Pseudoephedrine For Infants: The BEST (unless you are an idiot)

[edit-explanation:] the dosing schedule / dosage by weight information you want is at the bottom of the page. There is a little math involved. The top of this page is all ranting; feel free to scroll down.[/edit-explanation]

In 2005-2006, the world for Central Texans (highest allergy prescription rate in the country last I heard) and all those who ever suffered from a stuffy or runny nose, or sinus headache, changed forever. 3 children died. And somebody figured out that you can make illegal substances out of legal ones.

Congress decided to Do Something(!)

What they did would not have prevented those childrens' deaths, and it has probably never caused one gram fewer of methamphetamine to be manufactured in a speed-freak's basement. As with almost everything Congress can do, it only made life harder for the already-law-abiding, and the criminals and the criminally stupid will go on as if nothing much has happened.

Now, instead of going to the appropriate aisle in any store that sells medicine and buying it like any other helpful thing, you have to go to the pharmacy counter at a major retailer (if the pharmacy is open, if not tough cookies) and swipe somebody's driver's license in a scanner. No comment on the security of the system, which is somewhat like a colander for keeping water secure, but I digress.

To review: if you have sinus pressure, a sinus headache, a runny or stuffy nose, or itchy, watery eyes, you want an appropriate dose of pseudoephedrine, PERIOD.

If you take too much of any drug, you will get hurt. This is no exception. If you can't figure out how much of a drug you should give yourself you either a) went to government school, or b) are somewhere between a moron and and an idiot (literally). If you know how much to give yourself, but can't figure out how much to give to a child, you need to either a) consult a pediatrician or b) sit down with a pencil and figure it out, which should be free and cost about 3 minutes of your time.

For me, giving a small child a dose of medicine based on their weight is simple. For almost everyone, at least using the dose-by-age chart right on the bottle of medicine is simple. But at least 3 parents were thick enough to overdose their children on pseudoephedrine and kill them, in 2005. That's 3, out of probably a hundred million or more successful reliefs of miserable children by proper dosage of pseudoephedrine, including what I gave my own children. Thanks, and good job spoiling it for the rest of us. But this was just one shoe.

The other shoe dropped when the feds made it a slight hassle to acquire this, the most useful of all OTC cold remedies. Of course, introducing a minor obstacle for consumers eventually led to substitution with a medicine that basically doesn't work, and sales of the good stuff fell off a cliff, and the infants' and toddlers' packaged pseudoephedrine was pulled by the manufacturers, due to lack of profits for the safety of the children.

So now, instead of messing up the dose for an infant (do they get 1/2 or 12 droppers full?) we will have mouth-breathing parents out there (this is literal, not a pejorative, consider the topic of this essay) trying to figure out dosage for a 20lbs. person based on the dosage chart for a 100lbs person, with a wholly inadequate measurement system (how many times can you logically divide a tablespoon? milliliters, anyone?)

So, here's what you find when you google "pseudoephedrine for infants", basically verbatim, everywhere on the Internet:

You paid for all this, remember. Everything in brackets and all emphases are mine.

"The U.S. Centers for Disease Control and Prevention recommends that parents not administer over-the-counter cough remedies to children under the age of 2 without first consulting a doctor.

"This recommendation was based on a 2005 investigation of the deaths of 3 infants who were 6 months old and younger, who died of a fever after consuming cough syrup containing pseudoephedrine. The investigation found that the infants had levels of the decongestant that was up to 14 times the recommended pseudoephedrine dosage for children between 2 and 12 years of age. "

"In January 2006, NAME, in collaboration with CDC, initiated an e-mail inquiry, requesting reports of deaths in infants aged other than those from media [read: the ones you saw on the news were the only ones] and published reports were identified. From these reports, CDC identified [only!] three cases of infant deaths in two states during 2005 that were determined by a medical examiner or coroner to have been caused by cough and cold medications

"The three infants ranged in age from 1 to 6 months; two were male. All three infants had what appeared to be high levels of pseudoephedrine (a nasal decongestant) in postmortem blood samples. The blood levels of pseudoephedrine ranged from 4,743 ng/mL to 7,100 ng/mL.† One infant (patient 2) had received both a prescription and an over-the-counter cough and cold combination medication at the same time; both medications contained pseudoephedrine"[!]

"In another action, the availability of pseudoephedrine-containing medications has been affected by the federal Combat Methamphetamine Epidemic Act, which was signed into law March 9, 2006 [thanks President Bush!]. This act bans over-the-counter sales (but permits behind-the-counter sales in limited amounts) of cold medications that contain pseudoephedrine, which can be used to make methamphetamine. Because of this act, pseudoephedrine has been removed as an ingredient in many cough and cold medications and replaced with other nasal decongestants. . . .As an alternative to pseudoephedrine and other nasal decongestants, caregivers might consider clearing nasal congestion in infants with a rubber suction bulb; secretions can be softened with saline nose drops or a cool-mist humidifier." [note: this (deleted) does NOT work for more than a few minutes, unless your goal is to have a screaming baby. Oh, and you can give them a bloody nose with the suction bulb]

"The dosages at which cough and cold preparations can cause illness or death in pediatric patients younger than 2 years of age are not known, and there are no specific dosage recommendations (i.e., approved by the US Food and Drug Administration [FDA]) for the symptomatic treatment of cold and cough for patients in this age group. (See Dosage and Administration: Dosage.) Because of the absence of dosage recommendations, limited published evidence of effectiveness, and risks for toxicity (including fatal overdosage), CDC and FDA state that parents and other caregivers should not administer cough and cold preparations to pediatric patients younger than 2 years of age without first consulting a clinician and should follow the clinician’s instructions precisely."
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And finally, the money shot:
(I was actually looking for these data when I started out on the 'web tonight)
INFANTS' TYLENOL COLD PLUS COUGH (=the best medicine, EVAR, for minor nasal problems in infants)
Ingredients:
per 1.6ml (two dropperfuls)

* Pseudoephedrine 15mg (decongestant)
* Acetaminophen 160mg (fever reducer)
* Dextromethorphan 5mg (cough suppressant)

WHEN TO USE

Fever, aches, frequent cough, nasal congestion, mild runny nose (Day time).

It is safe to use in children six months and older for upper respiratory illness (such as colds and sinus infections). If your child has a lower respiratory tract illness (like pneumonia, bronchiolitis or asthma) you should ask your physician before using cold or cough remedies.

The chart that was on the side that was too difficult for "some people" to figure out:
Under six months: Consult physician
6-11 months (12-17 lbs): 0.8 ml every 4-6 hrs. (max 4 doses/day)
12-23 months (18-23 lbs): 1.2 ml (0.8 + 0.4ml) every 4-6 hrs. (max 4 doses/day)
2-3 years (24-35 lbs): 1.6 ml (0.8 + 0.8ml) every 4-6 hrs. (max 4 doses/day)
>35 pounds: Use Children's liquid

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Okay, so let's say I have a 6 month-old infant with sinus drainage and a boogery nose. He weighs 20lbs. I go to the chart and find I should give him . . . carry the 2 . . . 1.2ml per dose, about every 6 hours.

Now thanks to your Elected Heroes in Congress, I have to do some advanced calculus and geometry to get the proper dose for my baby.

I have before me in my baby-smelling fingers a bottle of Non-Drowsy children's [sic] Sudafed Nasal Decongestant, 4fl. oz (118ml). I turn it over and let's see... children 2 to 6 years of age, 1 teaspoonful. here it is Drug Facts: Active ingredient in each 5 mL (1 teaspoonful) [there's a graduated beaker for dosing and it's marked in both so everybody is happy and warm and fuzzy when drugging up Jr.] sorry, where was I?

oh yes 5ml of this juice has Pseudoephedrine HCl 15mg (Nasal decongestant).

Okay, where have I seen that number before? oh, wait, that's exactly the same dose as the wonderful-but-discontinued Infants Tylenol Cold Plus Cough, in 1.6ml (two droppersful)!

But I wanted 1.2ml of that stuff... so let me get the calculator out again...
5ml Sudafed = 1.6ml Tylenol (if that's all you can read out of this whole essay, please, go ask your doctor)
1.2/1.6=0.75. I want 0.75x the two droppersful dose. That's
5 * 0.75 = 3.75. 3.75ml of the Sudafed juice is the same as 1.5 droppers of the Tylenol juice.

Great, now I get to make my baby swallow almost 4ml of medicine instead of less than 1.5ml. Thanks, Congress!