The Right Medicine to Treat Your Cold : Health: Sufferers often pick the wrong over-the-counter products. Specific ingredients target specific symptoms.
Hold it! Put that codeine phosphate down. What you really need is guaifenesin for that thick, loose cough.
OK, if you don’t know the difference between guaifenesin and codeine phosphate, better learn now: Cold and cough season is here.
Since science has not yet mastered a cure for the common cold, the best thing you can do is learn which among 800 over-the-counter cold and cough remedies will give you some relief from your symptoms.
According to experts, consumers are unlikely to select the most appropriate product for their symptoms--wasting money and, even worse, prolonging cold symptoms.
“I think there is a lot of waste,” says Bobby Bryant, an associate professor of pharmacy at the Albany (N.Y.) College of Pharmacy. “For example, the symptoms of a cold change dramatically from the scratch in the back of your throat and watery eyes in the beginning to the point where you’re finally getting cleared up. You go through a large cycle.”
Dozens of products are introduced each year to battle that sweeping cycle of sneeze, sore throat, watery eyes, headache, muscle ache, fever, congestion and cough. About $2 billion is spent for OTC cold and cough remedies each year, with sales soaring in the winter, when half of the U.S. population has the common cold.
But the active ingredients found in most products don’t vary much, experts say.
And not much has changed in what cold and cough remedies can accomplish, says Frederick G. Hayden, a professor of medicine and pathology at the University of Virginia School of Medicine, a major center for research on the common cold:
“I’m impressed by the sometimes extravagant claims made in advertising. But all (cold remedies) are doing is moderating symptoms. There is no evidence that they shorten duration of the infection or prevent complications, such as middle-ear infections.”
Advertising claims often address other factors, however, such as that the remedies can hasten recovery and stop the spread of cold germs. These claims have not been proven, experts say.
“One could argue that if you reduce symptoms, such as sneezing or coughing, you could theoretically reduce exposure to other people,” Hayden says. “But that hasn’t been looked at critically yet.”
It is not surprising that consumers are confused about the effectiveness of cold and cough remedies. In the last 30 years, most cold remedies have evolved from low-dose ineffectiveness to high potency, many moving from prescription-only status to over-the-counter availability.
“The FDA has done a marvelous job, albeit slowly, of removing ineffective products from the market,” Bryant says. “And the medications out there are greatly improved over years ago (in providing relief from symptoms). But manufacturers can still play on some nuances where there isn’t enough scientific literature.”
For example, one of the biggest disputes between drug manufacturers and pharmacists is whether a product with five active ingredients that targets five cold symptoms is better than a single-ingredient product.
In recent years, the combination products--often called “shotgun” remedies or “cocktails”--have hit big in the marketplace as a safe, convenient and cost-efficient way to treat a cold.
But consumers may be paying for drugs they don’t need, or they may not get high enough doses of the ingredients they do need, experts say.
Some critics have even suggested that shotgun remedies be limited to three drugs. So far, the FDA has resisted.
“If one looks at the various multiple-ingredient products that are available, often they have inadequate doses of an agent you would want to have. Or they have ingredients that you don’t really need that could cause side effects,” says Hayden. “I tend to point people toward single-ingredient remedies for the symptoms bothering them the most.”
Many combination products mix a decongestant and pain reliever with an antihistamine. That has triggered another controversy.
Despite the popularity of cold remedies containing an antihistamine, there is no conclusive evidence that the ingredient helps relieve cold symptoms. In 1987, an FDA advisory panel found that antihistamines are ineffective for colds.
Antihistamines are effective for allergies and hay fevers when allergens cause cells in the nose to release histamine, a chemical that irritates nasal tissue and causes sneezing, congestion and runny nose.
But there is a lack of evidence that histamines are released in colds.
“If they do anything, they are mild sedatives that might make someone more comfortable,” says Matthew Conolly, a professor of medicine and pharmacology at the UCLA School of Medicine and the co-author of a 1988 book, “The Patient’s Desk Reference.”
Decongestants are among the most helpful cold-remedy ingredients. But the range of choices--oral, topical (spray), short-acting or long-acting--can alter effectiveness.
Decongestants, which constrict blood vessels in the nose, are designed to dry up nasal secretions, reduce swelling of nasal passages and unblock the nose.
Spray decongestants are considered more effective and work faster than oral types but should be used sparingly, because overuse can lead to rebound congestion that can worsen the problem. Each application causes a little irritation, which eventually accumulates and inflames and blocks nasal passages.
To avoid this problem, Bryant suggests using the longest-acting product you can find: “And try to wean yourself off those in a couple of days.” Saline nasal sprays can provide similar relief without the rebound effect because there is no drug in such a spray, he says.
Oral decongestants don’t cause rebound congestion. But because they constrict blood vessels throughout the body, they can cause mild side effects--like mouth dryness or more serious problems in people with high blood pressure. In healthy people, oral decongestants taken in proper dosages are safe, Bryant says.
Consumers have less choice when the chest is congested.
Expectorants work by stimulating coughing to bring up mucus from the chest. Cough suppressants, which act on the brain’s cough reflex to suppress the cough, are designed for use when there is no thick mucus and the patient needs relief from a dry cough.
Because coughing is an important way to clear matter from the throat and chest, Bryant says consumers shouldn’t use a cough suppressant when they have a productive cough. Moreover, he does not recommend products that combine a cough suppressant with an expectorant:
“That hacking cough is much earlier in the cold, while the productive, bringing-stuff-up cough comes later. And you don’t want to suppress that. There is value to that cough.”
Although cough suppressants can be very effective, some experts question the usefulness of expectorants. In 1989, the FDA cracked down on these products, citing guaifenesin as the only effective one.
“No one has really been able to show if expectorants work,” Bryant says. “I think as good a solution as anything is moisture from a shower or using a humidifier.”
Other home remedies may apply best when it comes to colds.
For sore throats, salt-water gargles and sucking hard candies to stimulate saliva flow may work as well as anything, Bryant says.
Over-the-counter lozenges and gargles containing antiseptics and topical anesthetics will numb the throat but do not affect the virus. And the tactic may backfire.
“Anything you do to deaden the nerve, your body will try to produce more saliva to wash it away,” Bryant says. “But I think people feel it gives them some amount of relief.”
Lozenges and gargles will not relieve laryngitis, he says. Again, water-vapor inhalation--either cool mist or steam--might provide the greatest relief, he says.
There are other precautions when purchasing cold remedies, especially for children, experts say. Although adults have a choice between aspirin, acetaminophen or ibuprofen for fever and pain relief, children should not be given aspirin because of its link to Reye’s syndrome, a potentially fatal illness.
And parents might want to read labels to see how much sugar or alcohol is in a product. Those called “syrups” are water-and-sugar based, while “elixirs” contain alcohol.
Products high in alcohol content are often labeled for nighttime use, Bryant says:
“Some of this stuff should be sold at the liquor store. But, for some people, a good night’s rest may be the best thing.”
Of course, cold researchers hasten to point out a couple of other solutions.
Don’t get sick, says Conolly.
“People let themselves get so stressed that they get infected in the first place. Maybe when we get a cold, rather than just cursing the virus, maybe we should look at our lifestyle. I think we pile too much on ourselves these days,” he says.
Or, you could maintain your burn-the-candle-at-both-ends lifestyle, get sick and do nothing, says Hayden:
“You don’t have to take anything. There is the old scientific saying that if you leave a cold untreated, it will clear up in a week. If you treat aggressively, it will last seven days.”
Fighting Coughs and Colds
DECONGESTANTS
Purpose: To suppress mucus production in nose.
Active ingredient: Pseudoephedrine hydrochloride or phenylpropanolamine hydrochloride.
EXPECTORANTS
Purpose: To stimulate coughing so mucus in chest will be loosened and coughed up.
Active ingredient: Guaifenesin.
COUGH SUPPRESSANTS
Purpose: To suppress a dry cough.
Active ingredient: Codeine or dextromethorphan.
ANALGESICS
Purpose: Relieve aches and pain.
Active ingredient: Aspirin or acetaminophen.
