Colds and the Flu - Treatment

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Oral Decongestants

Oral decongestants also come in many brands, which mainly differ in their ingredients. The most common active ingredient is pseudoephedrine (Sudafed, Actifed, Drixoral).

Side Effects of Decongestants. Decongestants have certain adverse effects, which are more apt to occur in oral than nasal decongestants and include the following:

• Agitation and nervousness
• Drowsiness (particularly with oral decongestants and in combination with alcohol)
• Changes in heart rate and blood pressure
• Avoid combinations of oral decongestants with alcohol or certain drugs, including monoamine oxidase inhibitors (MAOI) and sedatives

In November 2000, the Food and Drug Administration (FDA) banned products, including decongestants, which contained phenylpropanolamine (PPA). This action was in response to a few reports of an increased risk of stroke. (Stroke tended to occur in people who took diet suppressants containing PPA rather than decongestants. In any case, serious events were still very rare.) All major brands that previously contained PPA have now substituted other active ingredients (usually pseudoephedrine) and are safe to use. Anyone with old forms of any decongestant should check the labels and discard them if they contain phenylpropanolamine. It should be noted that PPA has been used in dozens of medications for over 50 years. Extreme concern, therefore, is unwarranted.

Individuals at Risk for Complications from Decongestants. People who may be at higher risk for complications are those with certain medical conditions, including disorders that make blood vessels highly susceptible to contraction. Such conditions include the following:

• Heart disease
• High blood pressure
• Thyroid disease
• Diabetes
• Prostate problems that cause urinary difficulties
• Migraines
• Raynaud's phenomenon
• High sensitivity to cold
• Emphysema or chronic bronchitis

People taking medications that increase serotonin levels, such as certain antidepressants, anti-migraine agents, diet pills, St. John's Wort, and methamphetamine. The combinations can cause blood vessels in the brain to narrow suddenly, causing severe headaches and even stroke.

Anyone with these conditions should not use either oral or nasal decongestants without a doctor's guidance. Other groups who should also use these agents with caution are the following:

• Anyone who is pregnant should not use these agents without consulting a physician.
• Children appear to metabolize decongestants differently than adults. Decongestants should not be used at all in infants and small children, who are at particular risk for side effects that depress the central nervous system. Such symptoms cause changes in blood pressure, drowsiness, deep sleep, and, rarely, coma.

Cough Remedies

Major studies have indicated that over-the-counter cough medicines are not very effective, but they are also not harmful.

• For thick phlegm, patients may try cough medications that contain guaifenesin (Robitussin, Scot-Tussin Expectorant), which loosens mucus. Patients should not suppress coughs that produce mucus and phlegm. It is important to expel this substance. To loosen phlegm, patients should drink plenty of fluids and use a humidifier or steamer.
• For patients with a dry cough, a suppressant may be useful, such as one that contains dextromethorphan (Drixoral Cough, Robitussin Maximum Strength Cough Suppressant).

Medications that contain both a cough suppressant and an expectorant are not useful and should be avoided. Medicated cough drops that contain dextromethorphan are not very useful. A patient is just as likely to find relief from hard candy or lozenges.

Children and Cough and Cold Medicines

In early 2007, the Food and Drug Administration (FDA) began reviewing the safety of common cough and cold remedies for children, following a survey by the Centers of Disease Control and Prevention (CDC). According to the CDC survey, 1,519 children under age 2 were treated between 2004 - 2005 in emergency departments for adverse side effects associated with cough and cold medicines. Three infants ages 1 - 6 months died in 2005. All three had high levels of pseudoephedrine, a nasal decongestant, in their blood. The FDA warns that parents should not give cough and cold medications to children under age 2 without first consulting a health care provider.

Remedies for Sore Throat Associated with Colds

Sore throats that are associated with colds are generally mild. The following may be helpful:

• Cough drops, throat sprays, or gargling warm salt water may help relieve sore throat and reduce coughing.
• Throat sprays that contain phenol (for example, Vicks Chloraseptic) may be particularly helpful. Phenol has antibacterial properties. In one study, patients with sore throat who used the spray experienced faster resolution of the cold itself, including fever, headache, and other symptoms compared to a dummy medication. The patients were not taking antibiotics.
• Cough drops that contain menthol and mild anesthetics, such as benzocaine, hexylrescorincol, phenol, and dyclonine (the most potent), may soothe a mild sore throat.
• One health professional suggested that people with sore throats from postnasal drip might try taking a teaspoon of liquid antacid. They shouldn't drink anything afterward, since the intention is to coat the throat and help neutralize the acid in the mucus that might be causing pain.

If soreness in the throat is very severe and does not respond to mild treatments, the patient or parent should check with the physician to see if a strep throat is present, which would require antibiotics. In one study only 17% of sore throats in adults were caused by Group A streptococcus, the bacterium responsible for strep throat. Nevertheless, antibiotics were prescribed in 73% of patients.

Combination Cold and Flu Remedies and Antihistamines

Dozens of remedies are available that combine ingredients aimed at more than one cold or flu symptom. In general, they do no harm, but they have the following problems:

• Some ingredients may produce side effects without even helping a cold.
• In some cases, the ingredients conflict (such as a cough expectorant and a cough suppressant).
• In other cases, a patient may wish to increase the dosage to improve one symptom, which serves to increase other ingredients that do no good and, in higher doses, may cause side effects.

Note on Antihistamines. Many combination remedies contain antihistamines. Antihistamines are used for allergies and not generally recommended to relieve the symptoms of the common cold. Some evidence suggests, however, that they may have some value.

One study has indicated that older so-called first-generation antihistamines may reduce cold symptoms. Experts theorize that their benefits for the cold are likely to be due to the drowsiness they cause. Such antihistamines include Benadryl, Tavist, and Chlor-Trimeton. The newer, second-generation antihistamines (Claritin, Allegra, Zyrtec) do not have these effects and also appear to have no benefits against colds.

Another study reported high levels of histamine in the urine of patients infected with type A influenza, suggesting that antihistamines may actually have some real value for viral infections, include flu and colds. More research is needed, however, before the significance of these findings is known.

Review Date: 03/06/2007
Reviewed By: A.D.A.M. Editorial Team: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy. Previously reviewed by Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital (12/4/2006).