Cold Preparations

Aka: Cold Preparations, Combination Cold and Sinus Preparations, Cough and Cold Medications

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II. Efficacy: Cold Preparations and their safety

  1. Sedating side effects may be only benefit
  2. No advantage compared with Placebo for Common Cold
    1. Study of 59 Preschool Children with URI
    2. Clemens (1997) J Pediatr 130:463-6 [PubMed]
  3. Cold medication components have serious adverse effects
    1. Pseudophedrine may cause Seizures in children
    2. Sedating Antihistamines have Anticholinergic effects
    3. Dextromethorphan may cause serious CNS depression
    4. Phenylpropanolamine (e.g. Dimetapp) was withdrawn from U.S. market due to Hemorrhagic Strokes
    5. Risk of accidental Overdose (e.g. Acetaminophen when in multiple combination products)
    6. Gunn (2001) Pediatrics 108:E52 [PubMed]
  4. OTC Cold Preparations lack of efficacy and risk of harm (editorial note by Scott Moses, MD)
    1. Greatest benefit appears to be to the manufacturer and reseller at the expense of the confused, acutely ill consumer
    2. Pharmacy aisles are filled with every possible combination and permutation of products with confusing naming
      1. "Cold and Sinus" concoctions may contain Naproxen or Acetaminophen, a Decongestant or Antihistamine or both
      2. In addition to cost, side effects and lack of efficacy, there is the risk of significant harm (e.g. Acetaminophen Overdose)

III. Preparations: Effective Cold Preparations

  1. Acetaminophen or Ibuprofen for fever, myalgias
  2. Nasal Saline used frequently
  3. Intranasal Decongestants
    1. Limit to no more than 3 days (for congestion refractory to Nasal Saline)
    2. Avoid Oxymetazoline (afrin) in children (Intranasal Phenylephrine, neosynephrine is safe)
  4. See Cough Symptomatic Treatment (or Cough Suppressant, Cough Expectorant)
  5. See Sore Throat Symptomatic Treatment
  6. Supplements
    1. Honey (Cough Suppression in age >1 year)
    2. Other agents with weak evidence or mixed results
      1. Echinacea for Common Cold
        1. Risk of ragweed-tyoe reaction
      2. Zinc Lozenges for Common Cold
        1. May have benefit if used every 2 hours while awak and started in first 24-48 hours of illness
      3. Elderberry for Influenza
        1. Very high dose at 22 g/day may have benefit if started with 48 hours
    3. Agents with no benefit in Common Cold
      1. Vitamin C

IV. Preparations: Combinations - Antihistamine-Decongestant (not recommended)

  1. Rarely indicated except possibly in the Chronic Cough evaluation as an empiric trial
  2. Sedating Antihistamine with Decongestant
    1. Actifed Cold and Allergy (Chlorpheniramine and Phenylephrine)
    2. Benadryl-D (Diphenhydramine and Phenylephrine)
    3. Dimetapp Cold and Allergy (Brompheniramine and Phenylephrine)
    4. Triaminic Cold and Allergy (Chlorpheniramine and Phenylephrine)
  3. Non-Sedating Antihistamine with Decongestant
    1. Allegra-D (Fexofenadine with pseudophedrine)
    2. Claritin-D (Loratadine with pseudophedrine)
    3. Zyrtec-D (Cetirizine and Pseudoephedrine)

V. Management

  1. See Sore Throat Symptomatic Treatment
  2. See Cough Symptomatic Treatment
  3. See Upper Respiratory Infection
  4. Maintain oral hydration
  5. Analgesics as needed for fever and pain
  6. Cool mist humidifiers
  7. Nasal Saline

VI. Prevention

  1. Influenza Vaccine
  2. Covid Vaccine
  3. Hand Washing
  4. Masking as needed

VII. References

  1. (2020) Presc Lett 27(1): 2-3
  2. (2022) Presc Lett 29(12): 67-8

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