by acting on adrenergic receptors.[5,7,8] Phenylephrine stimulates alpha-1 receptors, whereas oxymetazoline, xylometazoline, and naphazoline stimulate alpha-2 receptors.[8] Pseudoephedrine exerts its action by having both a direct and an indirect effect on adrenergic activity. Like phenylephrine and the imidazoline derivatives, pseudoephedrine stimulates alpha receptors but also indirectly causes the release of norepinephrine from its storage sites.[7,8]

Systemic and nasal decongestants are available OTC. Systemic nasal decongestants are indicated for temporary relief of nasal congestion, to promote nasal or sinus drainage, and for cough caused by postnasal drip. Topical nasal decongestants are indicated for the symptomatic relief of both nasal and nasopharyngeal mucosal congestion.[5,7]

Side effects from decongestants are more likely to occur in children than in adults. Effects include elevated blood pressure, tachycardia, palpitations, arrhythmia, restlessness, insomnia, anxiety, tremors, psychological disturbances, and hypersensitivity reactions. Because they are minimally absorbed, topical decongestants have systemic side effects that are milder and occur less frequently compared with systemic dosage forms. Topical use may cause burning, stinging, sneezing, or local irritation. The use of topical decongestants should be limited to three days, since prolonged use has been associated with tachyphylaxis, rebound nasal mucosa edema, and rebound nasal congestion.[5,7,8]

The recommended dosing for phenylephrine nasal drops is 1 to 2 drops of 0.16% solution in each nostril every three hours as needed in infants older than 6 months; in children aged under 6 years, the dosing is 2 to 3 drops of 0.125% solution in each nostril every four hours as needed.[2] Appropriate dosing of oral phenylephrine in children aged 2 to 6 years is 2.5 mg every four hours or 3.75 mg every six hours, with an MDD of 15 mg.[2,9] Pseudoephedrine in children aged under 12 years is dosed at 4 mg/kg/day divided every six hours as needed with an MDD of 60 mg.[2,9]