Choosing Over-the-Counter Cough, Congestion & Cold Remedies

As a pharmacist, I have been frustrated over the years by the tendency of people to rely far too heavily on advertising claims on packages when selecting over-the-counter cough, cold, congestion, and allergy products. To make the right choice, you need to learn the names of only a few basic ingredients (two for congestion, five for allergy, and two for cough). I've given you that information below to let you go right past all the hype and make an informed decision.

As a case in point, consider products that claim to be "non-drowsy". Some of these contain only an ingredient to treat nasal congestion. Decongestants do not cause drowsiness, but neither do they relieve watery eyes, sneezing, or runny nose. You need an antihistamine for that.

Though many products say they relieve congestion, there is a distinction between sinus congestion and chest congestion. For relief of the first you need a nasal decongestant and for relief of the latter you need an expectorant.

Another confusing practice is that manufacturers use the same name on a number of different products. An example is Robitussin. There are at least 25 different products with the Robitussin name. These cover body aches, chest congestion, cough, fever, flu, headaches, itchy nose and throat, itchy watery eyes, runny nose, sinus congestion, sneezing, sore throat, and nasal congestion!! It's enough to make you dizzy! It's a very simple matter to pick the right product if you know your ingredients.

To properly choose between OTC cough, cold, congestion and allergy products, learn the names of the few generic ingredients listed below. These names are long and difficult for some people to pronounce. I have given the pronunciations phonetically in parentheses. If you have a problem remembering them, write them down or print this article and keep it in your wallet.

Nasal decongestants are taken to relieve head congestion due to colds, hay fever, and other upper respiratory allergies, and due to sinusitis. They are also used to promote sinus drainage by shrinking swollen membranes, allowing fluids to drain. There are two nasal decongestant products that are taken orally.
1. Pseudoephedrine (pronounced Soo-doe-ee-fed-rin): Due to its potential for abuse, sale of this medication in some states in the U.S. is by prescription only. In other states, you may still buy this decongestant, within limits, without a prescription, by presenting photo identification and by giving other required personal information.
2. Phenylephrine (pronounced fee-nil-eff-rin): You can buy this one off the shelf, OTC.

Antihistamines relieve allergic reaction symptoms such as sneezing, runny nose, and watery eyes. These cause different degrees of drowsiness and are listed in order of severity, from least drowsiness (loratadine) to most drowsiness (diphenhydramine). The exception to that is that cetirizine and chlorpheniramine cause about the same amount of drowsiness. Individual sensitivities to products are different and this order of drowsiness my vary for any one individual. Following the pronunciation, I have given a brand name that you may be most familiar with.
1. Loratadine (pronounced low-rat-a-deen) (Claritin)
2. Chlorpheniramine (pronounced clor-feen-eye-rah-meen) (Chlor-Trimeton)
3. Cetirizine (pronounced say-teer-a-zeen) (Zyrtec)
4. Clemastine (pronounced clim-uh-steen) (Tavist)
5. Diphenhydramine (pronounced die-feen-high-drah-meen)(Benadryl)

Cough suppressants are taken to relieve cough caused by throat and lung irritations. They can cause drowsiness.
1. Dextromethorphan (pronounced decks-troe-meth-or-fan) (sometimes in combination with benzocaine, a local anesthetic)
2. Diphenhydramine (although it is most commonly used for its antihistamine effects, it suppresses coughs due to colds and allergy).

Expectorants moisten phlegm and respiratory secretions and make them less thick, aiding the body in removing them from the upper respiratory tract, making them helpful in treating chest congestion. Guaifenesin (pronounced gwy-fin-ah-sin) (sometimes listed as glyceryl guaiacolate) is the only commonly used OTC expectorant.

It is important to recognize that some manufacturers add acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) to their combination products. You must know which products have these added ingredients in order to avoid overdosing. Read your ingredients list. If you are taking (or worse, giving to your child) a combination product that contains the Tylenol equivalent and you are also taking Tylenol separately, you could easily overdose. Acetylsalicylic acid (aspirin) is also added to products occasionally.

It might be safer to buy single-ingredient products and give more than one product at a time than to always give a multi-symptom product when some of the symptoms are not present. Do you always need the cough suppressant every time you take a medicine for congestion? Do you always have congestion, cough, and allergy symptoms at the same time? Each ingredient has its own set of possible side effects. You or your child may feel a lot better when taking only the ingredients needed for the symptoms that are present.

DISCLAIMER: This information is not intended as a recommendation of any product for any illness that you may have. This article is in no way intended to make the decision for you of whether or not you may safely choose an OTC product instead of an evaluation by a doctor. It is intended to educate you about the main ingredients in over-the-counter remedies so that if you choose to buy one you can more easily choose the correct one. These medications can cause side effects and drug interactions that are not discussed in this article and which need to be considered.

SOURCES: I am a registered pharmacist and I have presented these facts as a drug expert. I have verified my facts by consulting: Facts and Comparisons, pages 685-713, published by Wolters Kluwer Health, Inc. This is a loose-leaf drug reference for which updates are received as information changes.