Monday, July 6, 2015

Have kids around the house? Avoid camphor products

A 5-year-old was accidentally given camphorated phenol liquid instead of acetaminophen (Tylenol) liquid. Camphorated phenol is meant to be applied to the skin only. The child developed seizures and was taken to a hospital emergency department (ED) for treatment. In the ED the child's mother produced a bottle of Rexall "Pain Relief" antiseptic liquid from which she had given her child 2 teaspoonfuls.

Have kids around the house? Avoid camphor products

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A 5-year-old was accidentally given camphorated phenol liquid instead of acetaminophen (Tylenol) liquid. Camphorated phenol is meant to be applied to the skin only. The child developed seizures and was taken to a hospital emergency department (ED) for treatment. In the ED the child’s mother produced a bottle of Rexall "Pain Relief" antiseptic liquid from which she had given her child 2 teaspoonfuls.

Well-meaning parents might miss the “external use only” warnings on some camphor product labels and give kids a teaspoonful or so to swallow, not realizing that it can be harmful. The child’s mother said she mistook the bottle for acetaminophen liquid and mentioned that she didn’t see anything on the label about it not being OK for oral use.

Nationally, camphor ingestions occur in about 9,000 children under age 6 years each year, with the vast majority unintentional.  It’s predictably toxic in children when swallowed. In fact, ingestion of less than 2 teaspoonfuls or 10 mL (just over 1 gram of camphor) can result in a range of adverse neurological effects and death.

The patient above was treated with medicines for seizures then transferred to an intensive care unit. Fortunately, he was later discharged in a normal state of health.

Looking at the bottle of camphorated phenol in the above case (Figure 1), the only place you can see “For external use only” is on a side panel in the Drug Facts section, which too many people fail to read. Some parents may not understand that terminology anyway. So more direct statements such as “apply ONLY to the skin” or “Do NOT swallow” or “Do NOT eat or drink” would better serve to prevent accidents if that was on the front label panel. I did contact the manufacturer in this case and also spoke to FDA about the need for label improvements to this and other brands that are similarly labeled.

Camphor is an ingredient in a number of products that are supposed to be applied to the skin, like the anti-itch product Benadryl Itch Stopping Gel. It’s also in balms for muscle pain like Tiger Balm and cold medicines like Vicks VapoRub. Its strong aromatic odor can repel insects and moths, for which camphor is used as a repellent. Camphor is never supposed to be swallowed, but that doesn’t stop curious little children or babies from trying to eat it.

Figure 1. Rexall brand camphorated phenol does not warn against oral use on front label panel.

In a previous blog I described cases where children had seizures after licking a cube of camphor used by the parents in a humidifier to treat the child’s cold. There was also a 22-month-old boy whose parents found him with a piece of camphor in his mouth after the family used it to control roaches and still another case where a 15- month-old girl had a seizure after her mother applied a camphor chest rub too often to the child’s chest, back, and head - every hour for 10 hours - to treat cold symptoms. Still others have pulled Vicks out of the jar and stuck it in their mouth or ingested camphor in other products in other ways, and wound up in the hospital.

My best advice is to avoid products medicated with camphor if you have children in the house. If you do choose to use them, read the Drug Facts section of product labels carefully. Don’t use them for pest control either, as there are safer products available. Keep all camphor products out of the reach of children.


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President, Institute for Safe Medication Practices
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Check Up covers regional health news and a wide array of healthcare topics from pharmaceutical happenings to patient safety. Read about some of our bloggers here.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Michael R. Cohen, R.Ph. President, Institute for Safe Medication Practices
Daniel R. Hoffman, Ph.D. President, Pharmaceutical Business Research Associates
Hooman Noorchashm, M.D., Ph.D. Cardiothoracic surgeon in the Philadelphia area
Amy J. Reed, M.D., Ph.D. Anesthesiologist and Surgical Intensivist in the Philadelphia Area
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