Cold Remedies
More than 100 viruses can cause the misery attributed to the common cold, and a cure remains elusive. Some experts say that a person can take nothing and the cold will disappear in about a week, or a person can take a drug and feel better in about 7 days. However, people spend billions of dollars every year trying to relieve cold symptoms. Children are especially likely to get colds and be given cold remedies, even though the effectiveness of such drugs for preschool children has not been proved.
Ideally, each cold symptom should be treated with a single drug. However, most remedies contain a variety of drugs--antihistamines, decongestants, analgesics, expectorants (drugs that make phlegm easier to cough up), and cough suppressants--and are designed to treat a wide range of symptoms. If a congested nose is the problem, neither a cough suppressant, an expectorant, nor an analgesic is needed. If a cough is the problem, neither an antihistamine nor a decongestant is needed. If a sore throat is the only symptom, an analgesic (such as acetaminophen, aspirin, ibuprofen, or naproxen sodium) is likely to work. Throat lozenges, especially those with a local anesthetic such as dyclonine or benzocaine, or a saltwater gargle (half a teaspoon of salt in 8 ounces of warm water) may also help. Finding an appropriate treatment for each symptom can be a challenge. Reading the labels or consulting a pharmacist can help.
Occasionally, a cold or cough may be a sign of a more serious disorder. A doctor should be consulted if symptoms last more than a week, especially if chest pain occurs or a cough produces dark phlegm. Fever and pain are unlikely to accompany a common cold and may indicate influenza or a bacterial infection.
Antihistamines
Many experts believe that antihistamines should not be included in OTC cold remedies. The concern is that most antihistamines can cause drowsiness, making people feel less alert. Anyone who drives, operates heavy equipment, or performs other activities that require alertness should not take the antihistamines included in OTC products. However, not everyone reacts the same way to antihistamines. For example, Asians seem to be less susceptible to the sedative effects of diphenhydramine than are people of Western European origin. Also, antihistamines cause the opposite (paradoxical) reaction in some people, making them feel nervous, restless, and agitated. Children, older people, and people with brain damage are more likely to react this way.
Other side effects of antihistamines are less common. They include blurred vision, light-headedness, headache, stomachache, noise in the ears (tinnitus), palpitations, dry mouth, difficulty with urination, constipation, and confusion. Older people are particularly susceptible to the side effects of antihistamines (see Section 2, Chapter 14).
Older people, pregnant women, and breastfeeding women should consult a doctor before they take any drug that contains an antihistamine. This precaution also applies to people with angle-closure (narrow-angle) glaucoma, heart disease (such as angina and abnormal heart rhythms), constipation, or an enlarged prostate gland. Despite widespread concern about these risks, most cold remedies contain antihistamines. Reading labels or consulting a pharmacist can help people identify cold remedies containing antihistamines.
Cold remedies containing antihistamines should not be taken with alcohol, sleep aids, tranquilizers, or other drugs that also cause drowsiness and decrease alertness. Such a combination may intensify the sedating effects of the drugs.
 See the sidebar Recognizing Antihistamines.
Decongestants
When viruses invade mucous membranes (especially in the nose), blood vessels dilate, causing swelling. Decongestants constrict vessels and thus provide some relief. Active ingredients in oral decongestants include pseudoephedrine and phenylephrine.
Side effects of decongestants may include nervousness, agitation, palpitations, and insomnia. Because these drugs circulate throughout the body, they constrict other blood vessels--not just those in the nose--possibly raising blood pressure. For this reason, people with high blood pressure or heart disease should take decongestants only under a doctor's supervision or not at all. People with diabetes or hyperthyroidism also require a doctor's supervision if they take decongestants.
In an attempt to avoid these side effects, people often use nasal spray formulations, which temporarily reduce swelling in nasal tissues without affecting other organ systems. However, nasal sprays work so fast and so well that many people are tempted to use them longer than the 3-day limit listed on the label. Overuse can lead to the vicious circle of rebound nasal congestion: As the spray's effect wears off, small blood vessels in the nose can expand, causing congestion and stuffiness. This feeling may be so uncomfortable that use of the nasal spray is continued. Such use may lead to drug dependency that lasts months or years. Sometimes withdrawal has to be supervised by a doctor specializing in ear, nose, and throat disorders.
Long-acting nasal sprays contain oxymetazoline or xylometazoline, which may provide relief for as long as 12 hours. Long-acting nasal sprays can be identified by reading the label. They also should be used for no more than 3 days at a time.
Cough Remedies
Coughing is a natural response to lung irritation; it rids the lungs of excess secretions or mucus as phlegm (see Section 4, Chapter 39). If a person is congested and can cough up phlegm, suppression of such a productive cough is unwise. Expectorants make phlegm easier to cough up. Guaifenesin, the only approved expectorant on the market, is supposed to help loosen lung secretions and make them easier to cough up, but the drug's actual benefit has been hard to establish.
An unproductive, or dry, cough can be very irritating, especially at night. A cough suppressant can provide relief and contribute to restful sleep. Dextromethorphan, a very effective cough suppressant, is the most common ingredient in OTC cough remedies. It is not an opioid (narcotic), and it rarely causes side effects, although an upset stomach or drowsiness can occur.
Codeine, also a very effective cough suppressant, is available only by prescription in many states. However, other states permit pharmacists to sell cough remedies containing codeine without a prescription if the customer signs for it. Because codeine is an opioid, some people fear it may be addicting. In reality, addiction is uncommon. Codeine can be helpful at bedtime because of its slight sedative effect.
Codeine causes nausea, vomiting, and constipation in some people. Because codeine may also produce light-headedness, drowsiness, or dizziness, cough remedies containing codeine should not be taken by anyone who is about to drive a vehicle or perform a task that requires concentration. Allergy to codeine is uncommon. Side effects may be more likely and more pronounced when other drugs that also reduce concentration (such as alcohol, sedatives, sleep aids, antidepressants, and certain antihistamines) are taken at the same time as codeine. Consequently, such a combination should not be taken except under a doctor's supervision.
To choose a cough remedy suitable for their symptoms, people should check the list of active ingredients on the package and talk with their pharmacist. They may need a product to help them cough up phlegm (a product containing guaifenesin), to suppress the cough (a product containing codeine or dextromethorphan), or to do both. A remedy containing codeine may be useful when a cough interferes with sleep.
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