Cold Medicines

I have previously discussed appropriate non-medicine treatments for common cold symptoms.  The data–or lack thereof– regarding so called cough and cold preparations (“C/C”) continues to grow.  Let’s review it here.

In a recent edition of the journal Infectious Diseases in Children, Edward Bell, PharmD offered an excellent summary of the subject. His most important summary is direct–“evidence supporting the efficacy of commonly available orally administered C/C product ingredients (e.g. cough suppressants, mucolytics, anti-histamines, decongestants) in children does not exist.” This statement is based on research from 2002-15 involving > 3 BILLION pediatric visits and 95 million C/C prescriptions.  Randomized, controlled trials conducted in 1991 and 1997 compared drugs like diphenhydramine (benadryl) and dextromethorphan (the “DM” in most cough medicine) to placebo for treatment of nocturnal cough and found no difference between the 2 treatments (“fake” medicine did just as much).  A 2015 comprehensive review of > 4000 subjects(212 kids) evaluated anti-histamines for common cold symptoms demonstrated similar results–no difference, and Congressional testimony from respected university educators and researchers concurred that there is no scientific evidence  for efficacy of anti-histamines for treatment of common cold symptoms.

It is also important to note the evidence of no benefit with the well documented list of common and sometimes serious side effects of these drugs.  Besides sedation, they can cause dry mouth, urinary retention, increased heart rate and appetite.  Please note that these occurrences are NOT rare.  Perhaps of even greater concern are the secondary effects from the well known problem with drowsiness–cognitive impairment with adverse effects on learning(school) and DRIVING (teens!), even hallucinations.

In 2017 the Food and Drug Administration labelled codeine as of no use for cough suppression in children under age 12 and then followed that up with warnings against its use up through age 18 as well.  Side effects here also include even more serious problems with drowsiness along with constipation, abdominal pain, agitation, sometimes even respiratory compromise and /or drug dependency.

Claims regarding so called “second generation” antihistamines, like loratidine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) being “non-sedating” are at least somewhat disputed by considerable published literature.  Those studies suggest that mostly the above problems still occur with these more recently developed products, only to a lesser degree than the older stuff.

So, please, parents, I urge you to stay away from this CRAP and concentrate on what works–fluids, vaporizer, nasal saline, OTC analgesics. And try and be patient: George Harrison of the Beatles sang “All Things Must Pass” (couldn’t resist the reference) and mostly nature will run its course and in a bit of time all will be well again.  Too often, trying to rush things along like with the above does little of benefit and can cause harm. (A lesson in life, perhaps?)

Certainly for more severe episodes with significant fever, pain, sleep or activity disruption, or prolonged disruptive symptoms more thorough evaluation and often treatments may be indicated.  Give me a call to discuss it, and thanks for following.

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