Dangers of Over The Counter (OTC) Cough and Cold Medicines

Jan. 3, 2011 - PRLog -- Most cold and cough preparations contain sympathomimetic decongestants (i.e. pseudoephedrine, phenylephrine, phenypropanolamine), and pain relievers (i.e. acetaminophen, ibuprofen). Many contain sedating antihistamines (i.e. diphenhydramine, chlorpheniramine, doxylamine), dextromethorphan, and/or guaifenesin.

Adverse effects occur in young children, particularly associated with the decongestant component, but also dextromethorphan and the sedating antihistamines. This has prompted the U.S. FDA to recommend that Over-the-Counter (OTC) cough and cold products not be used for infants and children under 2 years of age because “serious and potentially life-threatening side effects can occur”.

FDA has not completed safety review of OTC cough and cold medicines in children 2 through 11 years of age, but there are reports of serious side effects including death from these preparations in this age group.  Also, according to the American Academy of Pediatrics, “several studies show that cold and cough products don't work in children younger than 6 years and can have potentially serious side effects”.

Decongestants, Sedating antihistamines, and Dextromethorphan also have significant adverse effects and contraindications in adults. Decongestants constrict blood vessels and exert effects on smooth muscle throughout the body, as well as, directly stimulate the heart. Therefore, they are not recommended for people with heart disease, high blood pressure, glaucoma, thyroid disease, urinary retention problems, or certain people with asthma or diabetes.

Common side effects may include nervousness and palpitations (rapid heart beat), restlessness, excitability, dizziness, drowsiness, headache, nausea, weakness, and trouble sleeping. Patients may also experience increased blood pressure, irregular heartbeat, severe headache, tightness or discomfort in the chest, breathing problems, fear or anxiety, hallucinations, trembling or shaking, seizures, pale skin, or painful or difficult urination.

Decongestants should generally not be taken with the following drugs: (This list is not all inclusive.)

Asthma medicines: Decongestants are more likely to cause breathing problems in patients taking these medicines.
Caffeine: Increase side effects such as difficultly sleeping or restlessness, tachycardia, or arrythmia.
Diet pills: Individuals taking any type of diet pills, including sibutramine (Meridia®), orlistat (Xenical®), phentermine (Adipex-P®), or Ionamin (Fastin®), should not take decongestants.
Insulin: Decongestants may increase blood sugar in people with diabetes. Therefore, patients taking insulin should not take decongestants.
Medicines that lower blood pressure: Decongestants may increase blood pressure and should not be taken with medication that lowers blood pressure.
Monoamine oxidase inhibitors (MAOIs): Decongestants may interact with monoamine oxidase inhibitors (MAOIs) like phenzeline (Nardil®) or tranylcypromine (Parnate®). MAOIs are used to treat conditions like depression and Parkinson's disease. Patients should not take decongestants at the same time as MAOIs or within two weeks of stopping treatment with MAOIs.
Seizure disorder drugs: Decongestants may increase the chance of seizures. Individuals who have a history of seizures or who are taking seizure medications should not take decongestants.

Phenylpropanolamine (PPA), which was used in many products in the past, is now avoided because of possible risk of stroke. Pseudoephedrine, once a common over-the-counter decongestant, is only available behind-the-counter after talking with a pharmacist in many states. This is because there have been an increasing number of reports of people using pseudoephedrine to make illicit methamphetamine.

Adverse effects from sedating antihistamines occur more frequently and with greater consequence (i.e. fall and fracture) in the elderly. The most common are listed:

Drowsiness.
Headache.
Blurred vision.
Constipation.
Dry mouth.
Dizziness.
Difficulty passing urine.
Confusion.

Millions of Americans use Dextromethorphan safely each year to relieve cough symptoms due to the common cold or flu. It is a non-narcotic, non-addictive cough suppressant which raises the coughing threshold in the brain and has no pain relieving properties. However, some teenagers and young adults intentionally abuse large amounts of preparations containing Dextromethorphan to get high.

Adverse effects include dizziness; drowsiness; and stomach upset. Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).

I have described some of the dangers of Over The Counter Cough and Cold Medicines. It is evident from this that they should not be used in children, the elderly, and patients with contraindicating disorders. One wonders if the potential benefit of only temporary symptom relief merits the risk of side effects in anyone.

Certainly, we must be skeptical of marketing claims and not run for the quick fix advocated in TV commercials without considering the potential risk.

We also must read labels and be careful not to overdose on these medications by taking one for one symptom group i.e., "cold" and another for a different symptom group i.e., "flu", only to realize we have taken the same medication(s) twice.

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Tags: cold medicine, cough and cold medicine, cough medicine, otc cold medicines, over the counter

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