Table 4.

Summary of the Usual Daily Pediatric Dose, Toxic Dose, and Potential Toxidromes of OTC Cough and Cold Medications

Drugs	Usual Daily Pediatric Dose	Toxic Dose	Toxidromes (Toxicity Syndromes)	References
Acetaminophen	10 to 15 mg/kg/dose every 4 to 6 hours as needed; do not exceed 5 doses in 24 hours; maximum daily dose: 75 mg/kg/day not to exceed 4,000 mg/day.	Hepatotoxicity potentially occurs with acute ingestion of more than 200 mg/kg. According to the American Association of Poison Control Centers (AAPCC) guideline, ingestion of doses higher than 150 mg/kg/day for 2 days or 100 mg/kg/day for 3 days needs medical evaluation.	Acute overdose: anorexia, nausea, vomiting, altered mental status, hypotension, and metabolic acidosis. Massive overdose within 24–48 hours: hepatic necrosis with increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, accompanied by encephalopathy, metabolic acidosis, elevated PT/INR, and acute renal failure. Chronic excessive: nausea, vomiting, hepatic injury, and depletion of glutathione, resulting in anion gap metabolic acidosis.	[43,46,51–54,66]
Pseudoephedrine	3–5 mg/kg	Toxidromes start to appear 4–5 times the average therapeutic dose.	Effects on the cardiovascular system: tachycardia, hypertension, dysrhythmias, and myocardial infarction. Effects on CNS: agitation, psychosis, paranoia, hallucinations, seizure, and intracranial hemorrhage	[43,55–57]
Dextromethorphan	2 to <6 years: 5 mg every 4 h as needed; max. 6 doses in 24 hours	A dose more than 10 mg/kg usually causes moderate symptoms.	Effects on CNS: ataxia, somnolence, mydriasis, tachycardia, and hallucinations. General effects: flushing, rash, and respiratory symptoms such as hypoxia, respiratory depression, apnea, decreased respiratory rate, hypopnea, hypoventilation, respiratory disturbance, and respiratory failure, are also results of the toxicity of dextromethorphan	[43,51,58–60]
	6 to <12 years: 10 mg every 4 h as needed; max. 6 doses in 24 hours
	12 to 18 years: 20 mg every 4 h as needed; max. 6 doses in 24 hours
CTM	2 to <6 years: 1 mg every 4–6 h, max. 6 mg daily	The lethal dose of antihistamines in children may be as low as 20–30 pills, and toddler deaths and major poisonings have been linked to doses of 10–60 mg/kg.	Drowsiness, dilated pupils, flushed dry skin, fever, tachycardia, delirium, hallucinations, myoclonic movements, and serious overdose may result in convulsions, rhabdomyolysis, and hyperthermia	[43,61–64]
	6 to <12 years: 2 mg every 4–6 h, max. 12 mg daily
	12 to 18 years: 4 mg every 4–6 h, max. 24 mg daily