Choosing Cold Medicines and Using Them Safely

When it comes to available treatments, you're certainly not at a loss for options when it comes to cold medicines. Various widely available drugs can ease a variety of cold symptoms. While it's easy to pick up a cold medication at a drugstore or supermarket, depending on your overall health, you may need to avoid certain ingredients. In addition, you should keep dosing considerations in mind to ensure you're using these products as safely as possible.

Common cold medicines include:

• Decongestants (e.g., pseudoephedrine, phenylephrine)
• Cough suppressants (e.g., dextromethorphan)
• Expectorants (e.g., guaifenesin)
• Pain relievers (e.g., ibuprofen, acetaminophen, aspirin)

Each of these drugs carries its own risks, so it's important for you to understand what they are and how to safely use them.

Consider Your Health

Many chronic health conditions can impact what type of medicine you can take, and that includes over-the-counter cold medicines.

Some of these conditions include:

• Heart disease
• High blood pressure
• Glaucoma
• Diabetes
• Enlarged prostate gland
• Thyroid disease
• Asthma
• Emphysema
• Chronic bronchitis
• Kidney problems
• Liver problems
• Phenylketonuria (as some formulations may contain aspartame)

If you have one of these, or any chronic condition, talk to your healthcare provider about which medicines are safe to take and which are not. It's worth having this discussion before you are sick so you can make an educated choice if you find yourself in the market for cold medication, say, after-hours.

Pregnancy

Pregnancy can greatly limit what medicines you can take, and it's especially important to know what's safe because pregnant women tend to get sick more easily.

Most ob-gyns have lists of approved over-the-counter medicines you can take during pregnancy. If you don't have one or haven't asked your healthcare provider yet, you get general information from the U.S. Food and Drug Administration's website.

Keep in mind that if you are pregnant and are on other medications, have a pre-existing condition, or are considered high-risk, medications that are usually safe during pregnancy may not be safe for you and your baby. Your healthcare provider is always the best source of information on what's right for you.

Take Inventory of Your Medications

It's also worth having a conversation with your pharmacist, who can check for any potential interactions with other medications you are on and determine whether taking a cold medication in addition to other drugs you're on might cause you to exceed maximum dosages of a particular drug.

Interactions

Combining certain drugs can introduce or increase the risk of side effects.

For example, dextromethorphan may interact with selective serotonin reuptake inhibitor, or SSRI, antidepressants, resulting in serotonin syndrome (a potentially life-threatening condition). Pseudoephedrine may also interact with serotonin-norepinephrine reuptake inhibitors, or SNRIs, causing high blood pressure or a fast heartbeat. In addition, pseudoephedrine, phenylephrine, and dextromethorphan are all stimulants and may interact with MAO inhibitors, or MAOIs, a class of drugs that is rarely used to treat depression. When in doubt, check with your healthcare provider or pharmacist.

Accidental Overdosing

Aside from possible interactions between medications, it is possible to overdose on an active ingredient unintentionally when taking more than one cold product or using one in addition to medications used for other purposes, such as back pain.

Concerns include:

• Taking too much of a drug because you don't realize it's in more than just one medication
• Complications from taking more than one drug in a class

Many combination products include a pain reliever/fever reducer. The most common one is acetaminophen, which is the active ingredient in Tylenol—as well as a staggering 600-plus other medications (both prescription and over-the-counter).

Too much acetaminophen can cause liver damage or liver failure and could be fatal. In fact, acetaminophen causes nearly 500 deaths, 50,000 emergency room visits, and 10,000 hospitalizations in the United States each year. It's one of the most common reasons children are seen for poisoning in the emergency room.

Read all labels carefully to make sure you're not unknowingly doubling or tripling up on this (or any other) drug.

Safe Use

Read the package directions and don't take more than the recommended amount of any cold or flu medicine (or any medicine, for that matter).

To avoid taking too much of any drug:

• Make sure you're reading and comparing labels for the active ingredients in each medicine you take.
• Don't take two medications that contain the same ingredient at the same time.
• Be cautious if taking two medications from the same category (for example, two pain relievers) at the same time. When in doubt, always check with your healthcare provider or pharmacist, and take the lowest dose required to relieve your symptoms.
• When giving medicine to your children, write down the time and dose. Make sure other caregivers are aware of what you're doing.
• If you're not sure whether ingredients are the same, or in the same category, talk to a pharmacist. They're the top experts on drugs and their interactions. 

Intentional Abuse

Intentional abuse of cold medicines as recreational drugs is a very real problem, so it's important to be aware of whether they're in your home and who could have access to them.

Some of the intentionally abused ingredients in these medications are:

• Dextromethorphan (a cough suppressant)
• Pseudoephedrine (a decongestant)
• Codeine (a potentially addictive ingredient in some prescription-only cough syrups)

These medications can be very dangerous when taken in higher than recommended doses. They are considered safe, however, when used as directed.

If you have a prescription or over-the-counter cold and flu medication in your home that you no longer need, try to find a drug take-back site in your local community. If one is not available, then you should discard it in your trash at home after mixing the medication with dirt, cat litter, or used coffee grounds and sealing the mixture in a plastic bag. Saving it for next time only increases the risk that someone could use it inappropriately.