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  • 2009-02-11 (xsd:date)
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  • Does the Interaction of Motrin and Robitussin Cause Heart Attacks in Children? (en)
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  • We first received an admonition not to combine Motrin with Robitussin via email in December 2008: The story the warning is framed upon, that an eight-year-old girl named Madison died from a heart attack and strokes brought about by this combination of over-the-counter drugs, was unverifiable: the account provided no information as to Madison's surname, where she lived, who her doctors were, where she was treated, or even the date she died. Absent any of that information, trying to determine if there actually was such a child proved a nearly impossible task. It is possible that a child can have a heart attack. For example, a news report of 2 October 2007 noted heart attacks in children are a rare but under-recognized problem that are most likely caused by heart spasms which briefly cut off the blood supply. It therefore cannot be ruled out that a child called Madison (of no known last name or address) did experience an acute myocardial infarction. However, that in rare instances children have experienced heart attacks only proves that such events happen, not that any particular drug interaction causes them. The active ingredient in Children's Motrin is Ibuprofen, a nonsteroidal anti-inflammatory drug effective in relieving pain and reducing inflammation. (Ibuprofen is also marketed under several other brand names, such as Advil, Medipren, and Nuprin.) Children's Motrin Suspension first became available as a prescription product in 1989, and in 1995 it was cleared by the Food and Drug Administration for marketing as an over-the-counter product. Both those landmarks occurred only after the product had been extensively tested on children: Robitussin Pediatric Cough is a syrup that contains Dextromethorphan HBr, a cough suppressant. Its Pediatric Cough & Cold formulation contains Chlorpheniramine maleate, an antihistamine, in addition to the Dextromethorphan HBr. We have not yet turned up any studies confirming heart attacks brought about by the combination of these two over-the-counter medications, either in children or adults, but that is not to say children should be taking OTC cold medications. An 8 October 2008 statement by the FDA supports the recommendation of the Consumer Healthcare Products Association that children under the age of four should not be dosed with over-the-counter cough and cold products. This follows its January 2008 advisory that these products not be used in children under the age of 2 because of the risk of serious and potentially life-threatening side effects. As noted in a news report from September 2007: An FDA review of side-effect records filed with the agency between 1969 and September 2006 found 54 reports of deaths in children associated with decongestant medicines made with pseudoephedrine, phenylephrine or ephedrine. It also found 69 reports of deaths associated with antihistamine medicines containing diphenhydramine, brompheniramine or chlorpheniramine. Most of the deaths were children younger than 2. The FDA offers these medication tips to the parents and caregivers of small children: In 2003, another personal account circulated by e-mail implicated Children's Motrin in the formation of stomach ulcers in a child dosed with it. We did not encounter any subsequent reports of similar instances, and no specific interaction precaution guidance exists for that drug combination. On 22 December 2014, Children's Medical Center of Dallas addressed the recirculating rumor on Twitter: (en)
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