THE BANYAN TREE: VOLUME I : MOVE TOWARDS HOLISTIC HEALTH
( By Editor : Carol Huss )

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Appendix 2 : 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.

  1. if the unproductive, dry cough is to be suppressed it may contain noscapine, codeine, etc.. as single constituent.
  2. 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.
  3. 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

CategoryRational FormulationIrratioal 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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