Tapan Dey, a resident of Phulbagan in north Calcutta, swears never to use cough syrup again. Some time ago, he gave his five-year-old son cough syrup for a few days on the advice of a doctor. The cough did not get any better. If anything, the child became drowsy and at times even sounded incoherent. “We were really worried,” says Dey, an engineer. The child became normal only when he stopped the medication against the doctor’s advice.

Dey is not the only one who has encountered problems with cough syrup. Priyabrata Dasgupta, a resident of Calcutta, says cough syrup further “complicated” his son’s ailments whenever the 14-year-old who suffered from frequent cough and cold was prescribed one by his family physician.

True, cough syrup is often the first medication given to children suffering from a cold. But it may not necessarily do them good, doctors warn. In fact, the rampant misuse of these bottled medicines was the focus of a conference on paediatric pulmonology organised by the Indian Association of Paediatrics in Calcutta recently.

Pharmaceutical companies, however, offer a different perspective. “The use of any medicine is like using fire ? you can cook your food or you can burn your house. If properly prescribed by registered practitioners, cough syrup can be beneficial. But if used without prescriptions, like any other medicine, it might be harmful,” says Vidyadhar Desai, general manager of medical services at Nicholas Piramal in Mumbai.

Cough syrup essentially comes in three categories ? suppressant, expectorant and demulcent. While suppressants control coughs and expectorants bring out the mucus secretion, demulcents (available in the shape of throat lozenges) have a soothing effect on patients.

Experts caution that such syrups should be used carefully and only when needed.

Even medical journals ? like the March 2006 issue of the Monthly Index of Medical Specialities ? say that cough syrup, especially a suppressant, can do children more harm than good unless prescribed with utmost care.

Cough syrup with phenylpropanalamine is considered dangerous since it is used as an appetite stimulant and has been known to have caused strokes in the US, points out A.K. Manglik, a Calcutta-based paediatrician. But such cough syrups containing phenylpropanalamine are widely available in the market, he rues.

In the US and UK, the Food and Drug Administration and the National Health Service’s regulations are strict and cough syrup cannot be bought over the counter without a valid prescription. But India has no official guidelines on the different brands and almost 800 brands are openly available in pharmacies across the country.

Even consumer activists are concerned about the way cough syrup is sold and bought. “Doctors should be careful while prescribing one to children. They should take into account their medical history as cough syrup can aggravate a heart or a pulmonary disease a child may have,” says Prabir Basu, working president of the Bengal Federation of Consumer Organisations. Basu says a doctor could be taken to a consumer court for misprescribing cough syrup, especially if consumers can establish that the doctor prescribed it at the behest of a pharmaceutical company.

R.J. Jha, head of medical division at Wockhardt India, highlights another point. “Every medicine has a specific therapy and responsible prescription of cough syrups is like prescribing any other medicine.” Chandan Banerjee, a member of the central working committee of the Indian Medical Association (IMA), agrees. He acknowledges that the role of doctors in advocating cough syrup leaves a lot to be desired. “Though a number of factors are involved in this issue, there is no doubt that many doctors prescribe cough syrup irrationally and indiscriminately,” he says, adding, “advertisements for any cough syrup on television need to be banned by the government”.

But cough syrup cannot be done away with entirely. It has its uses and is sometimes required to help relieve patients of the symptoms of a cold. Some doctors say they are at times compelled by parents to prescribe cough syrup for suffering children. “Cough syrup is more misused than used and parental pressure plays a role in that,” says Mahesh Babu, a pulmonologist at Manipal Hospital in Bangalore. In fact, some doctors emphasise that for common cough and cold, no medicine is necessary as the disease runs its course anyway.

Gautam Ghosh, eastern zonal co-ordinator of the Indian Academy of Paediatrics says, a recent survey conducted by the Academy found that of 227 cough syrups, as many as 210 had potentially harmful components. “Some pharmaceutical companies even change the composition of a cough syrup without bothering to inform us,” he notes.

Doctors, therefore, seem to have a greater role to play in creating awareness. Banerjee points out the IMA is trying to address the problem by conducting what he calls continuing medical education for doctors although it cannot take action against a doctor who might have misprescribed a cough syrup. “We need concerted efforts involving doctors, government officials and the public to create greater awareness about cough syrup,” he emphasises. Until that happens, consumers need to be vigilant.

words of advice

• Do not resort to cough syrup unless the cough is very severe and distressing

• Consumption of warm water and steam inhalation can work wonders

• Do not give cough syrup to a child without a practitioner’s valid prescription

• Do not buy alternative brands of cough syrup in the absence of prescribed brands

• Check labels and expiry dates carefully when buying cough syrup

• Consult a physician only after a minimum of seven days of persistent cough.