It’s nasty outside, and you feel miserable inside. Your head is exploding, your eyes and your nose are running, your body is chilled and your bones ache. Once again, we find ourselves at the height of cold and flu season, and you are begging for relief.
The aisles at the pharmacy are bursting with enough choices to make your already aching head spin. The following is a little guidance to help you get through the Over-the-Counter (OTC) section and find the right product to soothe your ailments.
My Head is Going to Blow Up!
So you’re feeling pressure in your sinuses. You feel like the air is molasses, and you simply can’t breathe. It sounds like you need a decongestant.
How To Find:
Products that contain decongestants tend to have the following words on the label:
- Sinus
- Sudafed
- Congestion
- Decongestant
Once you find one of these boxes, you want to turn to the back of it and read the active ingredients. If the product contains one of the following two medications, you’re in business!
- Pseudoephedrine
- Phenylephrine
These products both work by shrinking the blood vessels in your nasal passages, which opens them up so that you can breathe.
What to Be Aware of:
- Hypertension
Unfortunately, oral decongestants are not selective to blood vessels in the nasal passages. They can constrict other vessels in your body, making them a poor choice if you have high blood pressure.
- Heart Problems
A side effect of decongestants is that they speed up your heart rate. If you already have issues with heart rate or heart rhythm, keep away from these.
- Thyroid disease
Decongestants may worsen the symptoms of an overactive thyroid.
- Galucoma
Decongestants can dilate the pupil and increase pressure in the eye. Do not use at all if you have closed-angle glaucoma. Use very carefully if you have open-angle glaucoma, since they may cause a sudden rise in eye pressure.
- Enlarged Prostate
Decongestants can also tighten muscles in the prostate and bladder, making it difficult to urinate.
Alternatives:
Safe alternatives for those not able to use decongestants are saline nasal sprays such as Ocean or Ayr or sinus rinses like the Neti Pot. If you use a nasal spray, make sure that it only contains saline (sodium chloride) and not a decongestant like oxymetazoline or phenylephrine. These have the potential to cause a rebound effect after a couple of days of use.
My Nose is Running Away!
They don’t make a box with enough tissues to keep up with you. If the cycle of blow/wipe/blow/wipe has you raw and exhausted, you are in need of an antihistamine. These products dry out secretions such as runny nose and watery eyes, and if your eyes happen to be itching, some products may take care of that as well.
How To Find:
The label for an antihistamine may include any of the following:
- Allergy
- Runny nose
- Sneezing
- Watery eyes
Once again, when you find a box or a bottle that says any of the above, turn to the back and look for the following active ingredients:
- Diphenhydramine (Benadryl)
- Chlorpheniramine (Chlor-Trimeton)
- Loratadine (Claritin)
- Fexofenadine (Allegra)
- Cetirizine (Zyrtec)
- Levocetirizine (Xyzal)
The first two items on the list are older and tend to cause drowsiness. They are usually taken every 4 to 6 hours as opposed to the once a day dosing of the newer antihistamines. When you’re sick and miserable, a little rest is sometimes the best thing. Drowsiness might be exactly what you are looking for.
If you need to be able to stay alert, go to work, drive your kids to school, etc., loratadine or fexofenadine are good options. Cetirizine and levocetirizine would work as well, but be sure to take them at bedtime as they may cause some sleepiness.
What to Be Aware of:
- Glaucoma
Similar to decongestants, the first generation antihistamines (diphenhydramine and chlorpheniramine) can dilate pupils and cause a a sudden surge in eye pressure. Avoid these if you have narrow-angle (closed-angle) glaucoma, and use with caution if you have open-angle glaucoma.
- Enlarged Prostate
Stay away from diphenhydramine and chlorpheniramine if you have an enlarged prostate or “BPH”. These first generation antihistamines make it difficult for urine to leave the bladder.
Alternatives:
Fortunately, the second generation products listed above (loratadine, fexofenadine, cetirizine and levocetirizine) are safe to use in both glaucoma and enlarged prostate.
What About Nasal Sprays?
Every now and then, a person just wants to get right to the source of things. Your nose is stuffy, and you want to deal with the problem where it lives. A nasal spray may be what you are looking for.
Basically, there are three types of nasal sprays that will help with nasal congestion:
- Steroid nasal sprays
- Saline nasal sprays
- Decongestant nasal sprays
How They Work
Each of the nasal sprays mentioned above will relieve congestion in different ways:
- Steroid Nasal Sprays
- Reduce inflammation (swelling) in the nasal passages
- Saline Nasal Sprays
- Clear mucus from the nasal passages
- Decongestant Nasal Sprays
- Shrink blood vessels in the nasal passages
How to Find:
Steroid nasal sprays that were once available by prescription only are now sold over the counter. You may see them under the following names:
- Flonase Allergy Relief (fluticasone)
- Nasacort Allergy 24HR (triamcinolone)
- Rhinocort Allergy (budesonide)
The name in parenthesis is the active ingredient in each product, and you may find it in generic or store brand.
Saline nasal sprays usually say exactly that or saline nasal mist on the label. You may also find them under brand names such as:
- Ocean
- Ayr
- Simply Saline
Decongestant nasal sprays are available under a plethora of names. The important thing is to look in the back of the package for any of the following active ingredients:
- oxymetazoline
- phenylephrine
- xylometazoline
The following is a short list of some of the names (among many) you may find in the aisle:
- Afrin
- Sinex
- Neo-Synephrine
- Dristan
What to be Aware of:
- Nose bleeds
Steroid nasal sprays (and sometimes decongestants) can occasionally cause nose bleeds. To avoid or minimize this annoying discomfort, always point away from the nasal septum when using nasal sprays. If the nose bleed is caused by dryness in the nasal passages, a saline spray or saline gel may be helpful.
- Rebound effect
This is awful, and it is part of the reason why I don’t normally recommend decongestant nasal sprays. Imagine that the little device that has brought you such instant joy and relief suddenly has the opposite effect. You spray, and your nose gets stuffier instead.
The rebound effect is, in essence, nasal spray addiction. It is caused by overuse of decongestant nasal sprays. The more you spray, the more your body needs in order to get the same effect. Your nasal passages get even more swollen than they were originally, so you want to spray more. It’s a vicious cycle.
The moral of the story is that, if you absolutely need to use a decongestant nasal spray, obey the package instructions that say to not use for more than three days. Really. Just three days.
How to Use a Nasal Spray:
Knowing how to properly use your nasal spray is key to getting the most out of the medicine. The following are basic steps to follow:
- Clear nose by blowing mucus out.
- Prime spray if the the packaging recommends it.
- Prime by spraying a few sprays into the air before using a nasal spray for the first time or after more than a week of not using.
- Hold your head straight.
- Do not tilt back or hold head down.
- Cover one nostril and spray into other nostril away from center of nose.
- Spray steroid nasal sprays using the hand opposite the nostril you are spraying into and pointing towards the outside of the nose.
- Spray saline and decongestant nasal sprays straight into the back of the nose and inhale.
- Clean the tip of the nasal spray before recapping, and do not share.
That Awful Cough
Either you can’t get that tickle out of your throat or you feel like there’s a lake sitting in your chest…or both. Regardless, you can’t sleep for the cough, and your entire torso aches from the constant effort.
Although they are not as strong as the prescription products, there are a few over-the-counter options that may bring you some relief.
The Hack:
A dry, hacking cough is usually caused by a post-nasal drip (mucus dripping from the back of the nose into the throat) or by seasonal allergies. An antihistamine can bring you relief by drying out secretions and addressing any allergens. A cough suppressant will tame down the urge to cough.
How to Find Antihistamines:
This is the same list from a section earlier in this post. I have separated the products by drowsy and non-drowsy categories.
- May cause drowsiness
- Diphenhydramine (Benadryl)
- Chlorpheniramine (Chlor-Trimeton)
- Cetirizine (Zyrtec)
- Levocetirizine (Xyzal)
- Non-drowsy
- Loratadine (Claritin)
- Fexofenadine (Allegra)
How to Find Cough Suppressants:
Dextromethorphan is the active ingredient that you are looking for when searching for a cough suppressant. Products with this ingredient are often labeled as DM. The following is a list of the more popular brand names for cough suppressants. You may also find store brands and generics by their side.
- Delsym
- Mucinex DM
- Robitussin DM
- Robitussin Dry Cough Forte
- Robitussin Long-Acting Cough Gels
- Robitussin 12 Hour Cough Relief
For Chest Congestion:
When your symptoms include tightness in your chest and a deep chesty cough, you likely want a product that will help loosen up the mucus in your chest and help you get it out once and for all. The active ingredient you are looking for in this case is guaiphenesin. Once again, the following is a list of the more popular brand names you will find in the pharmacy aisles. Store brands and generics will be in the vicinity, just look for the correct active ingredient.
- Mucinex
- Mucinex DM
- Robitussin
- Robitussin Chesty Cough
- Robitussin Chesty Cough Forte
- This one has two ingredients that help loosen and break up mucus.
What to Be Aware of:
- Serotonin Syndrome
Serotonin syndrome is a dangerous collection of symptoms that include sudden rise in blood pressure, heart rate and body temperature. It can be caused by the interaction of dextromethorphan with certain antidepressants and drugs called MAOIs. Consult with your pharmacist to learn if your medication interacts with your cough suppressant.
Cough Drops
Cough drops can conveniently be used between doses of cough suppressants or while having to sit silently through an important meeting…or an opera. Choosing a cough drop is mostly a matter of personal preference, but the following are two that I have personally tried and found to be quite effective:
- Cepacol Sore Throat Lozenge
This lozenge works because it contains 15mg of benzocaine that numbs your throat and erases the urge to cough.
Although there is a product by the name of Cepacol Sore Throat and Cough, I rarely recommend it. You sacrifice half of the benzocaine for a minuscule amount of dextromethorphan (cough suppressant). You are better off with the 15mg of benzocaine.
- Fisherman’s Friend
This surprisingly strong and satisfyingly effective lozenge was invented by a pharmacist over 150 years ago. Still going strong, each lozenge contains a mixture of menthol, eucalyptus oil and other ingredients just like the original recipe. Let the tablet dissolve slowly in your mouth, and enjoy it’s soothing effects.
I Ache with Fever!
Aches and pains and sometimes fever are symptoms I often hear patients complain about during cold and flu season. The main products you will have available over the counter to treat any of these ailments are Tylenol (acetaminophen) and a selection of anti-inflammatory agents (NSAIDs).
Tylenol (acetaminophen) is a good pain reliever and fever reducer, but it will not reduce inflammation.
The NSAIDs will bring down a fever and also relieve pain and inflammation. This would be a good option if your nasal passages are swollen and inflamed.
How to Find:
Acetaminophen is usually found under the brand name Tylenol and store brands with the active ingredient acetaminophen.
The anti-inflammatory agents are available over the counter under the following names:
- Motrin
- Advil
- Aleve
- Ibuprofen
- Naproxen
Motrin and Advil both contain the active ingredient ibuprofen, and Aleve contains naproxen.
What to Be Aware of:
- Liver problems
- Chronic alcohol use
Acetaminophen (Tylenol) taxes the liver and, in either of the conditions above, increases the risk of liver damage.
- Stomach bleeding or ulcers
NSAIDs can damage the stomach lining causing stomach bleeding and ulcers. Always take these products with food and avoid if you have a history of ulcers or gastric bleeding.
- Blood thinners (anticoagulants)
NSAIDs have a blood thinning effect. Taking them in combination with any other blood thinners may cause undesired bleeding.
- Heart disease
NSAIDs may increase the risk of heart attack or stroke. Use cautiously if you have a history of heart disease. Do not use if you have ever had coronary artery bypass surgery.
- Hypertension
NSAIDs have the potential to increase blood pressure through fluid retention.
- Kidney disease
NSAIDs may also decrease kidney function.
- Pregnancy
Do not use NSAIDs during the third trimester of pregnancy. They may cause fatal damage to the fetus. Use only with your doctor’s approval during the first two trimesters.
How to Choose a Combination Product
Now that you know how to treat your individual symptoms, you are equipped to choose a product that will address several symptoms. The important thing is to look at the active ingredients on the packaging and only take medication that treats what you are experiencing.
There is no sense in consuming chemicals that your body does not need just because they are wrapped in one package. If you cannot find a combination that specifically treats your symptoms, it would be wiser to choose two or three single-ingredient products that treat your specific symptoms.
Ask Your Pharmacist
This guide is not meant to replace advice from your doctor. Please note that it does not contain every drug interaction or every precaution. Always check with your pharmacist if you have questions regarding over the counter products and their use with your prescription medicines and medical conditions.
