Monday, January 24, 2011

Navigating the Aisle of Cold Medicine

It's that time of year where everyone's got some illness or other.  Coughing, sniffling, sneezing...  Welcome to winter, folks.

Growing up in a home where my mother worked in a pharmacy, I've always taken for granted knowing what to take when to cure what.  Dr. Mom always seemed to know just the right thing to take for a particular symptom or ill.  As I've grown, I'll often talk to friends who just wander the cold medicine aisle aimlessly and make semi-arbitrary decisions based on the claims on the packaging, brand names they're familiar with, or how much the medication "knocks them out."  It kind of amazes me and I often find myself giving advice.

The simple fact is that the majority of the "cold and allergy" symptom medications on the market today are cocktails of drugs that mix and match a very small handful of base medications.  If you know what each one does and how your body reacts to it, you can often make a wiser choice and spend a whole lot less money because you're not paying for a name.  I thought I'd take a few minutes and talk about these.  It's not food-related, but maybe it'll help you and your family go about your daily lives.

The Big Disclaimer
I am not a doctor.  I'm not a pharmacist.  I'm not a medical professional of any kind.  The info I'm about to provide could be found in any home remedy resource or on the web.  Use the info I'm about to provide at your own risk and you should never take anyone's word for granted, anyway when it comes to medication.  Always consult your doctor--or even better, a pharmacist, who actually has way more knowledge and training in medication than *any* doctor (bet you didn't know that either).

So here's how you do it...  Pick up any over-the-counter medication and look at the back or the side of the box.  There, you'll see a panel of info required by the FDA.  One of the sections says "Active Ingredients".  These are the actual drugs that are doing the work.  Anything else is usually a starch, solvent, or other item used to bind a pill together or make the medication liquid so you can consume it.  Most of the active ingredients found in cold and allergy remedies fall into a few basic groups:

Antihistamines shut-down the body's natural reaction to allergens, which generally amounts to mucus production, itching, and eye irritation.  When you have a cold or allergies, you know these are the primary symptoms.  Taking an antihistamine can make you feel more comfortable and be able to breathe better by stopping mucus production and drying things up.  Most antihistamines will cause drowsiness but it varies from drug to drug and person to person.  When you find one that doesn't make you personally groggy, remember it for the next time.  Some common ones:
  • Chlorpheniramine (Chlor-Trimeton) - This is my choice for a good cold but I find it too strong for daily allergy use.  Plus, it comes in 4, 6, and 12 hour doses.
  •  Diphenhydramine (Benedryl) - Well-known for its ability to stop itching and the discomfort of bee stings.  Makes most people so drowsy it's often used as a sleep aid.
  • Brompheniramine (found in Bromfed)
  • Centrizine (Zyrtec) - A popular daily antihistamine that recently went over the counter.  Comes in a 24-hour dose and a 12-hour dose when paired with a decongestant.
  • Fexofenadine (Allegra) - Annother daily allergy pill, less drowsy than most.
  • Loratadine (Claritin) - A daily allergy pill that claims to be non-drowsy.
Decongestants work to move mucus out of the sinus cavities, where it can get "gunked-up" (that's a medical term...yeah) and cause sinus pressure and other discomfort.  When you feel "stuffed-up," reach for the decongestant.  Be forewarned, though, that most decongestants are stimulants and will have roughly the same side-effect on most people as caffeine.  This is why you'll rarely see them in "nighttime formulas" of most cold symptom meds.

There are really only two main oral decongestants on the market right now and, because it's a main ingredient in home-grown crystal meth, one of them (the better of the two, IMHO)  unfortunately must now be sold behind the counter even though no prescription is needed.  They are:

Pseudoephedrine (Sudafed) - Probably the best working one out there, this is the one you now have to go to the counter to get and federal law limits you to a box per person per day (well, per pharmacy, technically).  In my opinion, it's worth the aggravation.

Incidentally, pseudoephedrine is a close cousin to "ephedra," a component in diet pills and some dietary supplements.  In fact, one of the side effects of pseudoephedrine is that it's an appetite suppressant (you won't feel as hungry while on it).  Ephedra was often abused and consequently is tested for during workplace drug tests.  The cold medication can show-up incorrectly as ephedra on these tests, so be careful if your workplace uses random drug testing.

Phenylephrine (Sudafed PE) - This is a similar product that has come back out in recent years to replace traditional pseudoephedrine because it *can* be sold over the counter.  Most cocktail drugs switched to this medication to prevent their packages from landing back with the pharmacist.

Cough Medicines
When it comes to cough medicines, you'll usually find two categories: "suppressants," designed to stop the urge to cough and "expectorants," designed to thin mucus out so you can bring it up out of the throat and lungs.  The two most common of each (Dextromethorphan and Guifenesin) are often formulated together and sold under the Robitussin brand name or the generic term "Tussin".  The drug sold as the brand name Mucinex is a large (triple or quadruple) dose of Guaifenesin.

Pain/Fever Relievers
Cold cocktail meds often throw in a pain reliever to help reduce a fever, headache, or get rid of the "aches and pains" often associated with the flu or caused by incessant coughing (your diaphragm is a muscle that'll eventually hurt after a lot of coughing).

On a side note...  You'll often see brand name pain relievers marketed as "Headache" or "Migrain" formulas that list one of the main pain relievers alongside caffeine as the active ingredient.  This is because caffeine opens the blood vessels and that can help relieve a headache faster
  • Acetylsallcylic Acid (Aspirin) - Good 'ole aspirin and aspirin derivatives.  Aspirin can be rough on the stomach (because it's an acid), so it often isn't used in mixed meds.
  • Acetaminophen (Tylenol) - Developed as an alternative to aspirin, this is perhaps the most common pain reliever out there and the most common found in cold and sinus concoctions.
  • Ibuprofen (Motrin) - In some ways, a little more powerful than the others.  Great for really bad headaches and also works as an anti-inflammatory drug (i.e. it'll help sore muscles and other inflammation).
  • Naproxen (Aleve) - A relative newcomer to the field.  A big-time anti-inflammatory drug.  Quite powerful in the grand scheme of things.
A Word on Dosages...
When it comes to medication, it's my opinion that more IS NOT necessarily better.  Also, the more powerful drug is not always the one you want to reach for.  Our bodies are very good at adapting to the things we feed it and we build-up tolerances, meaning we need more to take care of a problem next time.  If you use a maximum dose of a medication or the strongest medication every time you take it, you'll end-up developing those tolerances and there'll be nothing stronger for you to take next time.  Likewise, there's no sense in putting more drugs into your system than it needs to fight-off the problem.

My rule of thumb (take it as you will) is to try the weakest drug first (say Tylenol instead of Motrin).  If it works, great!  If not, take the stronger stuff.  The same goes for dosages.  If it says an adult does is two pills, try one.  If it hasn't kicked-in within the hour, take the second.  I've found that I can get away with half a dose of many of the meds out there and I feel less groggy.

There is one big exception to this rule and that's prescription meds.  If your doctor prescribes a dosage for you, take it as directed.  Many prescribed medications (like antibiotics) need to be taken well past the point when you feel better because they're designed to cure the problem, not simply help with symptoms.

I hope this helps!  Best of luck through the cold season.  :-)

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