Pseudoephedrine 22.5mg/5ml / Diphenhydramine 12.5mg/5ml oral solution sugar free

Background: Over the past 20 years or so, the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications, and decongestants are reportedly the most popular in being diverted and misused. Objective: While the current related knowledge is limited, the aim here was to examine the published clinical data on OTC misuse, focusing on antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate), dextromethorphan (DXM)- and codeine-based cough medicines, and the nasal decongestant pseudoephedrine. Methods: A systematic literature review was carried out with the help of Scopus, Web of Science databases, and the related gray literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261). Results: After completion of the selection, eligibility, and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organized according to the specific OTC recorded. Most articles focused here on DXM ( n = 54) and diphenhydramine ( n = 12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported. Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant, and ad hoc preventative actions should be designed and implemented.

Abstract licence: CC BY

BACKGROUND: The widespread availability and accessibility of over-the-counter (OTC) medicines play a vital role in modern healthcare systems, enabling individuals to manage minor health concerns independently. However, certain OTC medications possess pharmacological properties that render them susceptible to misuse and abuse, including stimulants, laxatives, sedatives, and opiate-containing products. Misuse involves improper dosage, duration, or indication, while abuse entails non-therapeutic use to achieve psychoactive effects or other illicit purposes, potentially leading to dependence and addiction. This review explores the risk of developing psychotic symptoms associated with OTC drug misuse. Synthesizing existing literature, it comprehensively examines the relationship between antihistamines, cough medicines, and decongestants misuse, and the onset of psychotic symptoms. METHODS: A systematic literature review was carried out using Pubmed, Scopus and Web of Science databases through the following search strategy: ("diphenhydramine" OR "promethazine" OR "chlorpheniramine" OR "dimenhydrinate" OR "dextromethorphan" OR "pseudoephedrine" OR codeine- based cough medicines) AND ("abuse" OR "misuse" OR "craving" OR "addiction") NOT review NOT (animal OR rat OR mouse). For data gathering purposes, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Research methods were registered on PROSPERO (CRD42024527558). RESULTS: We analysed 46 relevant studies out of an initial pool of 2,677 articles. Key findings indicate that antihistamines, dextromethorphan, and other OTC drugs can induce psychotic symptoms, such as paranoia, hallucinations, and thought disorders when abused. Dextromethorphan is particularly associated with a chronic tendency towards psychosis, whereas other substances more commonly result in acute substance-induced psychosis. CONCLUSION: The study underscores the necessity for increased awareness and specific interventions to address the misuse of OTC drugs and their potential to cause significant psychiatric disorders, emphasizing the broader public health implications of such misuse.

Abstract licence: CC BY

BACKGROUND: The common cold is one of the most frequently occurring illnesses worldwide. The aim of this study was to determine which OTC anti-common cold medications were most often recommended by pharmacists and if the COVID-19 pandemic affected such recommendations. METHODS: Non-interventional, observational research trial using a self-developed questionnaire to collect data on pharmacists' recommendations for anti-common cold OTC treatment. The data were collected during the COVID-19 pandemic (December 2021-February 2022) in four large community network pharmacies in Lodz (Poland) and then compared with an analogue period of time before the pandemic (December 2019-February 2020). RESULTS: During COVID-19 pandemic there was a significant (p < 0.05) reduction in paracetamol, acetylsalicylic acid, metamizole magnesium, inosines, alpha-mimetics, mucolytics, homeopathics, and sore throat products and an increase in other tablets/capsules and add-on product recommendations. There was a significant relationship (p < 0.05, OR > 1) between the recommended frequency of paracetamol, inosines, sore throat products (each symptom), metamizole magnesium (headache, fever), acetylsalicylic acid (headache, fever, fatigue), NSAIDs, alpha-mimetics (headache, rhinorrhea), pseudoephedrine (rhinorrhea), homeopathics (headache), herbal products (fatigue), antihistamines (rhinorrhea, cough), and mucolytics (headache, fever, cough). CONCLUSIONS: Favorable prices (before COVID-19 pandemic) and reports on common NSAIDs side effects (beginning of the pandemic) led to high sale of paracetamol. Increased awareness of clinical effectiveness of some medications or their reduced availability influenced their limited recommendations.

Abstract licence: CC BY-NC-ND

Easy access to over-the-counter (OTC) drugs makes it possible to procure active substances that normally used in therapeutic doses do not raise health problems. The use of high doses of OTC drugs containing codeine, loperamide, pseudoephedrine, diphenhydramine or dimenhydrinate, as well as the use of benzidamine systemically raises concerns regarding the increase in units sold. These drugs are used for recreational or euphorizing purposes, including by young women of childbearing age, psychoactive substance users representing a risk group in terms of the possibility of an unplanned pregnancy. Abusive consumption of OTC products during pregnancy is harmful, with consequences for both fetal and late development that can occur in the infant. This literature review presents the risks (teratogenicity, fetal toxicity, neonatal abstinence syndrome, etc.) associated with the use of potentially psychoactive OTC drugs to emphasize the importance of re-evaluating OTC classification and dispensing.

Abstract licence: CC BY