How to Navigate the Cold and Flu Aisle

Sept. 8, 2008— -- 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.

"The predominance of the evidence, in children, is that they don't work," Paul said. "The jury is still out for adults."

But that doesn't mean parents should abandon all medicines marketed to children, even when children are suffering from colds.

"We have very good medicines available for discomfort," Paul said. "One of the biggest things for cough and cold is discomfort, that feeling of being achy all over."

For that, Paul said parents can use the children's version of Advil, Tylenol or Motrin, the last two helpful to reduce a child's fever.

Parents could also use these drugs' generic equivalent, but doctors warn against using the combination pain and cold medications.

"Although you may want to make the kid feel better, these medications have been shown to have side effects," said Daniel Frattarelli, director of Pediatric Education for Oakwood Hospital in Deerborn, Mich.

Paul and Fratterelli say the side effects can range from hyperactivity to sedation, to death in some cases. While most side effects are the result of an overdose, finding the right dose for a child can become complicated fast with multisymptom drugs.

"Dad might give chest and cold and mom might give cold and flu and not realize there's the same medicine in both," Paul said. "Or they may spit some out and you try to give some more, so the dosing is imprecise."

Apart from the straightforward pain and fever relievers, Paul and Frattarelli have a few tricks to help sick children.

"Last year I published a paper that honey was better for suppressing cough than dextromethorphan -- the only over the counter-cough suppressant," said Paul, who warned that honey should not be given to infants younger than a year-old.

Frattarelli just thought children and parents need to take it easy.

Colds Happen: So Deal With It

"The most important thing parents [should] realize is that kids, on average, will get six or eight of these [colds] a year," Frattarelli said. "If the parent is getting all worked up about this, the kid is going to pick up on that."

Otherwise, said Frattarelli, "it's really just about supportive care and reassuring,"

Ted Epperly, president elect of the American Academy of Family Physicians, believes the same advices works for adults treating other adults.

"The key thing that is going to help people through this is to be patient," Epperly said. "I would caution people into thinking that medications are going to be a great help."

He added, "Nothing is as good as rest, fluids and just giving your body a chance to recover."

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