ASK THE DOCTOR: Array of cold medicines is enough
to give anyone a headache
By DR. JIM MITTERANDO
The Patriot Ledger

Q. There are so many cold medicines available. Which ones work? Which drug does what? What do you recommend?

A. Because of the dizzying array of cold medications available, I often wonder how anyone can choose one.

Why are there so many? Cold medications make up a billion-dollar industry, and all the manufacturers are vying for sniffling consumers' dollars. Different brands, though, contain the same basic ingredients.

Brands typically associated with specific symptoms, such as headache or stomach upset, have branched out into cold therapies, creating more confusion.

For example, Tylenol, the headache medicine, now has an assortment of cold medications, as does Alka-Seltzer, which originally was created to stop heartburn and hangovers. Robitussin makes multiple syrups, each appealing to you and your "individual" cough and cold.

Most of this is marketing magic rather than scientific medicine.

Colds are caused by viruses, not bacteria; therefore, antibiotics do not affect them.

Occasionally, one or two weeks later, a cold can escalate into an ear or sinus infection that may require an antibiotic. But because of the proliferation of drug-resistant bacteria, avoid taking an antibiotic to fight a cold; save such medicine for when you truly need it.

Most cold symptoms result from your body mounting an immune response to the virus. During an infection, the immune system releases chemicals that cause fever and aches.
Cold medications can relieve certain symptoms - aches, congestion, coughs - but do not cure or even shorten a cold.

Acetaminophen (the active ingredient in Tylenol and other non-aspirin drugs) and Nonsteroidal Anti-inflammatory Drugs (NSAIDs) such as aspirin, ibuprofen (the active ingredient in Advil, Motrin) and Naproxen (the active ingredient in Alleve) are great for treating fever and aches.
Just remember to take NSAIDs with food to avoid stomach upset and even ulcers. Because acetaminophen does not cause such side effects, it can be taken on an empty or upset stomach.

Although cough suppressants and decongestants provide only temporary relief, they are the most useful cold medicines.

Antihistamines, which dry up mucus, are less useful, unless your nose runs like a faucet that first day or two of a cold. Antihistamines, though, can thicken mucus, thereby inhibiting sinus drainage, which could cause a sinus infection.

Generally, I recommend antihistamines to combat seasonal allergy symptoms, such as sneezing, itchy eyes and runny nose.

The only over-the-counter cough medicine that works is dextromethorphan. Often referred to as "DM," it is an ingredient in most cough medicines and an excellent cough suppressant.
Remember, though: Rely on a suppressant only if a cough becomes overly irritating or inhibits sleep. It will not clear up the cough faster.

Allow me to debunk two misconceptions about colds: First, people mistakenly exaggerate the importance of bringing up, or expectorating, mucus.

The body naturally clears mucus from the lungs but cold sufferers, often unknowingly, swallow it. Studies demonstrate that expectorants such as guaifenisin - an ingredient in many cough syrups - do not loosen mucus any faster than simply drinking plenty of fluids.

Generally, I do not recommend expectorants, because, in addition to being fairly ineffective, they can cause nausea.

Secondly, many patients with a deep cough/bronchitis erroneously believe they need an antibiotic. Bronchitis is a general medical term that means inflammation of the large airways called bronchi. A cough is a reflex response to such inflammation or irritation. Generally, a cough does not require antibiotic treatment unless it persists past two weeks or if shortness of breath develops.

Decongestant pills such as pseudoephedrine (the active ingredient in Sudafed and Actifed) and phenylpronalamine can help relieve nasal congestion and sinus pressure, and also promote sinus drainage.

Recently, however, the Food and Drug Administration (FDA) ordered the removal of decongestants containing phenylpronolamine, because it may increase the risk of stroke. Pseudoephedrine remains available.

Avoid taking decongestants near bedtime, because they can make you jittery and keep you awake (the opposite effect of sedating antihistamines).

Often when patients have sinus pressure or pain, I recommend this combination treatment: decongestant pills and a four-day regimen of a decongestant nasal spray, such as Neo-Synephrine or Afrin.

Use decongestant nasal sprays cautiously, because prolonged use can cause "addiction" by triggering rebound nasal congestion. Saline nasal sprays are safe and useful when the inner nose becomes dry and irritated.

If sinus pain persists several days after starting this decongestant combination, see a doctor: You may have a sinus infection. Other signs of sinus infection include a foul taste in your mouth or bad breath.

Over the past few years, cold sufferers hoping to quicken their recovery have turned to unpalatable, but popular, zinc lozenges (Cold-eez). The results of limited studies remain inconclusive and may be unrealistic because test groups took the lozenges every two hours, an impractical time frame in real life. I am unimpressed by them.

Echinacea, the popular herbal remedy, has not fared well in multiple studies and does not help prevent colds, its marketing claim. Both echinacea and zinc manufacturers, though, have made a fortune selling these drugs to a public tired of sniffling and coughing.

Vitamin C has been espoused as the chicken soup tablet for colds. Again, studies have not been very supportive of its effectiveness. However, vitamin C does not hurt and often is recommended by health-care providers because there is not much more to do or offer.
Children younger than 5 should avoid taking cold medications such as decongestants and antihistamines. Studies have shown that children that young respond just as well to placebos as to any other treatment.

Adults often give these medications to their sniffling children to make themselves feel better. After all, no parent likes to see his or her child sick. I find Tylenol or ibuprofen helps relieve children's fever and fussiness, and, if necessary, a cough suppressant helps these ill youngsters sleep.

No need to see a doctor during the initial days of a cold. You merely need time and rest - not antibiotics.

Follow up with a doctor if your condition does not improve after one to two weeks or if you experience persistent ear or sinus pain or shortness of breath.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2001 The Patriot Ledger
Transmitted February 6, 2001