Little has changed in the $8 billion world of useless and confusing over-the-counter (OTC) cold, flu, and sinus medications since the Skeptical Cardiologist first tackled What Cold Medications Are Safe For My Heart in 2015.
The original post covers most of the usual suspects in this mostly useless arena. I updated it in 2016 with comments on a few additional OTC components. That post on Alka-Seltzer, phenylephrine, and doxylamine is included below.
I had always viewed Alka-Seltzer as an effervescent tablet for acid reflux, but the brand (now owned by Bayer) has moved aggressively into the bewildering morass of OTC cold meds. Indeed, when Alka-Seltzer began in 1931, it was a combination of aspirin and sodium bicarbonate (baking soda) marketed for upset stomachs. Popular commercials from the 1960s featured the catchy jingle (still stuck in my head) Plop, plop, fizz, fizz. Oh what a relief it is often sung by Speedy, an odd anthropomorphic creature with an Alka-Seltzer thorax and cap. (The jingle was written by Tom Dawes of The Cyrkle [Red Rubber Ball], not by the father of Julianna Margulies.)
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Recently, I received a request from an out-of-town guest who was suffering from a cough and upper respiratory infection to purchase Alka-Seltzer Plus in the form of a tablet that dissolves in hot water.
Like pseudoephedrine, phenylephrine is a sympathomimetic drug, meaning it stimulates receptors of the sympathetic nervous system. Unlike pseudoephedrine, phenylephrine is useless as a decongestant when taken in the dosages available over the counter.
A study published in 2015 confirmed what previous studies had suggested: Phenylephrine in dosages of 10 to 40 mg daily was no more effective than placebo in reducing symptoms of nasal congestion.
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The transition to useless phenylephrine took place when pseudoephedrine was taken off the shelves and put behind the counter to reduce its usage in making methamphetamine.
You can buy a large bottle of cheap generic acetaminophen and take exactly the right dose you need for relieving fever or body aches without paying for two useless accompanying drugs that have the potential for giving you unwanted side effects.
Doxylamine is the active ingredient in the brand-name sleep aid Unisom and the ZzzQuil products from the NyQuil brand that are promoted for inducing sleep. It is available in cheap, generic form.
Children's Sudafed Pe Cold + Cough Suppressant, Cold Medicine & Nasal Decongestant, Grape Flavor Liquid Cough Relief, 4 Fl. Oz
, It is also the most powerful over-the-counter sedative available in the U.S., and more sedating than many prescription hypnotics. In a study, it was found to be superior to even the barbiturate, phenobarbital for use as a sedative.
Note that the effective dosage recommended in separate sleep aids is 25 mg, not the 12.5 mg found in Alka-Seltzer OTC cold meds. Thus, if you want an effective dosage of doxylamine to help you sleep, you must double the recommended dosage of Alka-seltzer's nighttime product, which then gives you too much acetaminophen and dextromethorphan.
Doubling these drugs raises the potential for side effects. Common dextromethorphan side effects include nausea/vomiting, dizziness, diarrhea, and nervousness. Too much acetaminophen can damage the liver.
Codral® Cold & Flu Tablets
If you have a cough, recognize that the OTC ingredients are no better than placebo and are being abused as recreational drugs. Most coughs go away shortly; but if one is particularly troublesome and persistent, get a cough suppressing drug from your physician.
If you have a really runny nose with a lot of sneezing, it is probably OK to take pseudoephedrine even if you are a heart patient or have high blood pressure. Take it as I described above. Start with 30 mg of the little red pseudoephedrine pills. Wait an hour to see how you feel. Take a second if it has not been effective. Repeat at 4 to 6 hour intervals as needed. Take your blood pressure at least once after starting it.
Don't buy the multi-symptom multiple ingredient combinations, which are simply a marketing tool to get you to spend more money on something from which you won't benefit.
Heart Safer Nsaid Alternatives
Anthony Pearson, MD, is a private practice noninvasive cardiologist and medical director of echocardiography at St. Luke's Hospital in St. Louis. He blogs on nutrition, cardiac testing, quackery, and other things worthy of skepticism at The Skeptical Cardiologist, where a version of this post first appeared.Please note: This article was published more than two years ago, so some information may be outdated. If you have questions about your health, always contact a health care professional.
Flu has so far infected more than 6 million Americans this season, and winter colds are making their rounds. If you've been hit by either, you may be thinking about heading to your local pharmacy to relieve your aches, pains and congestion.
People with uncontrolled high blood pressureor disease should avoid taking oral decongestants, said Sondra DePalma, a physician assistant at the PinnacleHealth CardioVascular Institute at UPMC Pinnacle in Pennsylvania. And for the general population or someone with low cardiovascular risk, they should use them with the guidance of a health care provider.
Theraflu Nighttime Severe Cold And Cough Medicine
DePalma co-authored guidelines released in 2017 by the American Association and American College of Cardiology focusing on the management of high blood pressure in adults. Both decongestants and non-steroidal anti-inflammatories (NSAIDs), found in many cold medicines, were listed as medications that could increase blood pressure.
Decongestants – like pseudoephedrine or phenylephrine – constrict blood vessels. They allow less fluid into your sinuses, which dries you up, said Dr. Erin Michos, associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Disease in Baltimore.
But if you have high blood pressure or disease, the last thing you need is constricting blood vessels, she said. It can exacerbate or worsen the condition.
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The biggest concerns are for people who have had a attack or stroke, or have failure or uncontrolled high blood pressure, Michos said.
Looked at nearly 10, 000 people with respiratory infections who were hospitalized for attacks. Participants were 72 years old on average at the time of their attacks and many had cardiovascular risk factors, such as diabetes and high blood pressure. Researchers found that people who used NSAIDs while sick were more than three times as likely to have a attack within a week compared with the same time period about a year earlier when participants were neither sick nor taking an NSAID.
Merely having a cold or the flu strains the cardiovascular system. Fighting the illness raises the rate and causes inflammation. Meanwhile, NSAIDs – which carry a warning label about the increased risk for a attack or stroke – can cause problems by reducing the amount of sodium excreted through the urine, which increases fluid retention and raises blood pressure, DePalma said.
Cold Relief For People With High Blood Pressure
NSAIDs can be especially risky for people with disease or failure, Michos added. People who are sick should use both classes of medications – decongestants and NSAIDs – judiciously and understand the potential side effects.
For decongestants, blood pressure guidelines suggest using them for the shortest duration possible or using an alternative such as nasal saline or antihistamines to help with congestion. Decongestants shouldn't be taken longer than seven days before consulting with a health care provider, DePalma said.
NSAIDs taken as pills should be avoided when possible to avoid affecting blood pressure, guidelines advise. Rather, topical NSAIDs and acetaminophen are recommended alternatives.
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There are effective therapies that are less risky and definitely should be tried first, DePalma said. If other over-the-counter medications are needed, use them cautiously. And if someone finds they are having problems like high blood pressure or other things like palpitations, they should talk with their health care provider.
If symptoms are mild or moderate, rest and drink plenty of fluids, Michos said. Preventing dehydration should help reduce body aches, clear mucous and may reduce the need for decongestants.
To help avoid getting sick in the first place, Michos recommends frequent hand-washing and lots of sleep, especially during cold and flu season. The Centers for Disease Control and Prevention recommends an annual flu vaccine for everyone 6 months and older, and the pneumonia vaccine for children under 2 and adults 65 and older.
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