As if consumers weren’t already confused enough by the hundreds of cold/flu remedies, every year several dozen new products are introduced in hopes that they will capture a significant portion of the more than $1.4 billion over-the-counter market. Most are slightly altered versions of already existing products. Many contain a mix of ingredients, only some of which may be useful while others may be counterproductive.
If any medications are taken at all, experts advise that single-ingredient products be used, chosen to counter the most bothersome of your symptoms. When treating a cold, less is best. The more ingredients you take, the more likely you will experience adverse side effects that may actually make you feel worse. Keep in mind, too, that as a cold progresses, the symptoms change, and so should the treatment.
Pregnant women should not take any medication without checking first with their physicians. The elderly, too, should exercise caution, since they are more likely to experience toxic side effects from both over-the-counter and prescribed drugs. Also, anyone with a chronic health problem, from heart disease to glaucoma, and anyone taking prescribed medication, including psychotherapeutic drugs, should check with a physician before taking any over-the-counter cold/flu product.
Whatever drug you choose, there is no inherent advantage in paying more for heavily advertised “name” brands; generic or storebrand versions will work just as well (or as poorly). Here is what you might find in a cold/flu medicine.
Active ingredients: These are the substances that are supposed to have a direct effect on symptoms. They include analgesics (painkillers) and antipyretics (fever reducers), decongestants, cough suppressants, expectorants, and antihistamines.
Inactive ingredients: These include substances like alcohol that give the medicine form and texture, flavoring and coloring agents, stabilizers, sugar, and caffeine (often added to counter the drowsiness induced by antihistamines, but not too helpful if what you need most is sleep).
Analgesics and antipyretics: The common painkillers—aspirin, acetaminophen, and ibuprofen—play two roles. They relieve headaches and muscle aches and they reduce fever. If a product containing any of these is used, additional pain or fever medication should not be taken. Of the three, acetaminophen is least likely to cause stomach upset. Before taking aspirin or ibuprofen, it is wise to eat something. Aspirin has been shown to increase viral shedding (and thus may help to spread the cold to others) and it may also prolong the infection. Remember, too, that fever is one of the body’s main weapons against infectious organisms, so unless it is very high (say, above 102°F in an adult), you may want to let it run its course.
Decongestants: These help to relieve upper respiratory congestion (stuffy nose and sinuses) by shrinking blood vessels and reducing swelling in the nasal passages. But relief comes at a price. Oral decongestants can cause dry mouth, agitation, insomnia, increased heart rate, and raised blood pressure. Pseudoephedrine is the most popular decongestant used in oral medications. Phenylpropanolamine (PPA), the most common ingredient in diet drugs, is also often used as an oral decongestant, but it is more likely than pseudoephedrine to cause a steep rise in blood pressure. Oral decongestants may interfere with restful sleep and result in daytime fatigue. Limit their use to one week to avoid a rebound reaction— an increase in congestion and dependency on the product. Fewer side effects are associated with topical decongestants in nose drops and nasal sprays. Effective ingredients include xylometazoline, oxymetazoline, ephredrine, and phenylephrine. However, nose drops and sprays should not be used longer than three days; longer use can cause a rebound reaction.
Cough suppressants: These products, also known as antitussives, are used to suppress an irritative, dry cough. Experts recommend that they be reserved for coughs that disrupt sleep. Lingering coughs that interfere with a person’s waking life are best treated with home remedies like ample fluids, cough drops, and lozenges. The most popular cough-suppressant product is dextromethorphan. Others deemed effective are chlophendianol and codeine (a prescription drug that is sleep-inducing and can be habit-forming).
Expectorants: When a cough is “productive”—sputum-producing—it is consider a “good” cough that is cleansing the breathing tubes of excess mucus and potentially infectious microorganisms. The goal is not to suppress such a cough but rather to liquefy and loosen the phlegm so that it is more easily coughed up. This is the role of expectorants. Expectorants may also help to loosen up a “tight-chested” nonproductive cough that results from an accumulation of secretions so thick they cannot be coughed up. The only expectorant approved as safe and effective for over-the-counter use is guaifenesin. Though it may seem counterproductive to take a product that contains both an expectorant and a cough suppressant, the combination may be helpful when taken before bedtime if a productive cough frequently interrupts sleep.
Antihistamines: These products are designed to counter the symptoms of allergies by blocking the effects of histamine. Histamines play almost no role in colds and flu, but antihistamines have a potent drying effect, which has prompted their widespread use in products designed to stop the runny nose that is the hallmark of the early stages of a cold. However, this is one ingredient experts say should be avoided by cold and flu sufferers because it can thicken secretions in the chest and sinuses, making them harder to expel and setting the stage for a secondary infection. The antihistamines approved for over-the-counter use also cause drowsiness, adding to the fatigue induced by a cold and making driving or operating machinery very hazardous. Other side effects may include blurred vision, dry mouth, constipation, and urine retention. The most commonly used antihistamines in over-the-counter products are chlorpheniramine, triprolidine, brompheniramine, and doxylamine.
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