Study Finds Cough Drugs No Better Than Sugar Syrup

Tue Jul 6,2004, 12:06 AM ET  Add Health - Reuters to My Yahoo!

By Michael Conlon

CHICAGO (Reuters) - Two ingredients commonly used in cough syrup are
no better than sugar water in suppressing night-time coughing in
children, according to a study published on Tuesday.

The two ingredients are dextromethorphan -- often listed on labels
as "DM" -- and diphenhydramine, an antihistamine. The former is the
most common nonprescription cough suppressant on the U.S. market, and
commonly abused by adolescents who try to get high on cough medicine.

"Consumers spend billions of dollars each year on over-the-counter
medications for cough," said Ian Paul, a physician and assistant
professor of pediatrics at Penn State Children's Hospital.

"Our study showed that the two ingredients used in most over-the-
counter medications were no better than a placebo ... in providing
night time relief for children with cough and sleep difficulty as a
result of upper respiratory infection," he added.

Paul was the chief author of the study appearing in the July issue of
Pediatrics, the journal of the American Academy of Pediatrics.

The findings were based on 100 children aged 2 to 18 with upper
respiratory infections. Their parents were quizzed about the severity
of the children's cough and how well both parents and children slept
the previous night.

In the evening of the day the parents were questioned the children
were given either one of the commercial preparations or an inert
placebo -- in this case simple syrup.

"There was a significant improvement for all symptoms over the
previous night, which should reassure clinicians and parents that,
regardless of treatment, the natural history of an upper respiratory
infection favors resolution of symptoms with time," Paul said.

In an interview, Paul said the improvement in symptoms across-the-
board was due to both the natural progression of an infection easing
one day to the next and the well-documented "placebo effect," where
symptoms diminish because a patient believes a treatment is helping.

He said the sleep of both parents and children improved but the
improvement was the same in the group given sugar syrup as for the
children given the drugs.

Asked what parents should do, Paul said "my advice has been to do
things that are harmless but could help -- saline nose drops, good
hydration and humidified air."

Newer Heart Drug Found to Be No Better
Newer Heart Drug Is Found to Be No Better Than the Old Standby

The Associated Press

CHICAGO July 6, 2004 - A newer blood thinner is no better than the
old standby at treating victims of heart attacks or chest pain,
according to two major studies involving nearly 14,000 patients.
While the newer drug enoxaparin is more convenient to use than
heparin, it also caused modest increases in bleeding, the studies

The results are likely to add to the debate among cardiologists over
which drug to use.

The studies appear in Wednesday's Journal of the American Medical
Association. One was funded by enoxaparin's maker, New Jersey-based
Aventis Inc.

Dr. David Moliterno, author of a JAMA editorial, said the
results "look pretty darn lackluster," given earlier, smaller studies
clearly favoring enoxaparin over heparin.

He estimated 30 percent of heart patients receive enoxaparin but said
most doctors have a favored drug and predicted the studies would do
little to change their preferences.

"I think this gives some fodder for each argument naysayers who say
we don't need to bother using enoxaparins, that they only provide a
marginal benefit but still a bleeding risk. And supporters who
say ... you can use this drug and it's safe," said Moliterno, chief
of cardiovascular medicine at the University of Kentucky at Lexington.

A third study also funded by Aventis analyzed results from six
studies including the two new ones and found that enoxaparin was more
effective than the old standby, heparin. But other doctors questioned
the findings since the analysis included older data from when
treatment practices were different.

Heparin has been used for several decades to treat blood clots in
heart patients. Enoxaparin, which is sold under the brand name
Lovenox, is one of several newer, more potent heparin varieties with
a lower molecular weight. Enoxaparin was approved by the Food and
Drug Administration in the late 1990s for use in heart patients.

Enoxparin costs about $100 a day, several times more than heparin,
Moliterno said. But enoxaparin supporters say the newer drug is
ultimately the same in cost or cheaper because it is easier to
administer. Unlike heparin, it can be delivered by injection rather
than a continuous IV drip and does not require blood tests to monitor
how it is working.

Both studies were conducted by researchers at Duke Clinical Research
Institute in Durham, N.C., and other institutions.

The larger study looked at about 10,000 patients and found that 14
percent of those who got enoxaparin died or suffered repeat heart
attacks in the 30 days afterward, compared with 14.5 percent of those
who were given heparin.

However, patients treated with enoxaparin did experience more
bleeding usually at the site in the groin where a heart catheter was
inserted but rarely enough to cause complications.

The smaller study involved almost 4,000 patients who were also
treated with other drugs commonly given to heart patients. It found
no difference in effectiveness between enoxaparin and heparin.

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