Educating patients on cough and cold medications

In this article:

• What is the common cold? 
• What is a cough?
• Cough and cold medications
• Important considerations for children
• When to refer patients to a healthcare provider

In this article

• What is the common cold? 
• What is a cough?
• Cough and cold medications
• Important considerations for children
• When to refer patients to a healthcare provider

With the fall season approaching, cooler weather, earlier sunsets, and children’s return to school are on the horizon. The fall also marks the return of cold and flu season—a period when respiratory viruses heavily circulate. Colds are highly contagious and spread when cold viruses are transferred through touch or inhalation. In fact, adults average two to four colds per year, primarily between September and May.

Patients who are sick with a cold often turn to over-the-counter (OTC) medications for fast relief. As a pharmacist, you have the opportunity to offer recommendations, whether people are seeking OTC medications or lifestyle changes. You may also identify situations when patients should be referred to a healthcare provider for evaluation. Read on to refresh your knowledge on how to educate patients on cough and cold products.

What is the common cold? 

The common cold is one of the most common illnesses and is defined as a mild infection of the upper respiratory tract, which consists of the nasal passages, throat, and windpipe. Colds are caused by viruses that spread from person to person through the air or direct contact. For example, a patient can contract a cold after they touch a faucet that has the cold virus on it and then touch their eyes. Most colds are caused by rhinovirus. According to MedlinePlus, symptoms typically start a few days after becoming infected and can last as long as 10 to 14 days. Symptoms of a common cold usually include:

• Stuffy nose
• Runny nose
• Sore throat
• Cough
• Headache
• Muscle aches

While cold symptoms will typically resolve on their own over time, patients may turn to OTC medications for fast relief.

What is a cough?

As a form of protection against infection, a cough is a natural reflex designed to keep irritants and germs out of the airway. However, severe, frequent, or painful coughs can be bothersome and interfere with a patient’s day-to-day life. This is when many people may seek OTC cough treatment.

Cough and cold medications

Fortunately, there are various types of cough and cold medications available over the counter.

Antitussives

Antitussives are cough suppressants. They can help manage dry or non-productive coughs and work by blocking the cough reflex in the brain. Dextromethorphan (DM) is the most common OTC antitussive and is commonly found in OTC products, including Delsym and Robitussin DM.

Expectorants

Expectorants are best for wet or productive coughs because they work by loosening or thinning mucus in the chest. This helps people cough up and clear mucus more easily. The most common OTC expectorant is guaifenesin and it can be found in many OTC products such as Mucinex and Robitussin.

Decongestants

Decongestants can help relieve congestion and postnasal drip, which can cause coughing. They work by reducing swelling and narrowing blood vessels and tissues in the nose, allowing sinuses to drain and helping patients breathe more easily. Nevertheless, this can also increase blood pressure. Therefore, decongestants should generally be avoided in patients with severe or uncontrolled hypertension. Decongestants are available as oral and intranasal medications. Examples of common decongestants are:

• Pseudoephedrine: Pseudoephedrine–which is commonly sold as its brand-name counterpart Sudafed—is found behind the pharmacy counter due to its potential for misuse. While it can be an effective treatment option for congestion, the U.S. Food and Drug Administration (FDA) has a limit on how much of the drug can be purchased per month because it can be used to produce methamphetamine illegally.
• Phenylephrine: Often referred to by its brand name Sudafed PE, phenylephrine works similarly to pseudoephrine. However, in September 2023, the FDA concluded that oral phenylephrine isn’t effective as a nasal decongestant. It’s important to note that this finding doesn’t apply to phenylephrine in the nasal spray form, as this form is still considered effective.
• Oxymetazoline: Oxymetazoline is marketed as the brand-name product Afrin, a nasal decongestant spray used to treat stuffy noses and relieve sinus pressure. While oxymetazoline works well, using too much can cause rebound congestion.

Antihistamines

Certain antihistamines may be effective for those with a cough related to seasonal allergic rhinitis or atopic cough (a type of chronic cough). They work by blocking histamine, and some older antihistamines inhibit acetylcholine—a neurotransmitter that causes mucus secretion and airway tightening. Examples of older antihistamines include brompheniramine and chlorpheniramine. However, how exactly these mechanisms are beneficial in the treatment of cough is unclear, and more studies are needed to confirm the role of antihistamines in the treatment of chronic (long-term) cough.

Analgesics

Analgesics are pain relievers that can help with muscle aches and fevers, headaches, and sore throats. Common examples include Tylenol (acetaminophen), Advil (ibuprofen), and aspirin. It’s important to note that children and teens should not take aspirin due to the risk of Reye’s syndrome, a rare but serious condition.

Combination products

Many OTC cough and cold products contain a combination of ingredients and are marketed to treat multiple symptoms at once. A common example is DayQuil Cold and Flu, which contains acetaminophen, dextromethorphan, and phenylephrine.

Combination products can certainly be helpful for those with multiple symptoms; however, it’s important to consider each component’s potential side effects, interactions, and warnings. In most cases, patients should only take combination products if each ingredient is needed based on their symptoms.

Another concern with OTC combination products is the risk of inadvertent overdose of a drug or drug class when combining drugs with the same ingredient. For example, coupling DayQuil Cold and Flu (acetaminophen/dextromethorphan/phenylephrine) with Tylenol (acetaminophen) can be problematic as both contain acetaminophen. Taking more than 4,000 mg of acetaminophen total per day can increase the risk of serious liver damage, and the likelihood of overdosing is higher if patients double up on acetaminophen-containing drugs. Emphasizing the importance of reading drug facts and labels on OTC products to ensure patients aren’t doubling up on ingredients is key. 

Important considerations for children

According to the American Lung Association, young children have an average of six to eight colds every year. However, when it comes to treating coughs and colds in children, the options are limited. Colds will typically clear up on their own without medical treatment, and in most cases, healthcare providers recommend home remedies rather than medications for young children. In fact, many experts believe there’s no reason to give OTC decongestants or antihistamines to any child younger than 6 years of age due to the risk of serious side effects, including hallucinations and irregular heartbeats.

According to HealthyChildren.org, oral OTC cough and cold medications have serious risks for young children. The following is the recommendation for cough and cold medications in young children.

• Younger than 4: OTC cough and cold medications are not recommended.
• Ages 4 to 6 years: Certain cough medications can be used if approved by your child’s pediatrician.
• Older than age 6: Cough medications are safe for use. Follow the instructions on the drug facts label on the package to ensure the right amount is given to your child.

As discussed above, aspirin should never be given to children or teens as doing so can cause a serious and life-threatening condition called Reye’s syndrome.

When to refer patients to a healthcare provider

While most colds can be managed at home with OTC medications or home remedies, some cases warrant medical evaluation.

The following are examples of situations that warrant a referral to a healthcare professional:

• Shortness of breath or wheezing associated with a cough
• Coughing up blood or discolored mucus
• Difficulty breathing or fast breathing
• Fever that lasts longer than four days
• Worsening symptoms
• Symptoms that last longer than 10 days

As frontline healthcare providers, pharmacists can educate patients about when they should seek evaluation from their doctor.