How to Navigate the Cold and Flu Aisle

The moment when people want cold medicines the most, when their heads are stuffed, aching and dizzy, is exactly the worst time to try and decipher what to buy from the rows of cold medicine boxes with small print.

Instead of grabbing the first thing you remember from last night's commercial and ending up unsatisfied or with side effects, you can draw on recommendations from physicians and pediatricians on how to navigate the cold and flu aisle.

"I know this is a chore for patients, and it makes it much more complicated ... but whatever you're taking, make sure you put them all side-by-side and make sure that the ingredients don't overlap," said Dr. Vincenza Snow, director of clinical programs and quality of care at the American College of Physicians.

With lines of symptom-fighting drugs in combinations that could rival a fast-food restaurant menu, Snow said patients often get confused by what to choose. However, many of the over-the-counter cold medicines have the same active ingredients.

"Generally, they're very similar and only vary by one ingredient from one to the next," Snow said. That means when patients take one or two cold medicines, they may unintentionally be overdosing with the same compound.

"I actually had that happen with my own father, and he had a lot of [side effect] symptoms," Snow said.

Not only can mixing cold medicines cause problems, Snow explained that overdoing it with medication can rarely be strategic or prevent other symptoms from emerging.

"Generally, I just tell patients to treat just the symptoms they have," Snow said. "If you're not having a lot of congestion, there's no need for a decongestant."

Once a patient zeros in on symptoms, there may be more confusion. For example, there are suppressants to stop coughing and expectorants to help the person cough up more.

To Cough or Not to Cough?

When it comes to cough suppressants or expectorants, Snow said it matters if cough is wet and croupy or dry and wheezy.

"Cough is a reaction to get secretions out," Snow said. "If you're coughing up a lot of phlegm, it's actually better to allow yourself to cough it up."

For a wet cough, don't bother with suppressants unless, Snow says, you are hurting yourself. People have been known to break ribs coughing. It turns out wet coughs might not need expectorants either.

"There's some evidence to suggest that expectorants are not that helpful," Snow said. Although lab studies might show an effect, "in an actual person with a cough, just keeping yourself hydrated with a lot of water would help just as well."

Luckily, when it comes to the youngest members of the family, the advice gets much simpler: Just say no to cold and cough medicines.

Buying Cold Medications for Children

"We've seen advertising for these medicines for so long and the ads used to include things like 'pediatrician recommended,'" said Dr. Ian Paul, director of the Pediatric Clinical Research Office at Penn State College of Medicine in Hershey, Penn. "They may recommend them as individuals, but as a group, the American Academy of Pediatrics has said that these medicines don't work."

As of now, over-the-counter cough medicines have not been found effective in children younger than 12 and are flat-out contraindicated for children younger than two.

On Oct. 2, Paul and other doctors will testify in a Food and Drug Administration public hearing about the issue.

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