Hyderabad Paediatrician Issues Urgent Warning on OTC Allergy Drops for Infants
In a concerning development from Hyderabad, a prominent paediatrician has raised serious alarms about the over-the-counter sale of allergy drops for infants and young children. Dr Shivranjani Santosh, who previously exposed misleading marketing of sugary drinks as Oral Rehydration Solutions, has now highlighted how commonly available dropper bottles can deliver dangerous adult doses to vulnerable babies.
The Hidden Danger in Common Droppers
Dr Santosh explains that most allergy drops containing cetirizine or levocetirizine come with a 1 ml dropper that parents routinely use without realizing the critical dosage implications. What appears to be a small amount of liquid actually contains 10 mg of the active drug – essentially an adult dose that can overwhelm an infant's developing system.
"Parents don't realize that 1 ml contains 10 mg of the drug, which is essentially an adult dose," emphasizes Dr Santosh. "This high dose is particularly harmful for infants as it can cause excessive drowsiness and shallow breathing, failing to remove enough carbon dioxide and deliver sufficient oxygen."
Understanding Schedule H Classification and Its Importance
Both cetirizine and levocetirizine fall under Schedule H classification, meaning they are legally required to be sold only against a doctor's prescription. The classification exists precisely because misuse of these medications can cause significant harm, especially when administered to vulnerable populations like infants below six months of age.
"When such medicines are sold over the counter, parents often assume they are harmless," notes Dr Santosh. "This assumption is dangerously incorrect, particularly when these drugs are given to babies below six months."
Recommended Dosage Versus Common Practice
The maximum recommended dose for children between six months and two years is just 2.5 mg per day, with individual doses not exceeding this amount. This translates to approximately 0.25 ml depending on the specific formulation – a fraction of what a standard 1 ml dropper delivers.
"These medicines should not be used in babies under six months," Dr Santosh clarifies. "Even between six months and two years, they must be prescribed very judiciously. The problem arises when caregivers give 1 ml even once, or worse, multiple times a day, resulting in dangerous overdosing in infants."
Potential Health Risks and Real-World Observations
The sedative properties of these antihistamines pose particular risks for infants. Excessive doses can cause:
- Severe drowsiness that interferes with normal functioning
- Suppressed breathing that reduces oxygen intake
- In extreme cases, slowed or stopped breathing that can prove fatal
"I haven't received formal complaints yet," shares Dr Santosh, "but in just one week, I saw two infants – one barely a month old and another three months old – who had been given these medicines. My concern is prevention. We've seen similar patterns earlier with cough syrups and antihistamine overdoses, and the consequences only become visible later."
Systemic Issues Beyond Individual Brands
The problem extends beyond any single pharmaceutical company. Multiple brands and equivalent formulations exist, with most containing the problematic 10 mg per ml concentration. The issue is systemic, involving easy over-the-counter access, identical dropper designs across brands, and insufficient dosing awareness among caregivers.
"While drugs like levocetirizine may be less sedating compared to older antihistamines," Dr Santosh explains, "an adult dose given to a three-month-old baby is still dangerous. An infant's body cannot metabolize drugs the way adults do."
Practical Guidance for Parents
For parents facing situations where their baby shows cold or allergy-like symptoms and immediate doctor consultation isn't possible, Dr Santosh offers clear guidance:
- Avoid self-medication completely with Schedule H drugs
- For blocked noses, saline nasal drops provide safe relief
- If the baby exhibits breathing difficulties, continuous coughing, vomiting, or feeding problems, seek medical attention immediately
Call for Systemic Changes and Regulatory Action
Dr Santosh advocates for multiple interventions to address this public health concern:
- Strict enforcement ensuring Schedule H drugs are never sold without prescriptions
- Complete avoidance of these medications in babies below six months
- Improved packaging with droppers that physically limit doses to 0.25 ml
- Enhanced awareness campaigns targeting both pharmacists and parents
- Clear communication that drop or syrup formulations don't equate to safety
"Just because a medicine comes in drops or syrup form, it isn't safe," Dr Santosh emphasizes. "Schedule H exists for a reason. Until we take prescription laws seriously, children, especially infants, remain at risk."
The Hyderabad paediatrician's warning highlights the urgent need for better regulatory oversight, improved medication packaging, and increased public awareness about the proper use of antihistamines in pediatric populations.
