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Volume I : Move Towards Holistic Health
Appendix 2 : Survey of Cough Syrups
A
SURVEY OF COUGH SYRUPS
Objective:
To study the
various cough syrups and similar products used in the
treatment of cough, to find out the rationality of their
usage in therapy for cough, by doing a detailed analysis
of the various ingredients of the mixture and also
finding out the cost/day’s treatment.
Methodology:
Eighty
products listed by MIMS India, (june ‘86) classified
as expectorants, eough suppressants, mycolytics and
decongestents were included in the survery.
They were analysed according to the rationality from
therapeutic point of view under various categories A,B,C
as laid down in the summary part. To judge the
effectiveness of a particular cough mixture following
criteria should be considered.
As far as possible it should have a single ingredient
which is proven to have the desired effect e.g.
- if the unproductive,
dry cough is to be suppressed it may contain
noscapine, codeine, etc.. as single constituent.
- if the sputum is to
be expectorated (brought out) it may contain an
expectorant like Potassium iodide as single
constituent. However, steam is the best
expectorant and administration of other compounds
is not proven to be more efficacious for the
expectorant action.
- in patients of asthma
or chronic bronchitis where aim is to dilate the
airways and help clear them of excess secretions
it could contain bronchodilators like Salbutamol,
ephedrine, etc.. as single constituent
ingredients.
Whatever the ingredients
are present, they should be in sufficient doses which
would be therapeutically efficacious.
For therapeutic effects tablets are preferred over liquid
preparations most of the times. However when a soothing
effect on the pharyngeal mucosa (inside of throat)
desired, one could opt for alternatives like drinking hot
fluids or simple sugar syrups or sucking a sugar cube
eetc.
In case of multiple ingredients it is necessary to see
that the ingredients do not antagonise each others
actions in any form, e.g. A cough expectorant should not
be combined with a cough suppressant or an antihistamine;
a bronchodilater with an antihistamine or a cough
suppressant, etc.
The cost of therapy with a particular formulation advised
should be reasonable, i.e. as low as possible for the
desired action the therapeutic benefit.
In any case, one has to make sure that the cough syrup or
whatever formulation is being used has the capacity to
produce the action for which it is being marketed.
Summary of the
survey findings:
The formulations are categorised as explained
below:
Category
A - Only Antitussive (can
suppress the cough reflex)
B - Only expectorant
9which help in bringing out the sputum)
C - Only mucolytics (which
is supposed to liquify the sputum)
D - Only bronchodilator
(which dilates the bronchi)
E - Only Antihistamine
(anti-allergic compounds)
F - Expectorant +
Antitussive
G - Expectorant +
Bronchodilator
H - Expectorant +
Mucolytics
I - Expectorant +
Antihistamines
J - Having more than 2 of
the A,B,C,D,E.
K - Bronchodilator +
Antihistamine
L - Bronchodilator +
Mucolytics
Table 1
Break up of Categories
Total
No. of formulations : 80
|
| Category |
Rational Formulation |
Irratioal Formulation |
A
B
C
D
E
F
G
H
I
J
K
L
|
5
2
-
2
-
-
2
-
-
-
-
-
|
-
-
4
-
-
6
-
-
7
47
3
-
|
| |
11(13.75%) |
67(86.25%) |
Table 2
Type of Formulation |
Tablets/capsules
|
19
|
23.75%
|
Liquid/Syrups
|
56
|
70.00%
|
Other forms
|
5
|
6.25%
|
TOTAL
|
80
|
100%
|
Table 3
|
No. of Ingredients
|
No. of Formulations
|
%
|
1
|
9
|
11.25
|
2
|
11
|
13.75
|
3
|
20
|
25.00
|
4
|
11
|
13.75
|
5
|
13
|
16.25
|
6
|
7
|
8.75
|
7
|
2
|
2.50
|
8
|
5
|
6.25
|
9
|
1
|
1.25
|
10
|
0
|
-
|
11
|
0
|
-
|
12
|
1
|
1.25
|
| |
80
|
100.00
|
Table 4
|
Cost/day
for an Adult
|
No. of Formulations
|
%
|
| Below Re.0.50 |
1
|
1.36
|
| Re.0.50 - below 0.95 |
5
|
6.84
|
| Re.1.00 - Rs.1.95 |
23
|
31.50
|
| Rs. 2.00 and above |
44
|
60.27
|
| TOTAL |
73
|
99.97
|
| Source: |
LOCOST, c/o P.O.Box 134,
Baroda 390001. Survey done by LOCOST. |
CONCLUSION
The findings
of this survey are left open to the people for
discussion. But we would like to raise the basi issues
such as the uselessness of the mixtures in cough therapy,
especially the lqiuid preparations when compared to the
medical benefits they are likely to have.
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