{"hq_id":"hq-p-bdy-000106","name":"Cough syrup (expectorant/suppressant)","category":{"primary":"personal_care","secondary":"OTC oral medicine","tags":["cough syrup","dextromethorphan","DXM","guaifenesin","OTC","antitussive"]},"product_tier":"BDY","overall_risk_level":"moderate","description":"OTC cough syrup combining dextromethorphan (suppressant) and/or guaifenesin (expectorant). Some formulations contain alcohol (up to 10%), sucrose as sweetener, and parabens as preservatives. DXM has significant abuse potential — high-dose DXM abuse ('robotripping') produces dissociative hallucinations and is a growing problem among adolescents and young adults. ~5% of the population are CYP2D6 poor metabolizers who experience amplified DXM effects. Guaifenesin is generally safe at recommended doses.","synthesis":{"derived_risk_level":"moderate","synthesis_confidence":0.88,"synthesis_method":"compound_composition","context_used":"human_child","context_source":"product_users","exposure_modifier":1,"vulnerability_escalated":true,"escalation_reason":"Child exposure group","compounds_resolved":2,"compounds_total":2,"synthesis_date":"2026-03-27","synthesis_version":"1.0.0"},"hazard_summary":{"sensitive_populations":"adolescent, child, CYP2D6_poor_metabolizers","overall_risk":"low-moderate","primary_concerns":["DXM abuse potential: dissociative effects at high doses; growing adolescent abuse trend","Serotonin syndrome: DXM + SSRIs/MAOIs interaction","Alcohol content: some formulations contain up to 10% ethanol","CYP2D6 poor metabolizers: amplified DXM effects at standard doses"],"exposure_routes":"oral"},"exposure":{"routes":["ingestion"],"contact_types":["oral_direct"],"users":["adult","child","adolescent"],"duration":"short_term","frequency":"every_4-6_hours","scenarios":["Therapeutic use at recommended dose (safe)","DXM abuse — ingestion of entire bottle for dissociative effects","Alcohol-containing syrup given to children","CYP2D6 poor metabolizers experiencing amplified effects"],"notes":"~5% of Caucasians are CYP2D6 poor metabolizers who experience exaggerated DXM effects at standard doses."},"consumer_guidance":{"red_flags":[{"indicator":"Alcohol content >5% in children's formulation","meaning":"Unnecessary alcohol exposure for children","action":"Choose alcohol-free pediatric formulations"}],"green_flags":[{"indicator":"Alcohol-free, dye-free formulation","meaning":"Reduced unnecessary excipient exposure","verification":"Check label for 'alcohol-free' designation"}],"what_to_ask":[],"alternatives":[{"name":"Honey (age 1+)","notes":"WHO-recommended; clinical evidence for cough relief comparable to DXM in children; no drug interaction risk"},{"name":"Guaifenesin-only formulation (no DXM)","notes":"Expectorant without abuse potential or serotonin syndrome risk"}],"notes":null},"regulatory":{"applicable_regulations":[{"jurisdiction":"USA","regulation":"FDA OTC Drug Monograph — Antitussive","citation":null,"requirements":"DXM 10-30mg/dose approved OTC. Some states restrict sales to minors.","compliance_status":null,"effective_date":null,"enforcing_agency":"FDA","penalties":null,"source_ref":null}],"certifications":[],"labeling":{"required_disclosures":["Drug Facts label","Alcohol content warning if applicable"],"prop65_warning":{"required":null,"chemicals":[],"endpoint":null,"notes":null},"ghs_labeling":{"required":null,"signal_word":null,"pictograms":[],"hazard_statements":[],"notes":null},"hidden_ingredients":{"trade_secret_protected":null,"categories_hidden":[],"estimated_count":null,"known_concerns":null,"notes":null},"notes":null},"recalls":[],"regulatory_gap":"DXM abuse not adequately controlled; age restrictions inconsistent across states","notes":null},"lifecycle":{"recyclable":true,"disposal_guidance":"Drug take-back program","hazardous_waste":false,"expected_lifespan":"2-3_years"},"formulation":{"form":"liquid_oral","key_ingredients":[{"hq_id":"hq-c-org-000295","name":"Dextromethorphan HBr (DXM)","role":"cough_suppressant","concentration_pct":"1.0"},{"hq_id":null,"name":"Guaifenesin","role":"expectorant","concentration_pct":"10-20"},{"hq_id":"hq-c-org-002065","name":"Alcohol (ethanol)","role":"solvent_preservative","concentration_pct":"0-10"},{"hq_id":null,"name":"Sucrose","role":"sweetener","concentration_pct":"30-50"},{"hq_id":"hq-c-org-000087","name":"Methylparaben","role":"preservative","concentration_pct":"0.1-0.2"}],"certifications":[]},"materials":{"common":[],"concerning":[],"preferred":[]},"compound_composition":[{"hq_id":"hq-c-org-000295","compound_name":"Dextromethorphan (DXM)","role":"cough_suppressant","typical_concentration":null},{"hq_id":"hq-c-org-000087","compound_name":"Methylparaben","role":"preservative","typical_concentration":null}],"identifiers":{"common_names":["cough syrup","cough medicine","cough suppressant","expectorant"],"aliases":[],"manufacturer":null,"brands":[]},"brand_examples":[{"brand":"Generic Mass-Market Brand A","manufacturer":"Consumer Products Corporation","market_position":"mass_market","notable":"Widely available mass-market option"},{"brand":"Generic Mass-Market Brand B","manufacturer":"Consumer Goods Ltd","market_position":"mass_market","notable":"Popular budget alternative"},{"brand":"Premium Brand A","manufacturer":"Premium Consumer Inc","market_position":"premium","notable":"Upscale premium positioning"}],"sources":[{"type":"expert_curation","name":"ALETHEIA Safety Database","date":"2026-03-24"},{"type":"regulation","title":"FDA OTC Drug Monograph — Antitussive","jurisdiction":"USA","id":"src_89a6a66f"},{"id":"fda_dxm_safety_2010","type":"regulatory","title":"FDA Drug Safety Communication: DXM Cough Suppressants — Not for children <4 years; CYP2D6 poor metabolizer drug interaction; serotonin syndrome risk; adolescent abuse robotripping; Coricidin HBP triple-C abuse; NMDA antagonism high dose (2010)","year":2010,"inherited_from_compound":"hq-c-org-000295"},{"id":"aapcc_annual_2022","type":"regulatory","title":"American Association of Poison Control Centers (AAPCC): National Poison Data System Annual Report — Pediatric cocaine/stimulant exposures; body packing emergencies; levamisole agranulocytosis; accidental child ingestion outcomes (2022)","year":2022,"inherited_from_compound":"hq-c-org-000295"},{"id":"eu_sccs_parabens_2021","type":"regulatory","title":"EU Scientific Committee on Consumer Safety (SCCS): Opinion on Parabens (Methylparaben, Ethylparaben, Propylparaben, Butylparaben) in Cosmetics","year":2021,"inherited_from_compound":"hq-c-org-000087"},{"id":"iarc_3_methylparaben","type":"regulatory","title":"IARC Monographs Volume 101: Methylparaben — Group 3 Evaluation (Not Classifiable as to Carcinogenicity in Humans)","year":2013,"inherited_from_compound":"hq-c-org-000087"}],"meta":{"schema_version":"4.0.0","last_updated":"2026-03-24","timestamp":"2026-05-02T18:16:25.435Z"}}