House Calls / Dr. Michael Schwartz

As the cold and flu season approaches, many patients purchase over-the-counter medications for relief of their symptoms. Given the vast assortment of products available, selecting the correct over-the-counter medication can be overwhelming. Advertisers are clever at listing the symptoms treated by their company's products; in reality, there are a limited number of unique medications offered simply bearing different names and labels, and sold as individual compounds as well as in combination with other products.

The information below provides the names and a description of the purpose for treatment of the more common cold medications sold over-the-counter:

Antihistamines -- sedating (e.g., chlopheniramine, Benadryl, diphenhydramine, doxylamine) block the effects of histamines in the body which are responsible for allergy symptoms. In general, these medications are used to treat a runny nose, sneezing and itching. Side effects include fatigue, dry mouth and difficulty with urination.

Antihistamines -- non-sedating (e.g., Claritin, Zyrtec) also block the effects of histamine, but tend to cause less fatigue and somnolence.

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Ibuprofen (e.g., Advil, Motrin) is an anti-inflammatory medication. This medication can be used to treat fevers, body aches or a sore throat. Patients with a history of stomach ulcers, kidney problems or high blood pressure need to be cautious using these medications.

Acetaminophen (e.g., Tylenol) is pain medication and fever reducer. Overuse of this medication can cause liver damage.

Guaifenesin (e.g., Muccinex, Robitussin) is an expectorant which helps remove phlegm or sputum from the lungs. Side effects may include nausea, vomiting and dryness.

Pseudoephedrine (e.g., Sudafed) is a stimulant which is used as a nasal decongestant. Side effects include insomnia, nervousness, dizziness, elevation of blood pressure and a rapid heartbeat.

Phenylephrine (e.g., Sudafed-PE) is also used as a decongestant although it works differently from pseudoephedrine. Most common side effects include headache and high blood pressure.

Dextromethorphan (e.g., Delsym) is a cough suppressant. The most common side effects include fatigue, dizziness and rash.

Manufacturers have become creative in their ability to combine many of these medications in order to promote new cold products. Combinations of various cold remedies often contain a pain reliever, a fever reducer, a cough suppressant and an expectorant. In addition, some may also often include either a decongestant and/or an antihistamine in order to dry the mucous produced by the body. For many patients, deciding which cold product to purchase is difficult.

While perusing the aisles of your local drug store you will see the words, "maximum strength," "cold and flu formula," "cold and sinus relief," "daytime," "nighttime," "DM and CF," "severe cold" or "cough-relief." Always review the ingredients of each product carefully in order to insure that you are taking a medication which will be useful for your symptoms and not contraindicated for any other chronic medical condition you may have. Furthermore, some patients may already be taking medications which inappropriately interact with these over-the-counter compounds. Be cautious -- it is common for patients to mistakenly take several cold medicines at the same time which frequently contain the same medications. This is not just a waste of money on products but more importantly, such dosages can increase the risk for an adverse side effect or interaction.

Also, remember to shop for generics to save money. Brand names are not always better when purchasing a cold medication. Most of these medications are offered in generic formulations. Compare labels. Many brand and generic products will read identically, e.g., "ibuprofen 200 mg."

Be aware that medications containing pseudoephedrine are kept behind the pharmacy counter and require a driver's license in order to purchase. This is the result of some individuals using the drug to create an amphetamine ("speed") for a drug of abuse. Therefore the government mandates the monitoring of sales of these products.

Finally, if your symptoms last for more than a few days, make sure to visit your doctor. You may require additional treatment such as antibiotics or flu medications. The choices are not always clear, so read the labels carefully and ask your pharmacist for assistance.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at