The cold, cough, and flu season is in full swing. Because pharmacies and stores are stocked with so many different products, it can be hard (and downright confusing) to choose the most appropriate product. As a general rule of thumb, generic or store brands are cheaper than name brand products and they contain the same active ingredients! I want to tell you about the ingredients which are found in virtually all cold and cough remedies on the shelves these days. You can buy these products individually or in combination with each other. For your safety, always follow the dosing recommendations provided and do not exceed the recommended dose.
Dextromethorphan: (“DM”, Delsym, Robitussin, “cough”) Dextromethorphan is a cough suppressant which is available in short acting (4-6 hour) and longer acting (12 hour) formulations. A common side effect of dextromethorphan is confusion and altered mental status. Patients taking this medication should use caution and determine how it affects them before driving or working. Dextromethorphan has the possibility to produce positive results on a urine drug screen. Dextromethorphan is not recommended for those aged 65 and older as it can increase the risk of dizziness and confusion. Children under 4 should not use this medication.
Guaifenesin: (Mucinex, “mucus”) Guaifenesin helps break up chest and throat congestion and is currently the only expectorant available over the counter. It is available in liquid and tablet form. Guaifenesin is generally a safe medication and works best when taken with plenty of water.
Pseudoephedrine: (Pseudophed, “D”) Pseudoephedrine is a powerful nasal decongestant regulated by law and is sold behind the pharmacy counter. It is often combined with an anti-histamine or NSAID such as ibuprofen or naproxen. Its use is not recommended for those with high blood pressure or cardiovascular disease. Patients with diabetes or glaucoma should also use with caution. The major side effect of this medication is dry mouth, nervousness, increase in heart rate, and trouble sleeping. Notify your doctor if you are using pseudoephedrine and your symptoms do not improve within 7 days.
Phenylephrine: (“PE”) Phenylephrine is a nasal decongestant that is a safer alternative for patients with high blood pressure. As with pseudoephedrine, you may experience nervousness or trouble sleeping if take close to bedtime. Pregnant women should not take this drug at any stage of pregnancy.
Anti-histamines: (loratidine, cetirizine, chlorpheniramine, fexofenadine, diphenhydramine): (Benadryl, Claritin, Zyrtec, Allegra, Coricidin) Anti-histamines help decrease itchy nose, throat, and eyes. They also reduce nasal congestion and sore throat caused by nasal drip. These medications are generally safe with very few side effects. Diphenhydramine may cause drowsiness so use with caution and administer during the day hours.
Acetaminophen: (Tylenol, APAP) Acetaminophen helps reduce fever and pain. It is generally safe for everyone except those with liver disease. It is a safer alternative for those with heart disease, hypertension, or kidney problems. Be aware of any other sources of acetaminophen that you may be taking from prescription or other over the counter products. The maximum daily dose of acetaminophen should never exceed 4000 mg/day.
Ibuprofen and naproxen sodium (NSAIDS): (Advil, Motrin, Aleve) NSAIDS such as ibuprofen and naproxen help reduce fever and pain. They are generally safe except for patients with long-term cardiovascular and kidney disease. Taking NSAIDS with food may help decrease any upset stomach side effects.
Oxymetazoline: (Afrin) Oxymetazoline is powerful and quick acting nasal decongestant that is available in a nasal spray. It is for short-term relief of nasal congestion. Patients with heart disease, high blood pressure, diabetes, thyroid disorder, or trouble urinating due to enlarged prostate should talk with their doctor before using this medication. Use should be limited to a maximum of three days because after this time period rebound congestion can occur.
I hope this information helps you pick the best over the counter cold and cough remedies and saves you a few dollars as well. As always, your pharmacist is available to answer any questions or concerns that you may have. If you have tried an over the counter medication for over a week and it is not relieving your symptoms, you should talk with your doctor.
Kelly Loignon, PharmD Candidate 2018
Presbyterian College School of Pharmacy