Quebec coroner wants cough syrup behind counter

The provincial government should require cough medicine containing dextromethorphan behind pharmacists' counters.

The request follows the deaths of two Quebec men who took cough syrup and failed to follow instructions on the product label.

Yvon Boucher, 64, and Marcel D'Amour, 65, died within a month of each other in the spring of 2011, both as a result of accidental poisoning with dextromethorphan (DM) a cough suppressant commonly found in over-the-counter cold remedies.

Coroner Pierre Guilmette investigated the case of Boucher, who died April 7, 2011 – three days after his family doctor advised him to continue taking cough syrup and prescribed him a 15-day course of the antibiotic Biaxin for a nagging case of bronchitis. 

A deadly combination

Boucher had bipolar disorder and was also taking the antidepressant Prozac.  Guilmette concluded the combination of the three drugs – Prozac, Biaxin and dextromethorphan – proved lethal.  

Canadians fill 25 million prescriptions a year for Prozac and other antidepressants in the same chemical family, the coroner pointed out, and Biaxin is a common treatment for respiratory tract infections.The popularity of those drugs combined with the easy access to off-the-shelf cough medications containing dextromethorphan constitute a danger to public safety, he said.

In D'Amour's case, coroner Andrée Kronstrom concluded the man died of an overdose of the cough suppressant, having failed to consult a doctor for his flu symptoms.

"The blood sample is very clear," Kronstrom said of the toxic level of dextromethorphan she found.

Cough medications containing DM should be controlled by a pharmacist who can counsel consumers on how to use it properly and warn of its interaction with other medication, Kronstrom said.

"The pharmacist should speak to each person [who asks for a cough suppressant] and provide advice," Kronstrom said.

The coroner's office said a public awareness campaign is necessary to warn consumers of the dangers posed by over-the-counter cough medicines and other readily available remedies for cold and flu symptoms.

It said between 2000 and 2009, 20 people in Quebec died of accidental poisoning from medications including cough suppressants, acetaminophen (found in Tylenol and its generic equivalents) and acetylsalicylic acid (found in Aspirin and similar drugs).

The coroners have recommended that Quebec's Order of Pharmacists ask its members to take dextromorphan off their shelves and put it behind their counters voluntarily, before a change in provincial legislation makes it mandatory.

Pharmacists study question

However, the group has not decided whether to endorse that recommendation, saying it's important not to restrict consumers'  choices.

"It's a question of access — a lot of people need these kind of cough syrups," said president Diane Lamarre, adding  problems such as those that caused the deaths of Boucher and D'Amour are relatively rare. 

Lamarre and other health officials concur on one point: Whether a drug is sold off the shelf or from behind the counter, it's important to follow the warnings and instructions on the label.