Folk remedy wins out over synthetic drugs; Finding follows expert panel’s advice to avoid giving young kids common OTC cough-cold drugs
by Craig Weatherby
It seems that your grandmother (or great grandmother) knew best when she offered honey as a way to soothe childhood coughs.
The results of a revealing clinical trial show that honey eases childhood coughs more effectively than the leading non-prescription cough medicine for kids: an antitussive (cough-suppressing) drug called dextromethorphan or DXM.
- Honey surpassed dextromethorphan (DXM) for kids’ coughs in a controlled clinical trial.
- DXM proved no better than placebo in earlier study.
- Expert FDA panel advises against use of DMX and common cough-congestion drugs in kids under six.
DXM is the active ingredient in dozens of OTC medicines such as Dimetapp DM, Robitussin, Sudafed, Triaminic, Tylenol Cold, Vicks 44 Cough Relief, Vicks NyQuil, and store brand counterparts.
This news follows the October, 2007 conclusion of an expert FDA panel, which scrutinized the safety and effectiveness of antihistamines, decongestants, antitussins (e.g., DXM) and expectorants, and concluded that the FDA was wrong to rely on tests in adults to allow use of these common drugs in children under 12.
The panel found that DXM-based cough medicines don't work for children under age 6, and recommended against giving DXM to young children.
As the FDA said in its August, 2007 announcement of the panel’s October review, “Questions have been raised about the safety of these products and whether the benefits justify any potential risks from the use of these products in children, especially in children under 2 years of age” (FDA 2007).
In higher doses, DXM produces effects similar to those of the illegal drugs ketamine and PCP, which are known to errant adolescents as “special K” and “angel dust.”
Accordingly, the FDA has received several reports of deaths associated with youngsters’ abuse of DXM, as well as brain damage, seizure, loss of consciousness, and irregular heart beat (FDA 2005).
The experts’ recommendations are non-binding, but may prompt eventual changes in FDA rules regarding use of cough and cold medicines in kids.
And the new findings that honey is better than DXM should dissuade parents from assuming that FDA-approved drugs are safer or more effective than time-tested natural remedies for mild, transitory illnesses.
Honey's ancient healing reputation
Honey has been used for thousands of years to treat wounds and illnesses, but the sources of its reputed powers remain unclear.
It is proven that honey possesses strong antiseptic and antibacterial properties, mostly related to the fact that honey is powerfully “osmotic”.
In other words, when bacteria or other microbes come into contact with honey, the sweetener’s physical properties are such that it sucks all of the water out of the microorganisms, killing them instantly.
This osmotic property explains why you can keep honey at room temperate indefinitely, without fear of spoilage or mold.
Researchers from the Penn State College of Medicine conducted a controlled clinical trial to test the anti-tussive (cough-suppressing) powers of honey, versus dextromethorphan (DXM).
Clinical trial yields sweet results for kids' cough care
The scientists enrolled the parents of 105 children aged two to 18 who were suffering from with upper respiratory tract infections and nighttime coughs. They chose only kids whose illness was no more than a week old (Paul IM 2007).
The parents and kids were divided into three groups:
- Honey treatment (buckwheat honey)
- Honey-flavored DXM treatment
- No treatment
The trial was “blind” with regard to honey and DXM, in that the parents could not distinguish between the two treatments.
The children received the normal recommended dose of DXM syrup, or an equivalent volume of honey: children aged two to five received 1/2 teaspoon, children aged six to 11 received one teaspoon, and children aged 12 to 18 received 2 teaspoons of DXM syrup or honey, 30 minutes before bedtime.
The parents were asked to use a point score to quantify the frequency and severity of their kids’ coughing, and how well they and their children slept, for 24 hours before and during the night of treatment (or non-treatment).
All of the parents who gave their kids honey reported levels of improvement greater than those reported by the DXM group. Unsurprisingly, the parents chosen to administer no treatment reported the poorest results.
The children treated with honey improved by an average of 10.71 points, versus only 8.39 points for DXM-treated children and 6.41 points for the kids who received no treatment.
As the Penn State team wrote, “In a comparison of honey, DXM, and no treatment, parents rated honey most favorably for symptomatic relief of their child's nocturnal cough and sleep difficulty due to upper respiratory tract infection. Honey may be a preferable treatment for the cough and sleep difficulty associated with childhood upper respiratory tract infection” (Paul IM 2007).
Cough and decongestant drugs prove no better than placebo
In 2004, the same Penn State researchers published the results of a similar trial, in which they tested DXM and the decongestant/sedative drug Benadryl (diphenhydramine) against a placebo (inactive) pill.
They tested the two drugs and a placebo in 100 children with upper respiratory tract infections and nighttime coughs, and their findings and conclusions were damning (Paul IM 2004):
- “...neither diphenhydramine [Benadryl] nor dextromethorphan [DXM] produced a superior benefit when compared with placebo for any of the outcomes studied.”
- “Insomnia was reported more frequently in those who were given dextromethorphan [DXM], and drowsiness was reported more commonly in those who were given diphenhydramine [Benadryl].”
- “Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection.”
- “Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families.”
Indeed, the Penn State team’s subsequent findings suggest that honey may be a better, cheaper, safer alternative cough medicine.
- FDA. Public Health Advisory: Nonprescription Cough and Cold Medicine Use in Children. August 15, 2007. Accessed online December 17, 2007 at http://www.fda.gov/CDER/drug/advisory/cough_cold.htm
- FDA. FDA Warns Against Abuse of Dextromethorphan (DXM). FDA Talk Paper T05-23, May 20, 2005. Accessed online December 17, 2007 at http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01360.html
- Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM Jr.Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents.Arch Pediatr Adolesc Med. 2007 Dec;161(12):1140-6.
- Paul IM, Yoder KE, Crowell KR, Shaffer ML, McMillan HS, Carlson LC, Dilworth DA, Berlin CM Jr.Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents.Pediatrics. 2004 Jul;114(1):e85-90.