Docs: No pholcodine, no problem

PETALING JAYA: Despite the sudden withdrawal of cough syrups and lozenges containing pholcodine, private pharmacies and health practitioners say there are enough alternatives available.

The cough syrups and lozenges have been pulled off shelves following a notice from the Health Ministry.

Medicines containing the opioid cough suppressant have been taken off shelves and placed under quarantine before being returned to their suppliers.

Several other countries have also pulled the medication over allergy fears.

Local doctors were left surprised by the recall.

Many general practitioners (GPs) have been prescribing pholcodine-based medications for many years without any problems, said Dr Raj Kumar Maharajah, president of Medical Practitioners Coalition Association of Malaysia.

He added that GPs were required to keep records when pholcodine was prescribed.

“It was a cough mixture which we found to be effective. We hardly hear of complications. So we are also shocked that this has come up suddenly.

“We would like to know how many cases with side effects were seen in Malaysia as we have been giving this (medication) for several years without a problem,” he said.

However, he said the availability of other cough syrups and lozenges had improved.

Certain medication such as Benadryl and herbal-based cough syrups are some of the alternatives available.

“We have been prescribing herbal syrups. Benadryl just returned to the market about a month ago,” he said.

Benadryl had not been available for more than six months due to raw material issues in China.

Dr Steven Chow, president of Federation of Private Medical Practitioners Associations Malaysia, said pholcodine was mainly used as a suppressant for dry coughs.

“Alternatively, dextromethrophan is available. Some brands of dextromethrophan are available, while some brands may be out of stock,” he said, adding that the shortage of cough syrup had been a problem since 2022.

“This is mainly due to the shortage of raw materials,” he said.

While the withdrawal of pholcodine could have some negative effects, he said the bigger problem was the supply.

Association of Private Hospitals Malaysia president Datuk Dr Kuljit Singh said private hospitals usually bought original and generic medicines of various brands and types, therefore alternatives would be available.

“We must remember that not every medication works well with all patients, so we always keep different types. So, there is no issue if one medication is not available,” he said.

Dr Kuljit, however, stressed that patient safety was the priority of private hospitals, and the medication had been withdrawn in line with the ministry’s circular.

Asked about the cost incurred, he said hospitals might have to absorb the loss.

“In this sector, there is no such thing as compensation. We have to absorb the loss. If the company is willing to take up the stock and reimburse, it is something we can negotiate,” he said.

“If not, we have no choice but to accept the loss.”

Malaysian Community Pharmacy Guild president Foon Hwei Foong said pharmacies had a wide range of products available.

“We stopped selling the products once we received the notice from both suppliers and the National Pharmaceutical Regulatory Agency (NPRA),” she said.

“Pharmacies, however, will not suffer losses as supplier will pay compensation.”

Health Minister Dr Zaliha Mustafa said on Wednesday that the Drug Control Authority had issued an order for products containing pholcodine to be recalled.

She urged those taking cough medication with pholcodine to stop consuming it and consult a doctor for an alternative treatment.

Among the recalled products are the Duro-Tuss cough syrups, Difflam lozenges, Russedyl compound linctus and Pholcodine syrup.

Dr Zaliha said the NPRA had received 12 reports of 17 people suffering adverse effects.