Article by Sandra Harley Counts, PharmD
I’ve just retired to Hilton Head Island after 38 years of teaching drug therapy to family medicine doctors in training. I miss sharing information, so CH2 magazine has agreed to let me try my hand at a health column! Here’s my first one.
As the weather gets colder, people gather indoors and spread germs more easily. In addition to the COVID virus and its mutations, there are over 200 viruses that can cause a cold. Since no one has yet found a cure for the common cold, the best we can do is target and treat the symptoms.
There’s a whole aisle of products available at the drugstore and choosing can be overwhelming. Many people choose a ‘multi-symptom’ product with an array of ingredients such as an antihistamine+ decongestant+ cough suppressant+ analgesic combo. But this is not the best tactic. It’s best to treat only your one to two main or most bothersome symptoms with a product that matches your needs vs. a smattering of ingredients. You can do this by buying separate ingredients and combining them as needed.
For example, if you are stuffy/congested, choose a plain decongestant. There are several single-ingredient choices, but the most effective oral product is pseudoephedrine/Sudafed. Don’t choose phenylephrine … it’s less effective. Since pseudoephedrine is a stimulant, you may experience jitteriness/anxiousness or trouble sleeping. You may also want to avoid it because it can potentially increase blood pressure in patients who have uncontrolled high blood pressure. (It’s okay if you are on meds for BP and your numbers are good i.e., < 140/90. Also, if you are pregnant or trying to conceive, you should also avoid oral decongestants. The better option for these situations is a nasal decongestant spray such as oxymetazoline/Afrin.
Plain Sudafed tabs are non-prescription but are kept behind the pharmacy counter and aren’t available in stores without a pharmacist. There are two types of plain Sudafed, long- and short-acting. The short acting is preferred because it enters the bloodstream faster and wears off before it’s time to fall asleep. If you are super stuffed up, it’s okay to combine Sudafed tabs with Afrin nasal spray. Don’t use the spray more than two to three days in a row since it can cause rebound stuffiness. Choose generics to save money.
If sneezing/watery eyes, and runny nose are your main symptoms, choose an old-fashioned antihistamine, such as chlorpheniramine. Benadryl will also work but causes twice the drowsiness as chlorpheniramine. Many people make the mistake of buying non-drowsy allergy products such as Claritin, Zyrtec, Allegra, or Xyzal, but these won’t work for runny noses that often accompany the common cold! These products are specifically for runny noses caused by allergies, not those caused by the viruses that cause colds.
So, what about coughs? If a cough is productive, it’s best to leave it untreated during the day so your body can rid itself of phlegm (always hated that word!). It’s okay to take a bedtime dose if the cough is bothersome and you can’t sleep. Cough suppressants such as dextromethorphan (DM) are counter-productive to this natural process. If a cough is non-productive (i.e., a dry, irritating cough) then it’s okay to treat it. Amazingly, one of the most effective and safest cough meds is honey! Any kind of honey can be used. It’s also a safe and effective choice for kids, but due to the risk of botulism, should never be use in kids under one year of age. Give up to a tablespoonful in adults, 2 teaspoonfuls in kids. Take it either straight or mixed in a hot beverage.
Treat headaches or other body aches associated with the common cold with your analgesic of choice: Tylenol/acetaminophen, Motrin/ibuprofen, or Aleve (naproxen). One study even shows naproxen can decrease cough frequency.
To recap, choose single generic ingredients to stock your medicine cabinet, and combine them as needed for your most bothersome symptoms:
• Decongestants (fast acting/30 mg Sudafed and Afrin spray) for stuffiness
• Antihistamines (fast acting 4 mg chlorpheniramine) for sneezing, watery eyes, or drippiness (may be hard to locate on pharmacy shelves, so ask for help if needed)
• Cough suppressants: Honey (throughout the day if cough is not productive), or just at bedtime if it is
• Pain: Tylenol, Motrin, or Aleve
• Other: wash hands frequently and cover your sneeze. Avoid shaking hands in public.