Monday, February 11, 2013

Aisle full of cold medicine choices, but which is the right one?

Achoo!  Gesundheit!  If you are coughing, sneezing and sniffling right about now, you’re not alone. The vast majority of people we’re seeing at the office at this time of year for same-day sick visits have an upper respiratory infection…aka, a cold. Now, colds come in different varieties; there’s the garden variety “Rhinovirus” which gives the old tried and true cold symptoms. There’s also the more powerful RSV (Respiratory Syncitial Virus) which packs a punch to all who get in it’s way but even more to our littlest babies (more to come on this, keep reading). The flu is also still out there too (yes, still time to call the office to get your flu shot). So if you’re in battle with any of these right now, you’re not alone. I was in a visit with a patient last week and we got into a lengthy discussion about cold medicines; I joked with him at the time that I should blog about this topic then thought about it some and thought it would be worth sharing…so now I am!

I’ve read estimates of Americans getting 4 billion colds every year. This is why the US spends in the neighborhood of 4.2 billion dollars (yes, that reads billion) every year in cold remedies. By the USA Today report I read, that is only the “traditional” medicines, not the alternative ones (think Vitamin C, Echinacea and Zinc…so that number could double!). So now you realize why the cold/cough/flu remedy aisle in your local pharmacy or grocery store is SOOOO long and full of options. Simply stated, we buy them. I hope to help clear up which options to consider in your quest to feel better.

The thing about any and all cold medicines is this: they don’t make you better. They help you feel better sometimes. I hear all the time that the cold medicines help, but as soon as they wear off, the love is gone and symptoms return. They mostly exist as 4 hour formulations, which is not really that great. By the time you find improvement in your symptoms, the medicine is just about to wear off. Taking it every 4 hours is so time consuming. I don’t think there is anything I can manage to do every 4 hours during a busy day as a mom and at work. So I can practically recommend the 12 hour extended release formulations of any drug you take. Take one in the mornings when you wake up to help you with those daytime symptoms and another sometime 12 hours later—this second dose will help you manage symptoms overnight while you’re sleeping. Getting rest can be the difference in getting better or lingering sick. It won’t magically make you better but when you’re rested, you’ll FEEL better…and isn’t that really what you’re looking to do?

Let me start with the one I wish didn’t really have such a big place on the shelves. Dextromethorphan. It is billed as a cough suppressant. This makes sense at first. Yes, stop the cough. But think about it a little more carefully and you’ll see that the cough is actually protecting you. Let’s consider two scenarios. One - the cough is from lung/heart/stomach disease; so suppressing it allows you to go undiagnosed and that could be life-threatening…so, suppressing that cough is not a great idea. Two - the cough is from your upper respiratory area; the mucous is coming from your nose and sinuses and is caused by the mucous as it drips and drains into the upper part of your throat. The body tries to avoid that mucous from getting into the lungs to cause a pneumonia/lung the cough is actually a good thing there. The other thing about dextromethorphan is that it actually could be DANGEROUS! Yes, dangerous. It can interact with many depression/anxiety medicines causing a serious interaction. Since you can buy dextromethorphan without a prescription or even a talk with your pharmacist, this frightens me. So look for this drug and think three times before you buy it. Look for any drug that has a DM after it (DextroMethorphan) and, in my opinion, avoid it.

The one I really DO like is pseudoephedrine. This drug is not for everyone. Some people don’t tolerate it. I’d say, in my experience, 1 in 10 people tell me they cannot take it because it makes them jittery or have a fast heart beat. The other consideration is people with high blood pressure. For most patients who have controlled, treated high blood pressure, it’s OK to take this drug FOR A FEW DAYS while you’re sick and not worry it will cause serious damage (if your blood pressure is uncontrolled or it’s used beyond a few days, your doctor or provider should be involved). If you’re one of those people, this drug is not for you. If you’re not, this may be something that helps open up your nasal passages and keep you moving air…which is a good thing! In addition to causing nasal passages to clear, this can dry up some mucous secretion (more of a side effect than anything) making you feel better too, reducing that pesky cough. Phenylephrine is an alternative to the pseudoephedrine;  it is less stimulating and doesn’t raise the blood pressure. To buy pseudoephedrine, you must show a photo ID to the pharmacy staff. Phenylephrine is available grab-and-go off the shelf. Be warned, it doesn’t have the same power pack the pseudoephedrine punches.

The next among the big-three of cold medications is guaifenesin. This functions to loosen the mucous and help make it slippery and ready to cough/blow/spit out. This keeps down the likelihood that the mucous will be a breeding ground for bacteria to come in and infect later. This is a particularly good one to consider if you’re prone to sinus and ear infections after a cold. All in all, it’s not a bad choice.

One word of advice: READ!  Read the label of the drug you are about to buy and put into your body. This is important. If you decide to get a multi-symptom drug it has multiple drugs in it. Often, one of those drugs is a fever reducer/pain medication. If you don’t have pain or a fever, that may be unnecessary. Also, you may not need a cough suppressant AND decongestant AND mucous thinner AND fever reducer. I’m a minimalist. If you are not experiencing a particular symptom, don’t take a drug to fix it. There are side effects and interactions for every drug so choose them carefully and only when necessary. Many of them interact with prescription drugs—fever reducers can interact with blood thinners and contain the same active ingredient as some pain medicines. If you’re taking a prescription drug and see the same ingredient on the cold medicine label, think again and consider asking the pharmacist or your healthcare provider if it’s OK. Also, it’s helpful to us if you know what you’re taking if you come to see us. It helps us know what to avoid giving you to avoid further interaction if a prescription drug is provided at your visit. So please, read labels.

I mentioned RSV and babies. This is yet ANOTHER reminder that there are NO SAFE COLD MEDICINES FOR BABIES and children under age 5. Never give a child with a fever aspirin. Also, remember that doses of medicines are weight based. If you don’t know what dose of acetaminophen or ibuprofen to give your child/baby, don’t guess…please ask your doctor or pharmacist for some help.

Now, I’m a mom of 3 little boys. So I understand that weakness you feel at 3 a.m. with a coughing child (or more) wanting to get them to feel better and get everyone back to sleep. The problem is, the cough and cold medicines not only don’t work for them, but they also cause HARM to them. Many thousands of children under age 5 were taken to emergency rooms yearly when the FDA allowed the sale of those medicines. They removed them from shelves after it was clear they were causing more harm than good.

So what can you do for those little ones? There are a few old-school remedies that can help. At any age, the menthol/eucalyptus/rosemary rubs can be wonderful. They make reduced strength formulations for the little babies. It’s been shown to reduce symptoms in trials but this mom can tell you that it works. There’s no placebo effect (improvement/positive change in symptoms caused by the person’s desire to improve rather than the medication) when you’re dealing with a baby. So rub away! The other thing that helps lots of kid viruses (RSV, Croup) is humidified air. The humidity is helpful in decreasing the irritation of the lining of the respiratory tract. Finally, in children OVER AGE ONE; taking two teaspoons of honey before bed can help reduce cough symptoms.

Many will say these methods lack serious scientific clinical trials. I agree but challenge…is a safety trial needed for honey in a 3 year old? Dr. Andrew Weil spoke at the American Academy of Family Physicians’ educational meeting in Philadelphia this past fall. I was in the audience and was struck by something he said - I’ll paraphrase:  the more harm that can be done, the more studies that should be done. The harm factor of honey in a child OVER THE AGE OF ONE is minimal and so should be the trials. In my house, we mix in a little lemon juice and we call it honey-syrup (my kids don’t like the sweetness of honey straight-up).

I didn’t get into the alternative options much for adults but can say the honey trick would be something worth trying. I also read adding Cinnamon to that mixture in adults helps decrease the sugar-shock factor in people with blood sugar problems—so be sure to track your home blood sugars with your monitor to be sure your sugars are not bouncing high with this treatment. Remember, a sudden spike in your blood sugars could be a sign a serious infection is lurking.

I hope you all feel better soon. I keep hoping for an early spring but fear we are destined to another 5-6 weeks of winter. Well, mostly because that’s when it ends….March 21st! So keep hoping and marking off your calendar and before you know it, we’ll be right back here talking about seasonal allergy treatments!

Heritage Family Medicine


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