The most popular drugs on SingleCare in December

Cold and flu season starts heating up in December. Noses run, throats get scratchy, chests get congested and—ahem—coughs are born. 

According to research, a cough is the most common symptom for which people seek out medical care. And past Decembers were no exception. 

In the last month of each year, the most commonly prescribed drugs for which a SingleCare card was used were typically prescription cough medicines. The top five included:

A cough can be a sign of COVID-19. If you think you may have been exposed, call your healthcare provider.

There’s a long list of upper and lower respiratory infections that cause coughs. In addition to flu and colds there’s respiratory syncytial virus (RSV)—a common and contagious respiratory infection that primarily affects young children—pneumonia, bronchitis, and this year the novel coronavirus known as COVID-19, among others. And while any of these conditions can occur at any time of year, they’re more likely to be circulating when the weather turns cold.

“Wintertime in the pharmacy is extremely hectic—patients are continuously coming in with bacterial infections; the seasonal flu; common cold; allergies; and this year, COVID,” says Karen Berger, Pharm.D., community pharmacist and member of the SingleCare Medical Review Board. “The cold, dry air can make coughs even worse in the winter.”

Single-ingredient cough medicines

Benzonatate

According to SingleCare data, this was by far the most common cough medicine for which a SingleCare card was used. Benzonatate (brand name Tessalon Perles) numbs the throat and lungs, helping to suppress the coughing reflex. Three important things to keep in mind:

1. Never suck or chew on a benzonatate capsule. Doing so can cause nausea, dizziness, and other serious complications.
2. Don’t eat or drink with throat numbness. You could choke. Wait until any numbness or tingling subsides.
3. Don’t give benzonatate to children under 10.

Multi-ingredient cough medications

It’s not uncommon for cough medicines to be combined with drugs that treat additional symptoms, such as stuffy noses and itchy, watery eyes. And these combination cough medicines were also frequently prescribed to SingleCare card users last December.

Bromphen/pseudoephedrine HCL/dextromethorphan HBR 

The generic version is Bromfed DM. It contains three medications that work together to fight cold symptoms.

• Brompheniramine is an antihistamine. Histamine is a substance produced by the immune system in response to something it sees as a foreign invader, such as pollen, pet dander, and other common allergy triggers. Antihistamines fight that response.
• Pseudoephedrine HCl is a decongestant that helps ease stuffy nose and sinuses.
• Dextromethorphan HBr is a cough suppressant.

Promethazine/dextromethorphan

Promethazine/dextromethorphan is a prescription cough medicine that combines two types of medications to block histamine reactions and soothe coughs.

• Promethazine is an antihistamine.
• Dextromethorphan is a cough suppressant.

“One important thing to remember is a serious, life-threatening condition called serotonin syndrome,” Dr. Berger says. “Too much serotonin can be very dangerous. Something seemingly innocent like combining a cough medication like dextromethorphan with an antidepressant can send you to the hospital. Always check with your healthcare provider or pharmacist when selecting an over-the-counter drug to make sure that you can combine medications safely.” 

Promethazine/codeine

Promethazine/codeine is a prescription cough medicine that combines an antihistamine and a stronger cough suppressant. It is a controlled substance because of its potential for abuse and dependence from codeine.

• Promethazine is an antihistamine.
• Codeine is a narcotic cough suppressant. According to the U.S. Food and Drug Administration (FDA), codeine shouldn’t be used in children younger than 18. “Narcotic cough medications like codeine and hydrocodone come with a long list of potentially dangerous side effects,” Dr. Berger says, “including impaired alertness and coordination, respiratory depression, and have the potential for abuse.”

Codeine/guaifenesin 

Also a controlled substance, some brand names containing codeine/guaifenesin include Robitussin AC, Brontex, Cheratussin AC, Coditussin AC, and G Tussin AC. 

• • Codeine suppresses your cough.
  • Guaifenesin is known as a cough expectorant. It helps to loosen up and thin mucus and chest congestion so it can be cleared from the body.

What you need to know

No cough medicine treats the infection that’s causing the cough; it only helps treat symptoms. Cough medicines are also ineffective in treating a cough due to asthma or smoking. 

If you’re only dealing with a cough, steer clear of multi-action medications. They contain drugs you just don’t need and put you at risk for more side effects, some of which—depending on your age and other health conditions—can be serious. Talk with your healthcare provider about the risks associated with these medicines, even over-the-counter (OTC) ones, which can include:

• Sleepiness
• Slow breathing
• Increased blood pressure and heart rate
• Dizziness
• Irritability
• Dry mouth

Cough medicine for kids

Don’t give your child any cough medicine without first checking with your doctor. 

Although the FDA doesn’t recommend OTC cough and cold medicines for children younger than 2, this is just a general recommendation, Dr. Berger says. “Not all OTC medications are safe for children over 2 years old,” she says. “There are dozens, if not hundreds, of different cough and cold formulations which can be confusing and overwhelming for parents. Some of these medications are not appropriate for certain ages. Be sure to ask the pediatrician or pharmacist, who can help you select an appropriate product and calculate an appropriate dosage based on age and/or weight.” 

If your child’s symptoms are keeping her from eating or sleeping (or if she has labored breathing, a fever above 102 degrees F, are getting worse, or have a cough that won’t go away) speak to your doctor. In addition to medications, you can try:

• A cool-mist vaporizer in your child’s bedroom
• Encouraging your child to drink, especially warm fluids. This helps thin mucus. 
• Offering one half to one full teaspoon of honey (in children older than 1 year). Research shows honey can be as, or even more, effective as some cough medicines.

Is that cough COVID?

Cough is one of the major symptoms of COVID-19. But there are some important distinctions between a COVID cough and one caused by a cold or flu. 

“Although symptoms can vary, cough from COVID-19 usually is accompanied by fever, shortness of breath, and loss of sense of smell and/or taste,” Dr. Berger says. “A common cold usually won’t cause shortness of breath in people with normal lung function.”

If you’re worried, call your healthcare provider—or even seek out a COVID test if you could have been exposed. “A cough may be just a symptom of a minor cold,” Dr. Berger explains, “but with the second wave of COVID-19, it’s better to be safe than sorry and get a COVID test for an accurate diagnosis. This can help keep you and those around you safe.”