Antihistamines help dry up excess mucus. While diphenhydramine (Benadryl) is highly effective, it comes with some precautions. The drug can cause severe drowsiness, paradoxical stimulation in children, increased fall risk in elderly patients, and may worsen urinary disorders such as benign prostatic hypertrophy and urinary retention.
For patients on the go, Louton recommended a non-sedating antihistamine such as fexofenadine (Allegra) or loratadine (Claritin) in the morning, while reserving diphenhydramine’s sedative effects to help induce sleep and itching at night.
To date, guaifenesin remains the only OTC medication on the market for cough. Louton reserves this drug for deeper chest cough. Although there are a variety of guaifenesin-containing products on the market, Louton recommended Mucinex® for patients.
“Most of guaifenesin-containing products are 50-100 mg, but that’s not a high enough dose for an adult to thin out thick mucus,” Louton explained. She recommended cough suppressant-containing Mucinex DM for patients with frequent, deep chest cough; but she encourages pharmacists to warn patients of the risks of taking the liquid as opposed to the tablets or capsules.
“People take the liquid more often than they should, and this is especially problematic with the elderly and kids because overusing it causes hallucinations.”
Acetaminophen appears to be a top choice antipyretic among the pharmacists interviewed. Varin recommends acetaminophen for mild-to-moderate fever but reserves ibuprofen for patients who experience moderate fever in addition to pain.
Louton said that acetaminophen has several features that make it her first-line antipyretic recommendation. Among these are its faster onset compared with ibuprofen and longer-duration compared with other commonly used non-steroidal anti-inflammatory drugs (NSAIDs). Additionally, unlike NSAIDs such as ibuprofen, aspirin, and naproxen, acetaminophen does not cause gastrointestinal upset or exhibit blood-thinning effects. However, as with any drug, it has a few drawbacks, perhaps the most important of these being the risk for hepatoxicity associated with exceeding the recommended maximum daily dose.
Backus and Louton agree that NSAIDs make suitable second-line choices. Backus considers adding an NSAID when staggering antipyretic therapy.
Louton avoids recommending aspirin for several reasons. “Many people take blood-thinning medications, and you certainly don’t know what they’re on if you’re talking to them at the drugstore.”
She also steers clear of recommending the drug for children. Children less than 18 years of age who take aspirin during the course of a prodromal viral illness run the risk of developing Reye syndrome—an aspirin-induced form of hepatotoxicity.2
Clinical manifestations include lactic acidosis, microvesicular fat, and hepatic dysfunction accompanied by coma and encephalopathy. Signs of hepatic trauma or failure include elevated serum aminotransferase levels, hyperammonemia, and encephalopathy. Serum bilirubin levels, however, tend to show only moderate elevation in the condition. Nowadays, the condition has become rare—thanks to patient education and prudent avoidance.
Seventy-seven percent of Americans reported using dietary supplements in 2018, according to the Council for Responsible Nutrition—an all-time high. Given this trend, pharmacists will play an increasingly critical role in educating patients and helping to separate the facts from the hype. However, clinicians agree that many supplements have limited evidence supporting their benefit in mitigating cold symptoms.
Some data suggest that vitamin C, zinc, echinacea, and garlic offer some benefit in reducing both the severity and duration of cold symptoms, but Varin cautioned that evidence is conflicting. Moreover, as with any product ingested, dietary supplements also carry some risks.
For example, garlic can interfere with blood thinners. Although zinc is an essential element and has been shown to help ameliorate some symptoms associated with the common cold, intranasal zinc has been linked to anosmia, or loss of smell—which may be permanent.3
- 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