The common cold is frequently attributed to the rhinovirus, but more than 200 viruses can cause the common cold, according to the American Lung Association.1 Despite the large number of viruses that cause cold symptoms, the common cold usually resolves on its own, giving patients the option to self-medicate with OTC medications to ease their symptoms.
Solid Recommendations Require Detective Work
When making recommendations, pharmacists often have an arsenal of “go-to” drugs they recommend. However, a prudent clinician never proceeds without first collecting information about the patient’s history of present illness.
“Since the common cold has such non-specific symptoms, pharmacists should ask patients about their symptoms,” said Donald Backus, PharmD, a pharmacist at Oregon Health and Science University in Portland. “We should keep track of what they’re presenting with symptom-wise and make sure it’s not something more serious.”
Non-specific symptoms such as headache, fever, and congestion associated with the common cold can often be managed with OTC medications. However, eye exudate and coughing up green phlegm, or seemingly mild symptoms that have persisted for more than a week without improvement, are signs of a more severe illness. Such presentation warrants an immediate referral to the clinic.
If the pharmacist determines that the patient’s symptoms can be self-managed, the next step is to gather information about pre-existing medical conditions as well as prescription and OTC medications and supplements the patient is taking.
Jason Varin, PharmD, director of alumni relations at the University of Minnesota College of Pharmacy in Minneapolis encourages clinicians to find out which medications the patient has tried and whether those medications have worked for them in the past. Of equal importance is to identify the patient’s desires before recommending any OTC drugs.
“If patients have symptoms consistent with a cold, what are they looking for in the way of relief?” he said. “Perhaps a runny nose is not an issue, but they have a cough and want to sleep.” Other patients may seek relief from minor aches and a sore throat.
Gathering background information helps the pharmacist make a well-informed recommendation. Refining the recommendation may involve helping the patient read ingredient labels to identify ingredients that may aggravate pre-existing conditions—such as certain antihistamines that can induce drowsiness, making it dangerous to drive and operate heavy machinery.
For Betty Louton, PharmD, a population health clinical pharmacist at Banner Health in Phoenix, Arizona, simplifying the medication administration regimen helps improve patient reception and adherence.
She said that she finds her patients also enjoy the convenience of 12-hour dosing when many cough and cold medications are dosed twice or more a day with the Alka Seltzer Cold and Flu product line extension. They also reported the reconstituted powder soothed their scratchy throats.
“By default, I look for medications that only have to be taken once a day as opposed to twice daily, or every 4-6 hours, it’s easier—especially for patients who are already taking so many other medications,” Louton said.
For cold-like symptoms that can be managed with OTC medications, pharmacists distinguish their recommendations by the category.
Pharmacists have different preferences when it comes to decongestants. Varin chooses pseudoephedrine as his go-to drug because of its potent vasoconstrictive properties. However, side effects such as increased heart rate and insomnia make it unsuitable for patients who have uncontrolled hypertension or heart conditions.
For these and other patients, alternatives include oral phenylephrine and nasal sprays such as oxymetazoline and phenylephrine. Varin pointed out that phenylephrine is less effective than pseudoephedrine but carries a lower risk of affecting blood pressure, the heart, or disrupting sleep. He saves nasal sprays as a last resort—an option he personally reserves when flying with a head cold.
“The eustachian tubes that help the inner ear adjust to changing air pressure become congested, and the inability of the inner ear to depressurize can be extremely painful,” Varin said. “Nasal spray decongestants can be beneficial in this situation.”
However, he advised against using nasal spray decongestants for more than a few doses to avoid rebound congestion and sinus irritation.
- American Lung Association. Fact About the Common Cold. American Lung Association’s website. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/influenza/facts-about-the-common-cold.html.
- National Institute of Diabetes and Digestive and Kidney Diseases. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Last updated July 27, 2017. https://www.ncbi.nlm.nih.gov/books/NBK548900/
- Hsieh H, Vignesh KS, Deepe GS Jr. et al. Mechanistic studies of the toxicity of zinc gluconate in the olfactory neuronal cell line Odora. Toxicology in Vitro. September 2016. https://doi.org/10.1016/j.tiv.2016.05.003