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How to select cold medicines part five: expectorants

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Patients often consult your Intrepid Pharmacist over troubles with stuff in their lungs they are trying to get rid of. The “stuff” or “Crud” as it is often called is mucus or phlegm being produced by the body as it tries to get rid of what it attacking it.

As a reminder to the reader, the five drug areas examined this series are:

Antihistamines: take one of these many flavors if you have a runny nose that needs drying up, itchy watery, eyes, sneezing, etc. or a rash or poison ivy/oak/sumac. It can also help you sleep.

Cough Suppressant: take this for a mild cough

Decongestant: does just what it says and opens up and drains the sinus (so your nose will run).

Expectorant: helps loosen “Crud” (e.g. mucus) in the chest so you can cough it up.

Pain and Fever: antipyretic (fancy med-speak for “lowers your fever”) and anti-inflammatory drugs do just what they say, but which one do you need and where all are they found??

When do you need an expectorant? An expectorant helps loosen up a congested chest so that mucus in the chest can be cough up and (preferably) spit out (as opposed to swallowed—ewwww). As with cough suppressants, there only one expectorant and it is called guaifenasin. That’s “goo-y-fin-uh-sin” for those of you wanting to impress friends with pronouncing multisyllabic chemical names. For those not wishing to make such an impress, well, you know anyway. Drinking plenty of water—not coffee or soda—is important, so drink it and stay well hydrated. Your Intrepid Pharmacist has seen a number of physicians recommend this drug to patients unable to take pseudoephedrine (see part four) but needing to decongest their sinuses. The success rate has been variable.

Rules of Purchase: Obviously this is a medication you want to use if your chest is tight and you have stuff that needs coughing up. If you try guaifenasin in one product, though, and do not attain any relief do not go buy a different product; it will not work any better than the first one. Do not let the pretty boxes and colorful marketing mislead you. You can obtain guaifenasin as a standalone medication (Mucinex (blue box) or plain Robitussin (no letter or the like after the name)or your store’s on version of it (and yes it is the same chemical in both a brand product and a store brand)). Most often, however, patients take this drug as part of a multi-symptom product, or what your Intrepid Pharmacist likes to call the mix-and match products, since that is what the manufacturers do to create the illusion of lots of medications when there are really only a limited set of drugs they are working with.

Muti-Symptom Medications: Frequently you will find the expectorant paired with a cough suppressant (see part three) in things like Mucinex DM (pill form) and Robitussin DM (liquid form). Again do not let the pretty colors and different dose forms mislead you! Turn the boxes and bottles over and read the Active Ingredients list! The drugs in both these products are similar or the same. Manufacturers have merely taken the limited list of cold, allergy and pain medications and mixed and matched them and repackaged them in different ways. This rule is especially important on multi-symptom, mix and match cold, allergy and flu medications (NyQuil, Theraflu, etc.). Your Intrepid Pharmacist emphasizes this point so much because he is amazed how many people come to him who succumb to the marketing and pretty colors and never look at the Active Ingredient list to see the same drugs in both the products they are holding. Remember, buying OTC medications is like buying milk in pretty boxes! It’s all milk, you just have to read the label and see what kind of milk it is.

Cautions and Side Effects: With so many other cough, cold and allergy medications having side effects ranging from sedation to stimulation, guaifenasin is a refreshing change of pace. It is perhaps the only drug that has no serious reported side effects, drug interactions or disease state interactions.

Pregnancy: and Children: Guaifenasin is rated a Pregnancy Category “C”, which is more or less the pregnancy default category. It means no real data exists saying it is good to use, nor has any come out to show it is dangerous to use. Your Intrepid Pharmacist frequently sees this on OB lists “OK to Use” lists. That said, you Intrepid Pharmacist recommends you consult with your OB or physician handling your pregnancy.

As for children, guaifenasin is used in children and small children. As with other medications you will not find listings for under age two; your pediatrician will need to determine need and dose the medication for the child’s body weight.

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