Over-the-counter drugs are medications that you don’t need a prescription to buy. By governmental regulation, they must be relatively safe to use in the recommended doses. They are intended for short-term use (no more than a couple weeks) as symptomatic relief only (they cannot claim to “cure”).

The difficulty with over-the-counter drugs is knowing when to take them and for what. Advertising has a big impact on our drug use and can be misleading. For example, the efficacy of many over-the-counter drugs hasn’t been properly tested. Sometimes a drug that you think is helping you, provides nothing more than the placebo effect. It’s important to familiarize yourself with the drugs that are available to you and what they actually do, as opposed to what the manufacturer claims.

In this post, I’ll focus on over-the-counter cold preparations. The added difficulty with cold medications is that they tend to be mixtures. Manufacturers will combine multiple drugs together to guarantee that the preparation has some effect. But if you only need one particular component of a preparation, do you really want to be simultaneously taking a bunch of other drugs that you don’t need? Probably not! Instead, it’s a good idea to familiarize yourself with the common ingredients of cold preparations and pick one that addresses only the symptoms you need.

So what do cold preparations contain…

Antitussives

Antitussives suppress coughing. The common ones are codeine and dextromethorphan, which take their action in the brain’s coughing centre.

It’s important to realize however, that since codeine is associated with dependency/addiction, it is highly regulated. The actual amount of codeine allowed in an over-the-counter preparation is far too small to have any effect! Dextromethorphan doesn’t have the same dependency association, so it can be included in slightly higher amounts, but studies have shown that even the amount of Dextromethorphan in over-the-counter drugs is not high enough to have any antitussive effect. 

As such, the recommendation from physicians is usually to avoid antitussives. They really aren’t effective, and furthermore it should be a clinical decision whether to suppress a cough or not – sometimes a productive cough is valuable.

Expectorants

These are the opposite of antitussives – they supposedly encourage a productive cough. Unfortunately, there is no data to suggest that they have any effect at all. Hard to believe, but it’s true. A good steaming, on the other hand, will effectively loosen up your cough! So try to stay away from expectorants, and go the old-fashioned (but effective) way.

Decongestants

Decongestants cause constriction of blood vessels, reducing blood flow and swelling to places like the lining of the nose and the throat. The problem, is that they also take effect in the rest of the body! Now, you’re probably not likely to experience any adverse effects from that, but if you already have high blood pressure then taking a decongestant will only be contributory to your hypertension. Certainly decongestants are not recommended for children because there have been paediatric deaths associated with them.

An interesting phenomenon that I was just reading about is one called “rebound congestion”. The idea is that after taking a decongestant for too long (5-7 days), the nasal arteries will adapt and increase blood flow to the nose to compensate. The result is that when you stop taking the drug, you get all congested again when you wouldn’t have otherwise. People usually then put themselves back on the decongestant, thus worsening their problem.

Because of all these potential difficulties, using a decongestant should be reserved for when you really need it. And in those cases, find a preparation that is only a decongestant and not a mixture. Finally, don’t take it for too long.

Analgesics / Antipyretics

Analgesics are for pain, and antipyretics temper a fever. Finally, these are the ingredients of cold preparations that really work!! Some examples are Acetylsalicylic acid (Aspirin), Acetaminophen (Tylenol), and Ibuprofen (Advil). Each of these are sold within cold preparation mixtures, and individually. Now if they are the only truly active ingredient in a cold mixture, then why not just take them individually? And indeed, that is the recommendation by most physicians. When you have a cold associated with pain or a fever, certainly you will probably feel better by taking Advil or Tylenol (these are better options than Aspirin, because Aspirin is an acid and could cause an upset stomach).

Throat Lozenges

Throat lozenges contain an antiseptic that supposedly attacks any bacteria in your mouth and pharynx. However, as you swallow, the contact time between an antiseptic and the bacteria is far too short to have any appreciable effect. If anything, lozenges might be perceived as effective simply because they increase your salivary secretions which then coat the lining of your throat. You’d get the same effect by sucking on your favourite hard-boiled candy.

Cough/Cold Attack Plan:

So, after reviewing all of those ingredients, how should you use over-the-counter drugs the next time that you have a cold?

1. In general, avoid mixtures!! Most of the ingredients lack efficacy, and you can be much more targeted in your approach by selecting the individual drugs that you need.
2. If you’ve got pain or a fever, take Advil or Tylenol. These have proven efficacy, and are safe to use if the dose recommendations are followed. It’s important to remind people to keep Tylenol well out of reach from children, since Acetaminophen is the most common drug-poisoning seen in the ERs!
3. Steaming works much better to loosen your cough than any expectorant.
4. Use decongestants reservedly.
5. Suck a candy to reduce throat-soreness. Antiseptic-containing lozenges are unlikely to be any better.
6. Chicken soup!!! Most cold preparations are effective through the placebo effect alone. You can accomplish the very same placebo effect by making up a nice warm bowl of chicken soup, and convincing yourself that it will make you feel better !