Diphenhydramine 10mg/5ml / Dextromethorphan 6.65mg/5ml oral solution sugar free

Objective: To narratively review currently available antidepressants and future potential antidepressants as monotherapy for the treatment of depressive disorders. Methods: Selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), dopamine reuptake inhibitor (bupropion), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) were reviewed according to the results from Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study and systematic reviews. For the rest of the antidepressants, a PubMed/Medline search was conducted with priority for systematic reviews. For drugs in development for depressive disorders, PubMed, Google, and Clinicaltrials.gov databases were used. Results: The STAR*D Study demonstrated that sertraline, venlafaxine, and bupropion monotherapy had similar efficacy in patients with major depressive disorder (MDD) who failed citalopram. A network meta-analyses of randomized, placebo-controlled trials found that SSRIs, SNRIs, bupropion, TCAs, mirtazapine, and agomelatine had similar relative efficacy compared to placebo, but had different acceptability. Gepirone had more failed/negative studies and smaller effect size relative to placebo compared to other antidepressants. The combination of dextromethorphan and bupropion, ketamine infusion, and intranasal esketamine had faster onset of action but similar effect size compared to monoamine-based antidepressants as monotherapy. Brexanolone and zuranolone are effective in postpartum depression (PPD), but the effect size of zuranolone in MDD as monotherapy or adjunctive therapy was very small. Psychedelics, glutamate receptor-related agents, kappa opioid receptor antagonists, orexin receptor antagonists, new anti-inflammatory agents, and biomarker-based antidepressant therapy have been under investigation for depressive disorders. Psychedelics showed faster onset of action, large effect size, and long durability. Conclusions: Monoamine-based antidepressants likely continue to be the mainstream antidepressants for depressive disorder. NMDA receptor antagonists and neurosteroid antidepressants will play a bigger role with the improvement of accessibility. Psychedelics may become a game changer if phase III studies validate their efficacy and safety in depressive disorders.

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This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare honey with pharmacological treatment in pediatric patients with acute cough. Studies were searched across 5 databases. Analyzed outcomes were cough frequency, severity, and bothersomeness, alongside its impact on the sleep of both children and caregivers. A random-effects meta-analysis was performed using the Review Manager Web tool. A post-hoc subgroup and leave-one-out sensitivity analysis were conducted to evaluate the influence of individual studies and medication class on heterogeneity. 7 studies were included in the systematic review and 6 in the meta-analysis, totaling 576 patients. Among them, 305 (53%) received honey. Participants' mean age ranged from 3 to 5 years, and follow-up duration was limited to 3 days. The primary analysis showed high heterogeneity and no statistically significant differences across most endpoints, except for cough effect on child's sleep, which was significantly reduced in the honey group (MD: -0.73; 95% CI: -1.45 to -0.01; p = 0.05). After sensitivity analysis, honey significantly improved all outcomes, including cough frequency, severity, bothersomeness, sleep quality of children and caregivers, and global score. Subgroup analyses confirmed consistent results regardless of the pharmacological comparator used. Alone, the honey-vs-dextromethorphan group showed significant benefit in two endpoints.ConclusionWhile the primary analysis demonstrated comparable efficacy between interventions across most endpoints, except for child sleep quality, exploratory post-hoc sensitivity analyses revealed a potential signal of honey superiority across all outcomes. Although these findings should be regarded as hypothesis-generating rather than definitive, the potential clinical benefit, combined with the established risks of pediatric antitussives, supports honey as a promising, low-risk alternative.Trial registrationCRD420261356244.What is known• Pediatric acute cough commonly leads to inappropriate antitussive medication prescribing. • Honey outperforms placebo or no treatment for cough symptoms relief ≥ 10 or comorbidities.What is new• Post-hoc sensitivity analysis suggests that honey is more effective than pharmacological therapy across all symptom domains. • Honey should be actively promoted over antitussives medications in children, given its safety and low cost.

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Background: As February 2023, SARS-CoV-2 is still infecting people and children worldwide. Cough and dyspnea are annoying symptoms almost present in a large proportion of COVID-19 outpatients, and the duration of these symptoms might be long enough to affect the patients' quality of life. Studies have shown positive effects for noscapine plus licorice in the previous COVID-19 trials. This study aimed to assess the effects of the combination of noscapine and licorice-for relieving cough in outpatients with COVID-19. Methods: This randomized controlled trial was conducted on 124 patients at the Dr. Masih Daneshvari Hospital. Participants over 18 years of age with confirmed COVID-19 and cough were allowed to enter the study if the onset of symptoms was less than 5 days. The primary outcome was to assess the response to treatment over 5 days using the visual analogue scale. Secondary outcomes included the assessment of cough severity after 5 days using Cough Symptom Score, as well as the cough-related quality of life and dyspnea relieving. Patients in the noscapine plus licorice group received Noscough® syrup 20 mL every 6 h for 5 days. The control group received diphenhydramine elixir 7 mL every 8 h. Results: By day five, 53 (85.48%) patients in the Noscough® group and 49 (79.03%) patients in the diphenhydramine group had response to treatment. This difference was not statistically significant (p-value = 0.34). The presence of dyspnea was significantly lower in the Noscough® group versus diphenhydramine at day five (1.61% in the Noscough® group vs. 12.9% in the diphenhydramine group; p-value = 0.03). The cough-related quality of life and severity also significantly favored Noscough® syrup (p-values Conclusion: Noscapine plus licorice syrup was slightly superior to diphenhydramine in relieving cough symptoms and dyspnea in the COVID-19 outpatients. The severity of cough and cough-related quality of life were also significantly better in the noscapine plus licorice syrup. Noscapine plus licorice may be a valuable treatment in relieving cough in COVID-19 outpatients.

Abstract licence: CC BY