OVER THE COUNTER (OTC) COUGH AND COLD PRODUCTS
LEARN TO READ THE LABEL:
There are only 5 major groups of medications found in OTC cough and cold products.
They are:
1)
Decongestants: These medications cause the blood vessels in your nose
and sinuses to shrink, thereby drying up your nose and sinuses.
2)
Antihistamines: These medications block the body’s response to
histamine. Histamine is a chemical produced by certain cells in the body,
and is released by these cells when they are exposed to irritants. The
main irritant to these cells are allergens (things that a person are allergic to
I.E. pollen, cat and dog hair...). Histamine, when released cases the eyes
to water, nose to run etc..
3)
Expectorants: These medications cause the mucous in your lungs to thin
and break up so that you can easily cough it up.
4)
Analgesics: These are medications to relieve pain.
5)
Cough Suppressants: These are used to stop coughing.
The first of the OTC groups is Decongestants. This group of medications
are used in products that will dry up your nose and relieve sinus “pressure”. When you
are sick, the virus that is attacking your body causes the blood vessels in your nose and
sinuses to “leak”. This leakage becomes nasal drainage. What these medications do is
stimulate the blood vessels that they come into contact with (just your nose in the case of
nasal sprays or all the blood vessels in your body in the case of tablets or capsules) and
cause them to constrict or become less leaky. All of these drugs when taken by mouth
can cause an increase in blood pressure as well as dry up your nose. People with high
blood pressure, hyperthyroidism, diabetes mellitus, heart disease, or glaucoma should not
use products that have decongestants in them.
Some of the bad effects, or side effects of this group of drugs are anxiety,
restlessness, lightheadedness, increased blood pressure, dizziness, tremor, and insomnia.
Some people have what seem to be an opposite reaction to this class of drugs, I.E.
drowsiness and weakness, but this is fairly rare.
When you read the label of any OTC medication, it must tell you what the active
ingredients are. Here is a list of most of the OTC decongestants, and some of the
products that have them in it.
1)
Pseudoephedrine: This is one of the more common decongestants on the market.
It may also be safer than some of the other decongestants on the market because it
may not increase your blood pressure as much as some of the other
decongestants. The laws have changed due to people using this to make
methamphetamine, so you have to ask for any product containing this at the
pharmacy counter and you will have to sign a log and show your drivers license.
The usual dose is 60mg every 4 to 6 hours for the immediate
release (short acting) tablets or 120mg every 12 hours for the sustained release
(long acting) capsules or 240mg once a day for the extra long acting
formulations. Do not take more than 240mg in 24 hours. Some of the trade
names are Sudafed and Effidac and in the prescription only products Deconamine
SR, and in the OTC combination products like Allerest and Claritin D.
2)
Phenylpropanolamine: This drug is no longer on the market due to increased
risk of stroke.
3)
Phenylephrine: This drug is used in the nasal sprays and is the main ingredient
in the reformulated version of Sudafed PE. Nasal sprays usually don’t work as
well for sinus congestion because the spray may not be able to get up
into the sinuses due to congestion. The usual dose of the nasal spray is 1 to 2
sprays in each nostril of the 0.25% solution every 4 hours. The 0.5% or the 1.0%
solution may be needed in resistant cases. Some of the trade names are NeoSynephrine, Duration, and Nostril. The dose of Sudafed PE is 10mg (one tablet)
every 4 hours as needed (max 6 doses per 24 hours).
4)
Oxymetazoline: This drug is also mainly used in the nasal sprays and drops. The
usual dose is 2 to 3 drops or sprays in each nostril 2 times a day in the mornings
and evenings. some of the trade names are Afrin, Dristan Long Lasting, Nostrilla,
Sinex Long-Acting.
5)
Ephedrine: This used to be a popular decongestant back in the 1950’s and
1960’s, but is not used in OTC products.
6)
Naphazoline, Tetrahydrozoline, Xylometazoline, phopylhexadrine, 1desoxyephedrine are also decongestants that you may see in some products.
The second OTC group is antihistamines. This group of drugs is very useful in
relieving symptoms of allergies, (I.E. runny nose, watery and itching eyes, etc...) They
are used alone or in combination with decongestants. When used alone, these drugs will
not stop a runny nose unless it is due to allergies.
Some of the side effects of this group of medications include drowsiness or
dizziness and dry mouth. Some people have the opposite type effect and they may feel
nervous or can’t sleep, but this is very rare. People who have glaucoma, peptic ulcer
disease, urinary retention or who are pregnant should not use these medications.
Here is a list of most of the OTC antihistamines and some of the products that
have them in it.
1)
Loratidine: This is one of the new non-sedating antihistamines you can now buy
without a prescription. It is sold under the trade name Claritin, Alavert and Tavist
ND. The usual dose is 10mg once a day.
2)
Cetirizine: This is the other new lower sedating antihistamines you can buy under
the trade name Zyrtec. The usual dose is 10mg once a day.
3)
Diphenhydramine: This is one of the most common antihistamines on the OTC
market. It is also used as a sleep aid, to treat motion sickness, parkinsonism, and
as a non-narcotic cough suppressant. The usual dose is 25mg - 50mg every 6 to 8
hours. Some of the brand names include Benadryl, Diphenhist, Nytol, Sominex,
and Compoz.
4)
Chlorpheniramine Maleate: This as also a very common antihistamine. The
usual dose is 4mg every 4 to 6 hours for the immediate release form, or 8mg to
12mg every 8 to 12 hours for the sustained release form. Maximum dose is 24mg
per 24 hours. Some brand names include Chlortrimeton, Aller-chlor, Pedia Care
Allergy Formula and in the combination products Coricidin, Allerest 12 hour
caplet, and Contac Maximum strength.
5)
Brompheniramine Maleate: This is also a common antihistamine. The usual
dose is 4mg every 4 to 6 hours or 8mg to 12mg of the sustained release from
every 8 to 12 hours. Do not take more than 24 mg in 24 hours. Some of the
brand names include LoHist, Lodrane XR and in the combination products
Bromhist, and Lodrane 24 D.
6)
Triprolidine: The usual dose is 2.5mg every 4 to 6 hours. Some of the trade
names include Actidil and Myidyl and in combination products Actifed and
Actihist.
7)
Clemastine Fumarate: This used to be available by prescription only and now is
only available in combination products. The dose is 1.34mg every 12 hours. The
trade name is Tavist D.
8)
Azelastine: This is the active ingredient in Astelin Nasal Spray. The dose is 2
sprays in each nostril twice a day.
The third group of OTC products are Expectorants. This group is somewhat
useful in thinning and breaking up the mucous in the lungs. The main side effect of this
group is nausea. There are only 2 drugs left in this category fort OTC use. They are:
1)
Guaifenesin (Glyceryl Guaiacolate): This is the expectorant most commonly
used in cough syrups. To be most effective you must drink large quantities of
liquids with it. The usual dose is 100mg to 400mg every 4 hours or 600 –
1200mg extended release every 12 hours. Do not exceed
2400mg per 24 hours. The trade names include Robitussin Syrup and Mucinex
tablets and many combination products.
2)
Terpin Hydrate: This drug is no longer on the market.
The fourth group of OTC drugs are analgesics. There are 5 main drugs that are
used in cough and cold preparations.
Some of the side effects of this group of medications include nausea, heartburn,
and drowsiness.
1)
Acetaminophen (APAP): This is also listed as non-aspirin pain reliever or as
Tylenol. This drug is used to relieve pain/headaches and to reduce fever. The
usual dose is 325mg - 650mg every 4 to 6 hours or 1000mg every 6 to 8 hours, or
1250mg every 12 hours as sustained release tablets. DO NOT TAKE MORE
THAN 4000MG PER 24 HOURS. The FDA is currently looking at the dosing
guidelines and may be recommending lower dosing limits per dose and per 24
hours for due to safety concerns.
2)
Aspirin (ASA): This drug is not for use by children or teenagers who have
chickenpox or flu like symptoms. This use has been linked to a potentially fatal
syndrome called Reye’s syndrome. This is a rare syndrome characterized by
vomiting, lethargy and belligerence that may progress to delirium and coma. 20
to 30 percent of the children who get this syndrome will die from it ant the
survivors may have permanent brain damage. It is used in adults for pain, fever
and swelling (I.E. sprained ankles or for arthritis pain). The usual dose is 325mg
to 500mg every 4 hours as needed. There are may drug interactions with aspirin
and prescription medications and there are several medical conditions that doctors
recommend that aspirin be avoided (I.E. ulcers)
3)
Ibuprofen: This is one of 3 of the newer agents on the market that are classified
as NSAID’S (Non Steroidal Anti-inflammatory Drugs). It has many different
trade names including Advil, Nuprin, Haltran, Motrin IB, Pamprin-IB Rufen and
several others. It is used to treat pain, fever and swelling (i.e. sprained ankles or
for arthritis pain.) The usual dose is 200mg (1 tablet) every 4 to 6 hours. If pain
or fever does not respond to 200mg, 400mg may be used.
4)
Naproxen Sodium: This is a NSAID. It is used to treat pain and fever. It is
marketed under the trade name of Aleve. The usual dose is 200mg of naproxen
(220mg naproxen sodium) every 8 to 12 hours, or 400mg of naproxen (440mg of
naproxen sodium) initially followed by 200mg (220mg of naproxen sodium) 12
hours later. Do not exceed 600mg of naproxen (660mg of naproxen sodium) per
24 hours. Patients who are greater than 65 years of age should not exceed 400mg
(440mg naproxen sodium)per 24 hours.
The last category is cough suppressants. There are 3 main ones used in OTC
preparations. They are:
1)
Dextromethorphan Hbr.: This is a non-narcotic (meaning it does not have any
codeine or similar drug) cough suppressant. It should be used to control a
nonproductive cough. If you are bringing up a lot of mucous with your coughing
(I.E. not a dry cough), you probably should not use a cough suppressant unless the
cough is keeping you from getting adequate rest or causing excessive
discomfort. The usual dose is 10 to 30mg every 4 to 8 hours. Do not take more
than 120mg in 24 hours. It is found in may cough syrups including Robitussin
DM, and Vicks Formula 44D
2)
Codeine: This a product that can be obtained without a prescription, but there
are federal controls that make it difficult to obtain. There are may different
combination products with codeine that can be obtained by asking your
pharmacist, but a certain amount of paperwork must be filled out. The reason for
these controls are that you can become addicted to codiene. The usual. dose is 10
to 20 mg every 4 to 6 hours. Do not take more than 120mg per 24 hours. Trade
names of Products you can by include Robitussin AC, and Cheracol,
3)
Diphenhydramine: This product is an antihistamine. It is only used as a cough
suppressant for coughing due to colds or allergies. The usual dose is 25mg every
4 hours. Do not exceed 150mg per 24 hours.
Medicine Cabinet Recommendations:
Keep 1 generic version of the drug that seems to work best for you from each class of
medicine. Only use the medicines you need to treat you symptoms. Try to avoid
overmedicating yourself.
One possible example:
Decongestant: Generic Brand of pseudoephedrine 30mg tablets.
Antihistamine: keep the one that works best for you. For example benadryl if it does not
make you too sleepy or one of the new OTC non/low sedating ones like Claritin or
Zyrtec.
Expectorant: Keep or bottle of generic Robitussin plain or if you prefer a tablet,
Mucinex plain.
Analgesic: Keep a bottle of generic Tylenol or Generic ibuprofen or aspirin (beware of
many drug interactions with aspirin).
Cough Suppressants: Keep a bottle of generic Robitussin DM or you can ask your
pharmacist for a bottle of OTC Robitussin AC. Take only when your cough is excessive
(It is good to allow a productive cough to remove excessive mucous from your lungs).
H1N1 (swine flu) prevention/treatment tips

Who Should Get Vaccinated

pregnant women,

people who live with or provide care for infants younger than 6 months (e.g.,
parents, siblings, and day care providers),

health care and emergency medical services personnel,

people 6 months through 24 years of age, and,

people 25 years through 64 years of age who have certain medical conditions
that put them at higher risk for influenza-related complications.

Cancer
Blood disorders (including sickle cell disease)
Chronic lung disease [such as asthma or chronic obstructive
pulmonary disease (COPD)]
Diabetes
Heart disease
Kidney disorders
Liver disorders
Neurological disorders (such as epilepsy, cerebral palsy…)
Neuromuscular disorders (such as muscular dystrophy and multiple
sclerosis)
Weakened immune systems (such as people with HIV or AIDS or
who are on medications that weaken the immune system )
As we face this extraordinary flu season, consider these ten things you
can do to protect yourself and others:
1. Wash your hands often with soap and water for 20 seconds, or use an
alcohol-based hand sanitizer if soap and water are not available. Be sure to
wash your hands after coughing, sneezing, or blowing your nose.
2. Avoid touching your nose, mouth, and eyes. Germs spread this way.
3. Cover your coughs and sneezes with a tissue, or cough and sneeze into your
elbow.
Dispose of tissues in no-touch trash receptacles.
4. Keep frequently touched common surfaces clean, such as telephones,
computer
keyboards, doorknobs, etc.
5. Do not use other workers’ phones, desks, offices, or other work tools and
equipment. If you need to use a coworker’s phone, desk, or other equipment,
clean it first.
6. Don’t spread the flu! If you are sick with flu-like illness, stay home. Symptoms
of flu can include fever, cough, sore throat, runny or stuffy nose, body aches,
headache, chills, tiredness, and sometimes vomiting and diarrhea. CDC
recommends that people with flu-like illness stay home for at least 24 hours
after they are free of fever without the use of fever-reducing medicines. If
supervisors or employees have questions about use of leave for illness or to
care for an ill family member, please contact your local Human Resources
office or your office’s leave administrator.
7. Get vaccinated against seasonal flu. It can protect you against seasonal
influenza
viruses, but not against 2009 H1N1.
8. Ask your doctor if you should get the 2009 H1N1 flu vaccine. People
recommended to receive the 2009 H1N1 flu vaccine as soon as it becomes
available in October are health care workers, children, pregnant women, and
people with chronic medical conditions (such as asthma, heart disease, or
diabetes). People living with or caring for infants under 6 months old should
also be vaccinated to protect these children who are too young to be
vaccinated. For more information about who should get vaccinated, visit
http://www.cdc.gov/h1n1flu/vaccination/acip.htm.
9. Maintain a healthy lifestyle through rest, diet, and exercise.
10.Learn more. Visit http://www.flu.gov or contact CDC 24 hours a day, 7
days a week:
o 1-800-CDC-INFO (232-4636)
o TTY: (888) 232-6348
o mailto:cdcinfo@cdc.gov