The Common Cold (OTC Treatment)

Colds

      • Pediatrics may refers to people up to the age of 21
        • OTC pediatric use often deals with children under 12
          • Generally speaking:  OTC cough & cold products should NOT be used for children under 2 years of age
            • Recommend non-drug measures in kids under 4 years of age
      • Don’t use antihistamines just to make kids tired
      • Clinical presentation of Cold:  muscle aches, clear snot followed by thick yellow-green snot, cough, headache, low-grade fever, sneezing
      • Common cold is most commonly caused by a rhinovirus (viral infection) of the upper respiratory tract, colds are usually self-limiting (go away in 1-2 weeks)
        • The goal of treating a cold is to relieve symptoms and prevent transmission
      • Phenylephrine is the only decongestant used both orally & nasal
      • Generally speaking there is not significant evidence to show that cough medicines are legitimate
      • Decongestants cause vasoconstriction in the nasal passages (may also cause systemic vasoconstriction thus increasing heart rate and blood pressure
        • With controlled hypertension it’s generally OK to use with PSE
        • Decongestants are used for congestion, stuffy nose & post-nasal drip
      • Drug interactions w/ decongestants: MAOIs, sympathomimetics, methyldopa, antihypertensives/antiarrhythmics, tricyclics
      • At risk populations:  diabetes, pregnancy category C, coronary artery disease, hypertension, glaucoma, prostate disease, hyperthyroidism
        • Topical nasal decongestants cause less systemic effects & a better choice for at risk populations
      • Almost all topical nasal decongestants should be used for no longer than 3 days
        • Topical decongestants are more likely to cause rebound congestion when administered longer than 3-5 days
          • Most common with short acting topical decongestants
            • Short acting:
              • Phenylephrine  (ex. Neo-synephrine, Vicks sinex)
                • 2-3 sprays q 4 hours
              • Benzedrex:  ages 6 & up
                • 2 inhalations in each nostril q 2 hours, don’t use for more than 3 days
              • Levmetamfetamine (Vicks Vapor inhaler)–don’t use for more than 3 days
                • Ages 6-12:  1 spray in each nostril q 2 h
                • Ages 12 & up: 2 sprays in each nostril q 2 H
            • Long acting:  oxymetazoline (ex. Zicam, afrin, vicks sinex, mucinex)
              • 2-3 sprays q 12 hours
                • Long acting are more likely to have systemic side-effects
      • Antihistamines stop the degranulation of mast cells, but they don’t effect histamine that’s already released
        • Antihistamines have antimuscarinic side effects: can’t see, can’t spit, can’t pee, can’t shit
          • Diphenhydramine can also be used as a cough suppressant (antitussive)
        • Antihistamines are category B
          • Use non-sedating (2nd gen) antihistamines for pregnant women in 2nd trimester
      • There is a concern about antihistamines (especially 1st gen) entering breast milk & also causing a reduction of breast milk
      • Camphor/menthol are the only agents that act in the lung
        • However they (in particular camphor) can be toxic when given orally
        • Pregnant women are at risk
      • Antitussives: used for a cough related to bronchial or throat irritation or for a nighttime cough
      • Expectorants: used for chest congestion & nonproductive coughs
      • Consider the cost & appropriate dosing schedules of combination products when deciding whether or not to use them, especially for kids
      • Saline nasal drops help to dilute the mucosa (liquefy thick nasal discharges)
      • Squeeze bulb:  -Insert tip ¼ to ½ inch into one nostril,  -Release bulb slowly, -Empty stuff , -Repeat in other nostril, -Clean bulb with water and soap after each  use,  -Petroleum jelly may be applied to skin around nostrils to protect it
      • Humidifiers are used relieve nasal congestion & cough
      • Cool mist disperses the greatest amount of microorganisms & minerals in the air  (so make sure to use distilled water)
        • Cool mist humidifiers are preferred though over steam vaporizers b/c steam vaporizers are more likely to burn kids
        • Need to replace water daily
      • Vick’s VapoRub contains camphor which helps to relieve cough in kids over one year old
        • Don’t recommend for kids under one year due to risk of botulism
      • Andographis is a nutraceutical used for the prevention and treatment for different symptoms of the common cold & pharyngotonsilitis
        • Stimulates the immune system & stabilizes mast cells leading to anti-allergy activity
        • Higher the dose the greater the amount of side effects (unique)
        • In adults it’s used 400mg TID, unsafe in pregnancy (may induce abortions)
        • Possibly safe in kids
      • Echinacea is a nutraceutical used for the treatment of the common cold via boosting the immune system
        • Possibly safe in short term treatment for children  (also associated with rash though)
        • Antiviral & immune stimulatory effects
      • English ivy has expectorant and antispasmodic activity
      • North American Ginseng Extract:  possibly effective in upper respiratory tract infections, improves immune system
        • Well tolerated, may have additive effect when used with other stimulants
        • Must use for several months
      • Airborne: 7 herbal extracts & vitamin C
      • UMCKA: PSE & chlophendianol (cough suppressant) used for cough & nasal decongestion
      • Always want to recommend: rest, fluid intake, nutrition, prevent exposure to smoke, hygiene, prevent spreading
        • Don’t give kids adult medicines, only using measuring devices used to measure medicines, cough & cold medicines only treat symptoms
      • Guaifenesin:  thins and loosens mucus
        • Only used for people over the age of 12
        • Take 1-2 tablets Q12 hours  (max of 4 ts/24 hours)
      • Demulcents (Halls Breeze, Ludens): reduce pain & irritation associated with dry cough
      • Throat lozenges:
        • Cepacol, chloraseptic– (contain benzocaine & menthol)  for ppl over the age of 5
          • Throat strips also commonly contain benzocaine & menthol
        • Sucrets– (dyxlonine & menthol) for kids over 2 years old
      • Throat sprays typically contain phenol &/or glycerin
      • Local sore throat therapies are preferred over systemic pain medications
      • Vitamin C: unknown mechanism of action, but listed as possibly effective against cold
        • Antioxidant and maintains proper immune function
        • Problem with: patients with a history of oxalate kidney stones, & cancer patients
        • For treating cold: 1-3g/daily
        • For preventing cold: 600-1000mg
      • Cole-Eeze contains Zn
        • Must take within the first 48 hours
        • Rated as possibly effective, promotes the development & activation of T lymphocytes to help promote the strengthening of the immune system
        • Don’t eat or drink citrus fruits or juices a half-hour before or after taking Cole-Eeze
        • May cause an upset stomach & unpleasant aftertaste
      • Astragalus: improves immune response at multiple sites (could potentially be a problem in immunocompromised patients)
        • Used for prevention of common cold
        • 4-7 grams/day

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