Cold, Flu, Allergy Treatments

Cough Drugs for Cough and The different kinds of ingredients that may be Coughing is an
Nasal found in cough/cold combinations include: important way to
Congestion keep your throat
cough and cold and airways
Antihistamines—Antihistamines are used to
combination clear. However,
relieve or prevent the symptoms of hay fever
Drugs associated and other types of allergy. excessive
Nasal with Upper coughing may
congestion Respiratory mean you have
They also help relieve some symptoms of the
Tract Infection common cold, such as sneezing and runny an underlying
Common cold disease or
nose. They
disorder.
Treatment - Drugs associated Decongestants—Decongestants produce a
cold with Cold narrowing of blood vessels. This leads to Some coughs are
symptoms Symptoms, clearing of nasal congestion. dry, while others
are considered
Decongestants help clear a runny nose and productive.
Chills relieve postnasal drip.
A productive
Cough . However, this effect may also increase blood cough is one that
pressure in patients who have high blood brings up mucus.
Fever pressure Mucus is also
called phlegm or
Muscle aches sputum.

Runny nose Expectorants—Expectorants work by Coughs can be

loosening the mucus or phlegm in the lungs. either acute or
Sneezing chronic:
The main expectorant used in cough and cold
medicines is guaifenesin.
Sore throat  Acute
coughs
Other ingredients added as expectorants (for
Stuffy nose usually
example, ammonium chloride, calcium iodide,
begin
iodinated glycerol, ipecac, potassium
suddenly.
Sinusitis guaiacolsulfonate, potassium iodide, and
They are
sodium citrate) have not been proven to be
often due
effective.
to a cold,
flu, or
In general, the best thing you can do to loosen
sinus
mucus or phlegm is to drink plenty of water.
infection.
They
Analgesics—Analgesics are used in these
usually go
combination medicines to help relieve the
away after
aches and pain that may occur with the
2 to 3
common cold.
weeks.
 Chron
Anticholinergics—Anticholinergics, such as
homatropine may help produce a drying ic coughs
effect in the nose and chest. last longer
than 2 to 3
weeks.
Do not give any over-the-counter (OTC)
cough and cold medicine to a baby or child
under 4 years of age. Using these
medicines in very young children might
cause serious or possibly life-threatening
side effects .
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 1. Pain reliever and fever
reducer;

Acetaminophen is a pain reliever and

fever reducer.

2. Cough suppressant:

Dextromethorphan is a cough
suppressant. It affects the signals in the brain
that trigger cough reflex.

3. Congestion in your chest and

throat:
Guaifenesin is an expectorant. It helps
loosen congestion in your chest and throat,
making it easier to cough out

through your mouth.

4. Decongestant that shrinks blood

vessels in the nasal passages

Pseudoephedrine is a decongestant
that shrinks blood vessels in the nasal passages.
Dilated blood vessels can

cause nasal congestion (stuffy nose).

The combination of acetaminophen,

dextromethorphan, guaifenesin, and
pseudoephedrine is used to treat stuffy nose,
sinus congestion, cough, chest congestion, and
pain or fever caused by the common cold or flu.

Cold, Flu, Allergy Treatments

Every year, millions of people use over-the-counter (OTC) products to relieve nasal stuffiness and congestion,
sneezing, runny noses, sore throat, and cough. The common causes of these symptoms include the viruses that
cause the common cold, influenza virus, allergic rhinitis (hay fever), and sinus infections (sinusitis). Viral
infections can also cause headache, body aches, fatigue, and sometimes fever. Hay fever symptoms can also
include itchy eyes, nose, and throat, and watery eyes.
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To benefit from OTC products for cold, flu, and allergy, it is important to understand (1) the condition causing
the symptoms, (2) the predominant symptom(s) one wishes to relieve, and (3) the active ingredient(s) in the
product. Some OTC products contain a single active ingredient medication to relieve one symptom. Many
others contain a combination of two, three, and even four active ingredient medications to treat several
symptoms at once. Selecting the right product can be difficult at times.

Here we have categorized products for cold/flu/allergy according to the predominant symptoms they relieve:

 Headaches, body aches, fever, and "flu-like" symptoms

 Nasal congestion, runny nose, and sneezing

 Cough

 Sore throat

Since cold and flu sufferers usually experience several symptoms, products containing medication combinations
provide convenience. Therefore, you may need to take only one product as compared with two to four products.
You also may need to stock fewer items in the medicine cabinet. Nevertheless, it is preferable to take products
that contain only those medications you need for relieving the symptoms that are present. This prevents the
ingestion of unnecessary medications and reduces the chances of side effects. It is also easier to adjust the dose
of a single ingredient medicine to maximize relief of a predominant symptom and minimize side effects.

Headaches, body aches, fever, and flu-like symptoms

Medications that reduce pain (analgesics) and fever (antipyretics) are used to relieve headaches, body aches,
and fever. The three classes of analgesics/antipyretics that are available OTC are aspirin, acetaminophen, and
nonsteroidal anti-inflammatory drugs (NSAIDs).

Some OTC products contain an analgesic/antipyretic as a single ingredient. Others combine an

analgesic/antipyretic with a nasal decongestant, an antihistamine, or a cough suppressant. Products listed in the
headaches, body aches, fever, and flu-like symptoms category contain an analgesic/antipyretic either alone or in
combination with other ingredient(s) to treat cold/flu/allergy symptoms. Examples of products in the headaches,
body aches, fever, and flu-like symptoms category include:

 Aspirin (plain aspirin, coated aspirin, or aspirin mixed with antacid): Aspirin Regimen Bayer
Regular Strength, Extra Strength Bayer Plus Caplets, Bufferin Analgesic Tablets, Regular
Strength Ascriptin, Ascriptin Enteric, and Alka-Seltzer Extra Strength.

 Acetaminophen: Tylenol Regular Strength Caplets and Tablets, Aspirin Free Excedrin
Analgesic Caplets and Geltabs, Children's Tylenol Chewable Tablets, Elixir, and Suspension
Liquid, and Junior Strength Tylenol Coated Caplets and Chewable Tablets.

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  NSAIDs: Advil Caplets, Aleve Tablets and Caplets, Motrin IB Pain Reliever Caplets and
Gelcaps, and Children's Motrin Drops.

 Aspirin plus a decongestant and/or cough suppressant: Alka-Seltzer Plus Cold and
Cough.

 Acetaminophen plus a decongestant and/or cough suppressant: Tylenol Cold Medication

Multi-Symptom Caplets and Tablets, Theraflu Flu and Cold Medicine, Actifed Cold and Sinus
Caplets and Tablets, and Children's Tylenol Flu Liquid.

 NSAID plus a decongestant and/or cough suppressant: Advil Cold and Sinus Caplets and
Motrin IB Sinus Caplets and Tablets.

Nasal congestion, sneezing, and runny nose

Nasal congestion, sneezing, and runny nose are common symptoms of a cold caused by a virus. The viruses that
cause colds induce inflammation that increases the leakage of fluid from the blood vessels into the lining of the
nose and even into the nose. This causes swelling of the lining of the nose, obstructing the flow of air, and a
runny nose.

Symptoms of hay fever, or allergic rhinitis, are caused by allergens. Allergens are tiny particles that cause cells
in the lining of the nose and the airways of the lungs to release histamine and other chemicals. Histamine and
these other chemicals are responsible for the leakage of fluid, runny nose, sneezing, and nasal congestion, as
well as the itching of the eyes.

Cold symptoms usually resolve in one to two weeks whether treated or not. Antibiotics have no effect on
viruses, which are the cause of colds. However, bacterial infections that can follow viral infections, for example,
infections of the ears and sinuses, may be treated with antibiotics. For the temporary relief of cold symptoms,
plenty of oral fluids such as broth, chicken soup, and tea with lemon and honey and humidification of room air
are safe remedies for people of all ages. Saline (salt and water) sprays and mists can also safely provide
soothing moisture to dry, irritated nasal passages. In infants and young children, saline nose drops and clearing
the nose with a nasal syringe can temporarily relieve nasal obstruction. Allowing infants and young children to
sleep upright in car seats also improves the drainage of nasal secretions.

For short-term relief of nasal congestion in older children and adults, nasal decongestants can be used. Nasal
decongestants are chemicals (for example, pseudoephedrine, oxymetazoline, etc.) that narrow the blood vessels
in the nose, thereby preventing fluid from leaking and the lining from swelling. As a result, the lining shrinks
and the nasal passages open. Nasal decongestants can be used topically within the nose (nasal spray, solution, or
mist) or can be taken orally (tablets, caplets, or gelcaps). Topical nasal decongestants act faster than the oral
decongestants but have a shorter duration of action. Thus, more frequent dosing will be necessary. Oral nasal
decongestants frequently are combined with an antihistamine, a cough suppressant, or an analgesic in treating
cold/flu/allergy symptoms.

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The first step in preventing and relieving symptoms of allergy is to avoid the allergens. If avoiding allergens is
not feasible or does not adequately control the allergic symptoms, antihistamines are commonly used to block
the effect of histamines. Some of the antihistamines that are available OTC (diphenhydramine,
chlorpheniramine, etc.) are called "first generation" antihistamines. These antihistamines have been in use
longer, are less expensive, and are more sedating (more prone to cause drowsiness) than the newer, "second
generation" antihistamines (fexofenidine, loratidine, etc.), which have minimal sedative effects. OTC
antihistamines frequently are combined with a nasal decongestant and sometimes also with a cough suppressant
or an analgesic. Generally, antihistamine preparations are not effective for cold symptoms.

Examples of products in the nasal congestion, sneezing, and runny nose category include:

 Saline solutions as nose sprays or mists: Nasal Moist Solution, Pediamist, Afrin
Moisturizing Saline Mist, and Afrin Menthol Moisturizing Saline Mist. Note: Afrin nasal sprays
can lead to a rebound worsening of nasal congestion and become habit-forming, especially if
overused.

 Topical nasal decongestants as nasal sprays, mists and drops: Afrin Regular Nasal Spray,
Afrin Nose Drops, Duration 12 hour Nasal Spray, Neo-Synephrine Nasal Sprays, and Vicks
Vapor Inhaler.

 Oral nasal decongestant: Drixoral Nasal Decongestant.

 Oral antihistamine: Benadryl Allergy Chewables and Chlor-Trimeton Allergy Tablets.

 Oral nasal decongestant combined with an oral antihistamine (may also contain an
analgesic): Actifed tablet, Chlor-Trimeton Allergy/Decongestant Tablets, Coricidin "D"
Decongestant Tablets, Contac Continuous Action Nasal Decongestant/Antihistamine12 Hour
Capsules, Dimetapp Tablets and Liqui-Gels, Sinutab Sinus Allergy Medication Maximum
Strength Formula Tablets and Caplets, Sudafed Cold and Allergy Tablets, Tylenol Flu Nighttime
Medication Gelcaps, Allegra Tablets and oral suspension, Claritin tablets and RediTabs,
Claritin-D, and Vick's NyQuil Hot Therapy.

Cough
A cough is a common symptom of viral respiratory infections and allergies. A cough can also be caused by other
conditions, some of them serious. For example, a cough can be a symptom of asthma, acid reflux into the
esophagus (gastroesophageal reflux disease or GERD), sinusitis, postnasal drip, bronchitis, cigarette smoking,
pneumonia, tuberculosis, hypersensitivity pneumonia (inflammation of the lung from exposure to certain
environmental chemicals), and even lung cancer. Therefore, a persistent cough or a cough that is associated with
chest pain, fever, weight loss, or blood-tinged or discolored sputum should be evaluated by a doctor.

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There are three types of cough medications available OTC for the temporary relief of cough due to a cold. They
are oral cough suppressants, oral expectorants, and topical (externally applied) medicines.

Oral cough suppressants

Codeine and hydrocodone are narcotic oral cough suppressants that require a doctor's prescription.
Dextromethorphan is an oral cough suppressant that is available OTC. Dextromethorphan is chemically related
to codeine and acts on the brain to suppress cough, but does not have the pain-relieving and addictive properties
of codeine. Diphenhydramine is another non-narcotic medication that acts on the brain to suppress cough. It is
also an antihistamine.

Dextromethorphan and diphenhydramine can be used to relieve a dry, hacking cough. They are not generally
used to suppress a productive cough (when sputum is coughed up). Suppressing a productive cough impairs the
clearing of secretions and mucous from the airways, which is generally undesirable. However, cough
suppressants are sometimes used to suppress even productive coughs if they are especially bothersome and
prevent restful sleep.

Oral expectorants

Guaifenesin is an oral expectorant that is believed to increase the leaking of fluid out of the lung tissue and into
the airways. This action thins (liquefies) the thick mucous in the airways and facilitates the clearing of the
mucous by coughing. Clearing of mucous from the airways decreases cough.

Topical medications

Camphor and menthol are topical cough medications. Camphor and menthol ointments are rubbed on the throat
and the chest as a thick layer. The anesthetic action of their vapors is believed to relieve cough. They are also
available as products for steam inhalation. Menthol is also available as lozenges and compressed tablets.

Examples of products in the cough category include:

Cough suppressants: Benylin Adult Cough Formula, Buckley's Mixture, Diabe-Tuss DM, and St Joseph
Cough Suppressant for Children and Delsym (effective for 12 hours).

Expectorant: Hytuss, Robitussin and Mucinex.

Topical cough medicines: Hall's Menthol-Lyptus Cough Supp. Drops, Mentholatum, Vick's VapoRub, and
Vick's Vaposteam.

Cough suppressant plus an expectorant and other cold/flu/allergy ingredients: Alka-Seltzer Plus Cold and
Cough, Alka-Seltzer Plus Cold and Flu, Comtrex Deep Chest Cold & Congestion Relief, Coricidin HBP Cough
and Cold Tablets, Dimetapp Cold and Cough Liqui-Gels Maximum Strength, PediaCare Cough-Cold Liquid
and Chewable Tablets, Robitussin Maximum Strength Cough and Cold, TheraFlu Flu Cold and Cough
Medicine, and Triaminic AM Cough and Decongestant formula.

Since many of these combinations also contain an antihistamine, a decongestant, and an analgesic in addition to
the cough suppressant and expectorant, they also provide relief of nasal congestion, sneezing, fever, and aches.

In October 2000, an advisory panel of the U.S. Food and Drug Administration (FDA) recommended that
phenylpropanolamine (PPA), an ingredient contained in many OTC and prescription cold medications as well as

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weight loss products, be classified as unsafe because of reports of stroke associated with the this ingredient.
Many companies voluntarily chose to reformulate their products to exclude phenylpropanolamine. The FDA is
taking steps to remove phenylpropanolamine from all drug products and has requested that all drug companies
discontinue marketing products containing this ingredient.

Sore throat and other symptoms

Viruses are the most common cause of sore throat. A sore throat caused by a cold virus usually resolves in one
to two weeks without treatment. On the other hand, a sore throat caused by the streptococcus bacterium (strep
throat) should be treated with antibiotics to prevent damage to the heart valves. Generally, streptococcus
bacteria cause a more severe sore throat and a higher fever than viral sore throats. Sneezing, runny nose, and
cough more frequently accompany sore throats due to a cold virus, rather than streptococcus infections.
Sometimes, a throat culture is necessary to establish the cause of the sore throat.

Medications that are available OTC for the temporary relief of sore throat due to the common cold usually
contain anesthetics such as benzocaine and dyclonine or menthol and come in the form of lozenges, gargles, and
sprays. Children often prefer Popsicles, ice cream, yogurt, pudding, smoothies, or other cool/soft foods in lieu
of traditional medications. Aside from their analgesic effects, these foods also provide some nutritional benefit.

Examples of sore throat medications: Cepacol Sore Throat Maximum Strength and Sucrets sore throat lozenges.

What about vitamin C and zinc?

Vitamin C is an antioxidant. In the 1970s, Linus Pauling proposed that vitamin C can reduce the incidence and
severity of common cold. To date, there is no conclusive evidence that mega doses of vitamin C prevent colds
or decrease the severity and duration of cold symptoms. The article on vitamins further discusses the use of
vitamins and antioxidants in preventing diseases.

Zinc has been proposed as an antiviral medication. Some studies suggest that the frequent administration of zinc
lozenges may reduce the severity and duration of cold symptoms if started within hours of the onset of cold
symptoms, while other studies have not supported this conclusion. No studies have conclusively demonstrated
the effectiveness of zinc in children either.

Important considerations for the safe use of OTC products

To use OTC products safely, it is important to understand (1) their side effects, (2) their effects on other
underlying medical conditions such as diabetes mellitus, high blood pressure, asthma, and other conditions, (3)
their interactions with other prescribed medications such as antidepressants, blood thinners, and high blood
pressure medicines, and (4) the product's limitations.

The following guidelines are provided to help consumers make more informed choices when selecting
OTC products:

1. Always read the labels and know the ingredients in the products. Never take more than the
recommended dose without checking with your doctor first.

2. Do not use aspirin-containing medicines for children and teenagers with influenza, chickenpox
or other viral illnesses. Rare cases of Reye syndrome have been associated with the use of
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 aspirin in this population. Reye syndrome is a serious illness characterized by liver damage,
vomiting, and sometimes coma. It has a 50% mortality rate, and those who survive can be left
with permanent brain damage. Therefore, acetaminophen-containing products are
recommended for children with fever. NSAIDs may be used in children over six months of age.

3. Aspirin and NSAIDs can cause ulcers and increase the risk of bleeding, and should be avoided
by people with known ulcer disease or certain blood diseases. People who are scheduled for
elective surgeries should inform their doctors that they are taking aspirin or NSAIDs.

4. A true aspirin allergy is rare. Aspirin allergy consists of hives, occasionally difficulty breathing,
and rarely shock, within three hours of taking aspirin. Aspirin allergy is most common among
individuals who have asthma, urticaria, and nasal polyps. Individuals with aspirin allergy should
also avoid NSAIDs because they are chemically similar to aspirin.

5. Aspirin can cause complications during pregnancy and should be avoided during pregnancy.

6. Aspirin can increase the effectiveness of blood thinning by Coumadin and may increase the
risk of bleeding.

7. Topical (sprays or mists) nasal decongestants act more quickly than oral nasal decongestants.
However, the effects of topical nasal decongestants are short-lived. Topical nasal
decongestants should be used for only three to five days at a time since more prolonged use
can lead to rebound congestion with worsening nasal congestion. Patients with rebound
congestion complain of stuffy nose despite frequent applications of the nasal decongestant.
Treatment of rebound congestion involves the slow withdrawal of the nasal decongestant (one
nostril at a time) and applying saline nose sprays or drops to provide moisture.

8. Nasal decongestants can aggravate high blood pressure and should not be used in people
with uncontrolled high blood pressure without permission from the doctor.

9. Oral nasal decongestants can interfere with the action of a class of antidepressants called
MAO inhibitors.

10. Oral nasal decongestants can affect diseases such as hyperthyroidism, diabetes mellitus, and
coronary artery disease. Oral nasal decongestants and antihistamines can also precipitate

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 urinary obstruction in patients with enlarged prostates (prostate hypertrophy or BPH). Patients
with these conditions should consult their doctors before using OTC products.

11. OTC antihistamines can cause drowsiness. People taking antihistamines should avoid driving
or performing activities that require alertness. They should also avoid alcohol and other
sedatives.

12. Some antihistamines can cause excessive drying of secretions, making it difficult to clear
secretions. The accumulation of dried secretions in the airways can aggravate breathing
difficulties in people with chronic bronchitis and emphysema.

13. Infants and young children are sensitive to the side effects of antihistamines and nasal
decongestants. They can become irritable, restless, or drowsy with these medications.
Occasionally, hallucinations and psychosis can occur. Therefore, the parents or caretakers of
infants and young children with cold or allergy symptoms should consult their pediatrician
before using any of these products. Recent concerns by the FDA suggest that young children
should not take many of the commonly used cold and cough medicines.

Avoiding outdoor allergens

 People who are sensitive to outdoor allergens should follow pollen counts and avoid outdoor
activities when pollen counts are high.

 Keep the house and car windows closed and use air conditioners.

 People who are allergic to grass should avoid playing in grassy areas during spring and early
summer.

 Individuals who are allergic to outdoor molds should not mow the grass, rake leaves, or disturb
compost.

Avoiding indoor allergens

 Placing pillows, mattresses, and box springs inside airtight plastic covers that are cleaned
weekly can reduce house dust mite exposure. Avoid down pillows.

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 Removing dust-collecting furniture such as bookshelves, TV cabinets, stuffed toys, rugs, and
other dust-catching fabrics from the bedrooms can also reduce house dust mite exposure.

 Keeping pets outside or at least keeping them away from the bedroom of an allergic individual
can help decrease animal allergen exposure. Washing cats frequently can help decrease cat
allergens. It may be necessary to remove the cat from the household.

 Venting moist areas such as bathrooms, kitchens, and basements can reduce indoor mold
exposure.

 HEPA air filtration devices (freestanding or installed in the air heating or cooling system of the
home) can decrease the amount of pollen, mold spores, and animal allergens in the air. HEPA
filtration devices installed on vacuum cleaners can reduce the circulation of house dust mite
feces while vacuuming.

 Wear masks while vacuuming or dusting.

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