Is it safe for the elderly population to take cough syrup, especially those taking Selective Serotonin Reuptake Inhibitors (SSRIs)?

From the Guidelines

Elderly individuals, especially those taking Selective Serotonin Reuptake Inhibitors (SSRIs), should exercise extreme caution when considering cough syrup due to the potential for severe drug interactions and adverse effects. The use of cough syrup in this population can lead to serious complications, including serotonin syndrome, a condition characterized by symptoms such as confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and fever, as a result of the interaction between dextromethorphan (DXM) found in many cough syrups and SSRIs like fluoxetine, sertraline, and paroxetine 1.

Key Considerations

• The elderly are more susceptible to adverse drug events (ADEs) due to factors such as polypharmacy, advanced age, and decreased renal and hepatic function, which can affect drug metabolism 1.
• Polypharmacy, defined as the concurrent use of 5 or more medications, is common among the elderly and increases the risk of drug-to-drug interactions, medication nonadherence, and ADEs 1.
• Tools like the American Geriatrics Society Beers Criteria, STOPP (Screening Tool of Older Persons’ [potentially inappropriate] Prescriptions), and MAI (Medication Appropriateness Index) can help assess the safety of medications in older adults, including those taking cough syrup and SSRIs 1.

Recommendations for Safe Use

• Elderly patients on SSRIs should consult their healthcare provider before taking any cough medication to discuss potential interactions and side effects.
• Non-medicated options such as honey and lemon mixtures, steam inhalation, or staying hydrated should be considered as alternatives to cough syrups.
• If medication is necessary, products without DXM, alcohol, or sedating antihistamines should be chosen, and the lowest effective dose should be used.
• Regular monitoring for signs of serotonin syndrome and other adverse effects is crucial when elderly patients on SSRIs are taking cough syrup.

From the Research

Safety of Cough Syrup for Elderly Population Taking SSRIs

• The safety of cough syrup for the elderly population taking Selective Serotonin Reuptake Inhibitors (SSRIs) is a concern due to potential drug interactions and adverse effects 2.
• SSRIs are commonly used to treat depression and other psychiatric conditions in the elderly, but they can increase the risk of adverse reactions, such as gastrointestinal bleeding, falls, and fractures 2.
• Cough syrups containing dextromethorphan can also cause adverse reactions, including serotonin syndrome, which can be life-threatening 3, 4.
• The risk of adverse reactions is higher in the elderly due to age-related changes in drug metabolism and the presence of comorbidities 2, 5.

Potential Interactions between SSRIs and Cough Syrup

• The use of SSRIs and cough syrup containing dextromethorphan can increase the risk of serotonin syndrome, a potentially life-threatening condition 3, 4.
• The combination of SSRIs and dextromethorphan can also increase the risk of other adverse reactions, such as gastrointestinal symptoms, neurological symptoms, and psychiatric symptoms 5.
• The elderly are more susceptible to these adverse reactions due to their increased sensitivity to drugs and the presence of comorbidities 2, 5.

Precautions and Monitoring

• Elderly patients taking SSRIs should be cautious when using cough syrup containing dextromethorphan, and their healthcare provider should monitor them closely for signs of adverse reactions 2, 3.
• The use of SSRIs and cough syrup should be titrated slowly and carefully, and the patient should be educated on the potential risks and benefits of these medications 2, 6.
• Regular monitoring of the patient's condition, including periodic reassessment of the risk-benefit ratio of remaining on the SSRI, is essential to ensure safe and effective treatment 6.