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Cough and Cold Remedies
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Just Because It's Over-the-Counter, Does Not Mean It's Safe

Caution Sign
Many products for colds contain a combination of ingredients that will treat many symptoms of a cold. Taking 2 different products runs the risk of duplicating ingredients and causing serious side effects. Only take the product that will treat the symptoms you have, to minimize unnecessary medications, and potential side effects.

Elderly should avoid taking any over-the-counter cold medications due to the increased potential for serious side effects.

Children Always check with your pediatrician before giving your child any cold medicines. Each year, thousands of children under age 12 go to emergency rooms after taking over-the-counter cough and cold medicines. Most of these children were unsupervised when they took the medicine. In 2009, leading manufacturers of children's cough and cold medicines voluntarily changed the labels on these products to state that they should not be used in children younger than 4 years of age. Previously, the labels stated that these medicines should not be given to children under age 2. Products with the old labels have not been removed immediately from store shelves but are expected to gradually be replaced with products bearing the new labels.

What You Need to Know About Cough and Cold RemediesCold medications

If You Have This Symptom
Choose a Medicine With This Type of Ingredient
Stuffy nose, runny nose

Decongestants can relieve nasal stuffiness due to allergies, colds, or the flu. See cautions for decongestants--these products, other than Normal Saline, are not recommended for the elderly or young children. Decongestants are available in many OTC products in both oral tablets and nasal sprays. The most common ingredients are:

1) Pseudoephedrine: Oral; most effective decongestant available over-the-counter, but stored behind the pharmacy counter.

2) Phenylephrine: Oral and nasal decongestant; less effective than pseudoephedrine. Most common decongestant found in the products stored on the shelves.

Until recently, pseudoephedrine has been the more commonly used decongestant and the main active ingredient in many popular nonprescription cold and allergy medications. Unfortunately, pseudoephedrine is also a key ingredient in the production of methamphetamine, a highly addictive illegal stimulant. In an effort to combat methamphetamine production, federal law has recently required that all nonprescription medications containing pseudoephedrine be taken off drugstore shelves and be stored behind the counter in the pharmacy. To purchase these medications, you must go to the pharmacy, show some form of government-issued identification, and sign a logbook.

Some drug companies are concerned that this inconvenience may discourage people from buying cold and allergy medications containing pseudoephedrine. As a result they are quietly reformulating these products — removing the decongestant ingredient or replacing pseudoephedrine with phenylephrine. The label has not changed, and many people naturally assume that the product is unchanged as well.

3) Oxymetazoline: Available in nasal sprays

4) Saline Nasal Spray (Ocean Nasal Spray or Drops) Used every 2 hours, or as needed, is the safest method to help clear the nose and is the only decongestant recommended for the elderly.

Runny nose, sneezing Antihistamines relieve symptoms related to allergies, but also can have a side effect of drowsiness that helps with sleep in night-time cold remedies. Available OTC antihistamines include:
1) brompheniramine maleate
(Dimetapp),
2) loratadine (Allavert, Claritin), loratadine is non-drowsy in most people.
3) diphenhydramine HCl
(Benadryl Allergy, Tylenol PM),
4) chlorpheniramine maleate (Chlor-trimeton),
5) clemastine (Tavist Allergy).
Note: See cautions for antihistamines
Cough that is not productive of sputum (dry cough) that is keeping you awake at night

Cough suppressant-- Coughing is necessary to clear the lungs. Cough suppressants should be used sparingly, mostly to allow sleep. Cough suppressants may not relieve cough caused by asthma--the asthma will need to be treated to relieve the cough related to it.

For children: always check with your pediatrician before giving your child any over-the-counter medication. The most effective cough remedies are available only by prescription. The following over-the-counter remedies are mildly effective:

1) Dextromethoraphan is commonly the active ingredient in over-the counter cough suppressants but is no longer recommended for the the symptomatic relief of a cough associated with the common cold. Although it is slightly effective in relieving a mild cough, when taken in large amounts, dextromethorphan can produce hallucinations or "out-of-body" experiences similar to those caused by the hallucinogens phencyclidine and ketamine. Because of it's availability in the medicine cabinet, an alarming number of teens are abusing this medicine and causing serious, irreversible damage to their bodies.)

2) Diphenhydramine (Benadryl) and/or the decongestant pseudoephedrine (Sudafed) is recommended by the American College of Chest Physicians, for the relief of a mild cough related to a cold.

3) Prescription decongestants are the most effective in suppressing a cough.

3) Buckwheat honey: 1/2 to 2 tsp of before bedtime has been found to be helpful in suppressing a dry cough during sleep. A recent study compared the effectiveness of dextromethoraphan (the active ingredient in OTC cough suppessants) to 1/2 to 2 tsp of buckwheat honey, and the honey was found to be more effective. (Honey should never be given to children less than 1 year old.)

There are important contraindications for all of these medications, especially in children and the elderly.
Always read the label and know what you're taking

Dry Cough

Guaifenesin: Most common expectorant used by health care providers to help bring up the sputum. Not recommended for children < 6 years. For children: Always check with your pediatrician before giving your child cough medicines or expectorants.

Fever, headaches, minor aches and pains Pain Relievers--the most common ingredients for pain relief are acetaminophen, aspirin, ibuprofen, or naproxen sodium (See pain relief)
Daytime relief Read the label--choose one that doesn't cause drowsiness
Nightime relief Read the label--choose one that causes drowsiness
More
--Written by N Thompson, ARNP in collaboration with M Thompson, MD, Internal Medicine, Last updated October 2009

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