Neither the excretion of guaifenesin in milk nor its effect on breastfed infants have been studied. It is unlikely that with usual maternal doses amounts in breastmilk would harm the nursing infant, especially in infants over 2 months of age. It is best to avoid the use of products with a high alcohol content while nursing.

Acetaminophen is a good choice for analgesia, and fever reduction in nursing mothers. Amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.

A 47 year old woman presented to the emergency department for an intentional overdose of an over the counter cough suppressant. She had been seen multiple times over the last several months with the same presentation. Her work up revealed a significantly elevated chloride level (125 mmol/L, normal 98-107) as well as an anion gap of 1. She denied any other co-ingestions, including other over the counter medications or alcohol, and was otherwise asymptomatic. She was given fluids and supportive care. Ultimately, a significantly elevated bromide level was noted on a send out lab. She was diagnosed with chronic bromide toxicity (bromism) from recurrent over the counter Robitussin HBr use, which was the source of her hyperchloremia and decreased anion gap.

Dextromethorphan (DXM) is an antitussive drug found in commonly used nonprescription cold and cough medications. At low doses, DXM is a safe drug that does not produce adverse reactions. However, abuse of DXM has been reported among adolescents and young adults using the drug at higher doses. DXM is not a scheduled drug in the USA, and the primary reason for its abuse is the ease of availability. DXM is available to purchase in the form of over-the-counter cough medications, such as Robitussin(®) and Coricidin(®), or it can be purchased over the Internet in the form of a powder. In this research work, we developed an LC-MS-MS method that can quantify DXM and dextrorphan (DXO) in oral fluid in a high-throughput toxicology laboratory setting. The developed method was validated according to the Scientific Working Group for Forensic Toxicology guidelines. The linear dynamic range was 5-100 ng/mL with a lowest limit of quantitation (LLOQ) of 5.0 ng/mL for DXM and DXO. Overall, the results of the accuracy and the precision values were within the acceptance criteria for both drugs. In addition, selectivity, matrix effect and recovery were calculated for the LC-MS-MS method. Authentic samples (n = 59) were tested to evaluate the applicability of the method. Thirty samples were found to be positive for DXM and DXO and two samples were found to be positive for DXM only.

Liquid chromatographic assays were developed using a mixed-mode column coupled in sequence with a hydrophilic interaction liquid chromatography column to allow the simultaneous comprehensive analysis of inorganic/organic anions and cations, active pharmaceutical ingredients, and excipients (carbohydrates). The approach utilized dual sample injection and valve-mediated column switching and was based upon a single high-performance liquid chromatography gradient pump. The separation consisted of three distinct sequential separation mechanisms, namely, (i) ion-exchange, (ii) mixed-mode interactions under an applied dual gradient (reversed-phase/ion-exchange), and (iii) hydrophilic interaction chromatography. Upon first injection, the Scherzo SS C18 column (Imtakt) provided resolution of inorganic anions and cations under isocratic conditions, followed by a dual organic/salt gradient to elute active pharmaceutical ingredients and their respective organic counterions and potential degradants. At the top of the mixed-mode gradient (high acetonitrile content), the mobile phase flow was switched to a preconditioned hydrophilic interaction liquid chromatography column, and the standard/sample was reinjected for the separation of hydrophilic carbohydrates, some of which are commonly known excipients in drug formulations. The approach afforded reproducible separation and resolution of up to 23 chemically diverse solutes in a single run. The method was applied to investigate the composition of commercial cough syrups (Robitussin®), allowing resolution and determination of inorganic ions, active pharmaceutical ingredients, excipients, and numerous well-resolved unknown peaks.

Oxaliplatin, a third generation of platinum-based anti-neoplastic agent has been approved for colorectal cancer in both adjuvant and metastatic settings. In addition, oxaliplatin is also indicated for other gastrointestinal malignancies such as metastatic pancreatic cancer in combination with gemcitabine. Its common toxicities include infusional hypersensitivity reaction (HSR), GI symptoms with anorexia/nausea/vomiting, sensory neuropathy and bone marrow suppression. We report a case with persistent dry cough as a variant HSR to oxaliplatin. The patient is a 75-year-old gentleman with gemcitabine refractory metastatic pancreatic cancer who received oxaliplatin and mitomycin C for palliation. He developed sudden onset dry cough without infectious etiology during the 4th infusion of oxaliplatin. Robitussin with codeine and antibiotics did not offer any relief and the cough terminated after cessation of oxaliplatin for two weeks. We believe this to be the first case in the literature with cough as a sole manifestation of HSR to oxaliplatin.

Drug abuse has been a national social problem in the United States for decades and is often complicated by the emergence of new types of abused drugs or new forms of abuse. In the late 1980s, the community of Waynesboro, Pennsylvania began to detect behavior among its teenagers that suggested a new form of drug abuse and thus a new social problem. The drug was dextromethorphan, used in cough syrup-principally Robitussin DM. The form of abuse is often referred to as "roboing" or "robo-copping." This paper presents the results of the first phase of a comprehensive investigation of this phenomenon in the Waynesboro school district. Data from a survey of school personnel indicate that abuse of cough syrup (Robitussin or other brands) has increased over the years and is increasingly perceived as a problem by the community.