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Information for Healthcare Professionals COUGH Dry Cough • Chest Congestion • Coughing Fits The two types of cough, productive (wet cough) and non-productive (dry, spasmodic cough), require different types of treatment. A productive cough should not be suppressed, as it promotes expectoration of phlegm from the air ducts. A dry, fitful cough can be tiresome and prevent rest at night. Chestal® and Children’s Chestal® alleviate both types of cough through the relief of tracheal irritation causing dry cough, and facilitating the expectoration of thick mucus in productive cough. The syrup provides an emollient action, and the pasteurized honey adds its natural cough-relieving properties and a pleasant taste. Chestal and Children’s Chestal are over-the-counter homeopathic medicines that have no side effects such as drowsiness and are non-habit-forming. They can be used by patients taking other medications. Children’s Chestal can be safely recommended for children 2 years of age and older. As a first-line treatment for cough, Chestal offers many advantages: • Safe and simple solution for all types of cough • Doesn’t mask symptoms that could lead to an early diagnosis of a more serious problem • The syrup base is emollient and the filtered honey soothes dry cough Product How it Works Advantages Side Effects / Disadvantages Chestal and Children’s Chestal Homeopathic symptom specific activity on different types of cough: dry, spasmodic, productive. Emollient action of the syrup, cough-relieving properties of the pasteurized honey Non-habit-forming; safe for children 2 years of age and older, the elderly, and patients being treated for concomitant conditions None known Guaifenesin Expectorant; reduces the viscosity of secretions Well-tolerated Doesn’t relieve dry or spasmodic cough; combination with cough suppressant is controversial Codeine Sulfate Cough suppressant Fast-acting Low dosage efficacy is being disputed; sedative; not indicated in productive cough; may cause constipation in high doses; may mask the cause of cough Dextromethorphan Cough suppressant Non-habit-forming; fast and lasting action when given at the appropriate dosage Not indicated in productive cough; contraindicated in patients with risk of respiratory failure; overdose induces CNS depression; may mask the cause of cough Increases mucus production Traditionally used in teas or herbal preparations as natural self-medication Increases blood pressure; may induce hemostatic disorders; many contraindications (hepatic or renal impairment, high blood pressure, arrhythmia, etc.) Herbs Licorice (Glycyrrhiza glabra) Pharmacology Chestal and Children’s Chestal combine homeopathic medicines, manufactured according to the Homeopathic Pharmacopoeia of the United States guidelines, and using the highest standards of production and quality control. Indications for homeopathic medicines have been determined experimentally and verified by years of empirical use by thousands of physicians. As our knowledge of biochemistry and pharmacology progresses, more and more of these indications finally make sense. This table shows the relationships between the toxicopharmacological properties of the strain (in yellow) and the indications of its homeopathic dilutions (in orange). Chestal and Children’s Chestal should be used for their labeled indications. MEDICINES FOR DRY COUGH Bryony (Cucurbitaceae) Bryonia alba L. Roasted sponge (Spongidae) Euspongia officinalis L. Cucurbitacin glycosides: cytotoxic effects, irritation of mucous and serous membranes with intense dryness and inflammation. Iodine, bromine and silica: Burning and constriction of the pharynx and larynx, with dry croupy cough. Tree Lungwort (Lobariaceae) Sticta pulmonacea Ach. Mucilages, tannins, stictinic and norstictinic acids: expectorants, anti-inflammatory. Traditionally used for cough and bronchitis. Spongia tosta 3C Bryonia alba 3C Dry, painful cough worsened by the slightest movement. Sticta pulmonaria 3C Dry croupy and barking cough, worse at night, with dyspnea. Dry, irritant, hacking cough worse at night. MEDICINES FOR SPASMODIC COUGH Cochineal (Coccidae) Dactylopius coccus Costa Carmine acid, myristin. The powder provokes an irritation of the respiratory mucosa, fits of coughing followed by thready mucus. Coccus cacti 3C Spasmodic cough with laryngeal tickling. Sundew (Droseraceae) Drosera rotundifolia L. Proteases, naphtoquinones: Laryngeal and tracheal irritation causing suffocating, spasmodic cough with gasping for breath. Drosera rotundifolia 3C Barking fitful cough worse at night and when lying down. Ipecac (Rubiaceae) Cephaelis ipecacuanha Yellow Dock (Polygonaceae) Rumex crispus L. Emetine: emetic action. Cephaeline: expectorant. Inhalation of the powder triggers bronchospasm. Anthracenic derivatives: spasmodic, violent cough worsened by inhaling cold air. Ipecacuanha 3C Rumex crispus 6C Spasmodic cough associated with nausea. Dry and fitful cough triggered by inhaling cold air or by tickling of supra-sternal notch. MEDICINES FOR PRODUCTIVE COUGH Antimony potassium tartrate C3H4O3 (SbO2 )-COOK, 1/2 H2O Diluted emetic tartar was used as an expectorant. Ingestion activates pneumogastric area and secretion of mucus. Antimonium tartaricum 6C Wet cough with thick mucus difficult to expectorate, dsypnea. Wind Flower (Ranunculaceae) Pulsatilla vulgaris Mill. Ranunculoside, quickly hydrolyzed into anemonin: inflammation of mucous membrane with abundant, non-irritant, thick yellow discharge. Loose cough in the day with thick mucus. Pulsatilla 6C Cough dry at night, becoming wet during the day, with thick yellowish mucus. Homeopathic medicines are manufactured and marketed in the U.S. under the regulatory authority of the Food and Drug Administration.4 References used to prepare this document: 1. Demarque D., MD, et al. Pharmacology and Homeopathic Materia Medica. Ed. CEDH. 2. Martindale 30th edition. The Pharmaceutical Press, London, UK. 3. PDR for Herbal Medicines 3rd Edition. Thomson PD.R 4. U.S. Food and Drug Administration. Sec. 400.400 Conditions under which homeopathic drugs may be marked (CPG7132.15). Available at: www.fda.gov/ora/compliance_ref/cpg/cpgdrg/cpg400-400.html. 5. Chevallier A. The Encyclopedia of Medicinal Plants. Ed DK Publishing. 1996 Chestal available in 8.45 fl. oz. (250 mL) and 4.2 fl. oz. (125 mL) Children’s Chestal available in 8.45 fl. oz. (250 mL) and 4.2 fl. oz. (125 mL) DRUG FACTS ACTIVE INGREDIENTS PURPOSES (Chestal and Children’s Chestal have identical formulas) Antimonium tartaricum 6C HPUS: Bryonia alba 3C HPUS: Coccus cacti 3C HPUS: Drosera rotundifolia 3C HPUS: Ipecacuanha 3C HPUS: Pulsatilla 6C HPUS: Rumex crispus 6C HPUS: Spongia tosta 3C HPUS: Sticta pulmonaria 3C HPUS: Helps loosen thick mucus Relieves dry and painful cough Relieves cough associated with a tickling in the throat Relieves barking cough worse at night Relieves cough associated with nausea Relieves wet cough during the day becoming dry at night Relieves dry cough triggered by cold air Relieves dry, croupy and barking cough Relieves nighttime hacking cough The letters “HPUS” indicate that these ingredients are officially included in the Homeopathic Pharmacopoeia of the United States.4 INACTIVE INGREDIENTS WARNINGS Citric Acid, Honey, Purified Water, Sodium Benzoate, Sucrose Do not use if seal at base of cap is broken or missing USES • Temporarily relieves cough due to minor throat and bronchial irritation as may occur with a cold. • Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. DIRECTIONS Adults and Children 12 years and over 2 teaspoons every 2 hours. Children 2 to 12 years 1 teaspoon every 2 hours. Children under 2 years Not recommended. I0478-MD-rev. 12/09 OTHER INFORMATION • Store at 68-77°C (20-25°C) • Contains 4.2 g of sugars per 5 mL teaspoon • Contains 0.001% alcohol Ask a doctor before use if you have • Cough that occurs with too much phlegm (mucus) • Cough that lasts or is chronic such as occurs with smoking, asthma, chronic bronchitis or emphysema Stop use and ask a doctor if cough lasts for more than 7 days, comes back, or is accompanied by fever, rash, or a persistent headache. These could be signs of a serious condition. If pregnant or breast-feeding, ask a health professional before use. Keep out of reach of children. QUESTIONS, COMMENTS ? Visit us at www.boironusa.com email us at: [email protected] or call us toll free at: 1-800-BOIRON-1 (1-800-264-7661) or write us at: Boiron Information Center 6 Campus Blvd., Newtown Square, PA 19073-3267