liquorice liquid extract + menthol + squill tincture: clinical use

Prescribing considerations

• The selected product is discontinued; verify the exact formulation and licensing of any proposed alternative.
• Review cardiac history and medicines that alter potassium, magnesium or fluid balance.
• Account for sucrose and glucose in diabetes and for alcohol and preservative content in susceptible patients.
• Persistent or worsening cough requires clinical assessment rather than continued symptomatic treatment.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient
• Cardiac disorders
• Rare hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency

Monitoring

• If toxicity or a relevant interaction is suspected, assess fluid status, potassium, magnesium and cardiac rhythm as clinically indicated.
• Consider cough red flags such as breathing difficulty, chest pain or haemoptysis.

Clinical pharmacology

Squill glycosides have a reflex expectorant action after gastric mucosal irritation and are poorly absorbed. Liquorice is demulcent and mildly expectorant but may produce mineralocorticoid-like sodium retention and potassium loss. Menthol produces cooling and local analgesic sensations and is eliminated mainly as glucuronide conjugates.

Formulation and product differences

• The selected preparation was a brown, cloudy oral mixture containing peppermint oil, anise oil, capsicum tincture, alcohol, sucrose, liquid glucose, glycerol, caramel and parahydroxybenzoate preservatives.
• Different cough mixtures may have substantially different active ingredients and should not be treated as interchangeable.