Alternatives to pholcodine for coughs, colds and flu

The medicines Watchdog, the Medicines and Healthcare products Regulatory Agency (MHRA) has decided to recall and withdraw all medications that contain pholcodine in the UK as a safety precaution. The Commission on Human Medicines (CHM) discovered an increased risk of the extremely rare occurrence of allergic reactions, when combined with neuromuscular blocking agents (NMBAs) used in general anaesthetic.

Pholcodine is a well-known opioid medication for coughs and colds. Anyone taking cough medicine is advised to check the listed ingredients for pholcodine. As a precaution and to prevent health fears pholcodine-containing medicines will be disappearing from UK shelves.

This blog aims to provide you with the information you need on alternative medications to pholcodine available to alleviate your cough, cold and flu symptoms. Keep reading to learn more about these alternatives and how they may be beneficial for you.

What is pholcodine?

Pholcodine is a medication that you might come across when you’re dealing with a persistent and troublesome cough. It belongs to a family of drugs known as cough suppressants, which work by helping to soothe that irritating tickle in the throat that often accompanies a cough. It works directly in the brain, depressing the cough reflex, by reducing the nerve signals that are sent to the muscles involved in coughing. While pholcodine doesn’t treat the underlying cause of the cough, it can provide relief, especially at night when you’re trying to rest.

What are neuromuscular blocking agents (NMBAs)?

Neuromuscular blocking agents, also known as NMBAs, are important substances used during general anaesthetic procedures to help ensure patient comfort and safety. These special medications temporarily relax your muscles by blocking communication between your nerves and muscles, allowing your body to be completely still during surgery.

Why has pholcodine been withdrawn?

Research has shown that using pholcodine-containing products, especially in the 12 months leading up to general anaesthesia with muscle relaxants (NMBAs), can increase the risk of anaphylactic reactions. Scientists have found the antibodies from the pholcodine can stay in the body for a year and will fight the NMBAs as they are of a similar structure to the pholcodine.

To protect public health, pholcodine-containing medications are being taken off the UK market and will no longer be available in pharmacies.

Advice to patients

Before using cough or flu medicines, such as tablets or syrups, inspect the package, label, or accompanying patient information leaflets for the presence of pholcodine. Seek your pharmacist’s advice for alternatives if necessary. If your cough persists for longer, seek advice from a healthcare professional. Before any surgery, inform your anaesthetist if you’ve consumed pholcodine recently, especially within the last year, or suspect having taken a product containing it.

Which cough medicines have been withdrawn?

• Boots Night Cough Relief Oral Solution
• Boots Dry Cough Syrup 6 Years+
• Boots Day Cold & Flu Relief Oral Solution
• Cofsed Linctus
• Pholcodine 5mg/5ml Oral Solution Sugar Free
• Galenphol Linctus
• Galenphol Paediatric Linctus
• Galenphol Strong Linctus
• Covonia Dry Cough Sugar Free Formula
• Pholcodine Linctus Bells Healthcare 5mg Per 5ml Oral Solution
• Numark Pholcodine 5mg per 5ml Oral Solution
• Well Pharmaceuticals Pholcodine 5mg per 5ml Oral Solution
• Superdrug Pholcodine Linctus BP
• Strong Pholcodine Linctus BP
• Pholcodine Linctus BP
• Strong Pholcodine Linctus BP
• Pholcodine Linctus
• Day & Night Nurse Capsules
• Day Nurse Capsules
• Day Nurse

Europe’s medicines regulator, the European Medicines Agency, recommended the withdrawal of pholcodine medicines from the European market in December last year.

Alternatives to pholcodine for colds, coughs and flu symptoms

It is now crucial to explore alternative medications to pholcodine to ensure you can find the perfect remedy for your coughs and colds. Here are some suggestions:

1. Dextromethorphan:

Dextromethorphan, also known as DM or DXM, is a common over-the-counter medication to help suppress coughs. It works by acting on the brain’s cough centre, reducing the urge to cough. It is frequently found in combination with other medications within the cough and cold medicines such as Vicks, Robitussin and Benylin. This medication is non-habit forming, however, it should be used with caution in those with a history of liver or kidney disease.

2. Guaifenesin:

Guaifenesin, also known as glyceryl guaiacolate, is an expectorant found in many over-the-counter cough and cold remedies. It works by thinning and loosening the phlegm in the airways, making it easier to cough up and clear the chest. Guaifenesin is a popular choice for people who suffer from chesty coughs associated with colds and comes in the form of syrups, tablets, or capsules. It is particularly useful when combined with dextromethorphan if you are dealing with both a productive and a dry cough.

3. Simple Linctus:

Simple Linctus is a demulcent that is suitable for the whole family, including children, pregnant and breastfeeding women. It comes in the form of syrup and works by providing a soothing effect on the throat by forming a thin film, reducing irritation and the need to cough. Simple Linctus does not contain any active ingredients, so you can use it alongside other cough and cold medications for added relief.

4. Honey and Lemon:

Sometimes the simplest remedies can prove to be the most effective. Honey and lemon can provide an all-natural alternative to pharmaceutical cough treatments. Honey has antibacterial and anti-inflammatory properties, which can help soothe a sore throat and reduce cough frequency. Lemon, on the other hand, contains vitamin C, which is known to support the immune system. To make this concoction, mix a teaspoon of honey with the juice of half a lemon in a cup of warm water and drink 2-3 times per day as needed for cough relief.

5. Herbal remedies

Herbal remedies are another popular alternative to pholcodine. Some herbs, such as thyme, ivy and marshmallow root, have been found to have cough-relieving properties. These herbs can be consumed in various forms, such as teas, lozenges or extracts. While herbal remedies are generally safe, it is essential to consult with a healthcare professional, particularly if you are pregnant, breastfeeding or taking other medications. This ensures that there are no potential interactions or complications with your current medication regimen.

6. Steam inhalation:

Inhaling steam can help alleviate coughs and cold symptoms by helping to open up airways and making it easier to breathe. Steam inhalation can be easily done at home by boiling some water, pouring it into a large bowl and adding a few drops of essential oils such as eucalyptus or menthol if desired. Lean over the bowl with a towel over your head to trap the steam and inhale deeply for several minutes. Be sure to maintain a safe distance from the hot water to avoid burns.

Many alternatives, such as dextromethorphan, guaifenesin or natural remedies like honey, provide relief from coughs and colds without the need for pholcodine. As with any medication, it is necessary to consult with a healthcare professional before using these alternatives to understand their compatibility with existing medications or health conditions. By equipping yourself with these alternative options, you are sure to breathe easier and recover more comfortably during the cold and flu season.

Sources

• Class 2 Medicines Recall: Various Marketing Authorisation Holders, pholcodine-containing products, EL (23)A/09 – GOV
• Class 2 Medicines Recall: Pholcodine-containing products (Various Marketing Authorisation Holders) – MHRA
• RPS advice on withdrawal of pholcodine – Rpharms
• Class 2 Medicines Recall: Various Marketing Authorisation Holders, pholcodine-containing products, EL (23)A/09 – GOV