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Cold Comfort, Expertly Offered

Pharmacist offers advice for treating acute rhinitis – the common cold

By Bonnie Ward   |   November 02, 2015

You know the drill. It starts as a little tickle in your throat, perhaps followed by a tiny sneeze or a slight sniffle. Alarm bells go off in your head as you try to pretend you’re not getting a cold. You can’t possibly afford to get sick now, but before you can say gesundheit, you’re headlong into stuffy-headed misery.

Renu F. Singh, PharmD, a clinical professor at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California, San Diego, is often asked what to take to soothe this most common of afflictions.

cold sufferer

“If someone is feeling miserable, the first thing to ask is ‘what symptoms are you having?’’ Singh said. “It’s important to know their symptoms because each can be treated very specifically.”

Although highly trained as a medication expert, Singh advises to look first to non-pharmacologic options: plenty of sleep (at least eight hours), staying hydrated with eight to 10 glasses of water per day and, just like your mother told you, eating chicken soup, which has been shown to reduce the severity of cold symptoms.

Gargling warm water containing half a teaspoon of salt can ease sore throat pain. Singh also notes that throat lozenges, such as those containing menthol, calm irritation as well.

For sufferers who prefer over-the-counter (OTC) cold treatments, Singh is a fan of medicines which target a single symptom, rather than “multi-symptom” relief cold medicines. “Those typically have three or four different drugs in them,” she said.

For instance, a multi-symptom product may contain medication for a runny nose, another drug for coughing and acetaminophen, a pain and fever reducer. “But if you don’t have all these symptoms, you’re setting yourself up for potential side effects or drug interactions from medicines you don’t really need.” For example, she cited a person taking Tylenol in prescription form, who runs the risk of overdosing by taking cold pills, which they may not realize also contain acetaminophen.

“It’s best to check with a pharmacist or your primary care provider about any potential drug interactions or other contraindications between your prescribed drugs and over-the-counter medications,” she said.

Singh, who teaches a course on OTC medications to first year pharmacy students, emphasizes the importance of reading labels carefully, particularly the ingredients and dosing instructions.

“Always double check the dose,” she said. “There have been a lot of dosing errors in children. You have parents looking at medicine bottles in the middle of the night. Some dosing may be based on weight and others by age. It’s confusing and can be very dangerous,” she said, adding that overdosing on acetaminophen can cause liver toxicity and death.

Singh emphasized that pharmacists are readily available to answer questions. “Don’t hesitate to ask your pharmacist about proper dosages. They are the most accessible health care providers of all and they are there to help you.”

While self-treating a cold is fine for most people who do not have underlying medical conditions, Singh said that people should see their doctor if their symptoms are particularly severe, worsen after just a few days or last more than seven days.

She provided the following general information about OTC cold medicines:

  • Antihistamines are designed to help dry up nasal secretions. If you have a runny nose and post nasal drip down the back of the throat, this can offer some relief. 
  • Decongestants are intended to clear up stuffy noses and chest congestion. They come as topical nose sprays, pills or liquid. Some oral decongestants (those containing pseudoephedrine or phenylephrine) can raise blood pressure and heart rate so a topical version may be a better choice for people with these issues, as well as for those with overactive thyroid or ischemic heart disease. As a general rule, Singh noted people with chronic conditions should check with a pharmacist for possible contraindications between their illness and various medications.
  • Expectorants, such as guaifenesin-based products, like Mucinex, are designed to thin mucus secretions in the lungs to make coughs more productive. Singh isn’t a big believer in using these products for a typical cold. “One study showed that OTC-strength guaifenesin wasn’t any more effective at thinning mucous secretions than drinking 10 glasses of water a day.”
  • Cough suppressants seek to control or lessen the frequency of a dry cough. Guidelines issued by the American College of Chest Physicians do not recommend OTC cough products for the common cold. “The ACCP feels evidence is lacking as to their benefit for a cough related to a cold,” said Singh. Instead, the ACCP recommends using an antihistamine combined with an oral decongestant to dry up mucous secretions and reduce post-nasal drainage.” Singh added that coughing isn’t always bad. A productive cough that produces phlegm can help to clear mucous from your airways. But if it keeps you from sleeping, you may need to consult your doctor.

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