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How to select cold medicines part one: the overview

Mix and match marketing often leaves patients wondering what cold and allergy medicine they need
Mix and match marketing often leaves patients wondering what cold and allergy medicine they need

Your Intrepid Pharmacist has been meaning to do a series about cold and allergy medications. We are heading into cold and flu season, and already Tennesseans call or come by the Consultation Window to ask your Intrepid Pharmacist what medications they need for stuffy heads, runny noses and other achy cold-related inconveniences. So, now seems like a good time for some clarification and patient education. The problem with “the crud,” as it keeps being called, is that patients coming into the pharmacy (or calling for help) are overwhelmed by the myriad of treatment choices and ads on television for “new” OTC medications that are not really new, just a reformulation or different combination of the same drugs or a different dose form (melting strip versus tablet) of what is already out there.

For those who just want the quick read without the necessary details, your Intrepid Pharmacist has provided a summary below of the primary drug type/uses that will appear in each subsequent column. That said, he cautions you not to prove Gene Hackman’s assertion in The Birdcage that “Americans don’t read details. They don’t even trust details. They read headlines!” as the details here are important. So take the time to read each column in the series. And above all, before commencing your Robotrip (your Intrepid Pharmacist looks sharply in the direction of the teen age readers), do not buy into the fable that just because something is over-the-counter (OTC) rather than "prescription only" it is somehow safer than a prescription medication. This is absolutely not true.

The five drug areas we will be examining over the next several columns 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 and where are they found?

Today’s column looks at the “what drug(s) do I need?” question in the big picture sense. “What drug(s) do I need?” is also the question your Intrepid Pharmacist is asked a couple dozen times a day. And the seemingly overwhelming task of picking the right medication from the imposing wall of drugs in eye-catching pretty colored boxes is easy if you remember three basic rules:

Rule #1: There are a limited number of FDA approved OTC drugs. All manufacturers are stuck with the same limited number of drugs and the same maximum strength doses of those drugs. Thus, everything is mixed and matched by various manufacturers the way women mix and match their wardrobe. Your Intrepid Pharmacist is not being sexist here. When it comes to taking a limited wardrobe and making it seem three times larger than what it is, women cannot be beaten for their mix and match expertise. The same may be said of drug makers about OTC cold and allergy medications.

Rule #2: Be skeptical about advertising. Why is that people know they should be skeptical about adverts but then still allow it to cloud and confuse their thinking? Here’s a quick example: Tylenol PM versus Advil PM, which are marketed to help you sleep. What’s the real difference between them? One has Tylenol (an anti-fever and pain medication) and the other has Advil (ibuprophen), an anti-imflammatory. But as for the actual active ingredient that causes the drowsiness? Well, that is the antihistamine diphenhydramine (better known by its brand name Benadryl). And it is in both “PM” medications.

Rule #3: Chemical structure is an exact science. Something either is the molecule or it is not, and there is no sliding scale of quality as with clothing and televisions. If you change one atom of a molecule it is now a different molecule and a different drug. Get the version of what you need that is on sale that day.

Your Intrepid Pharmacist tells his patients to think of it as buying milk in really pretty boxes—you just have to turn the box over to see what kind of milk it is. Come back and reread this opening column after finishing this series and it will all come together nicely. Now, on to the milk!!!

There are essentially five types of “milk” in those pretty boxes: antihistamines, a cough suppressant, an expectorant, decongestants, and pain relievers. Each type of “milk” may be mixed with others in a combination package, which usually produces the most confusion among patients. Many patients are also confused about which medication (or “milk” for our metaphor) has what effect when you take it. To clear things up your Intrepid Pharmacist is providing a look at of what each type of “milk” is, what it does, and if there are other flavors of that particular “milk.” He will also be providing some helpful information on appropriate use in children. Be prepared for a few surprises along the way.



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