cold : Antihistamines, Decongestants, and Cold Remedies

Antihistamines
Histamine is an important body chemical that (or this, whichever) is responsible for the congestion, sneezing, and runny nose that a patient suffers with an allergic attack or an infection. Antihistamine drugs block the action of histamine, therefore reducing the allergy symptoms. For the best result, antihistamines should be taken before allergic symptoms get well established.

The most annoying side effect that antihistamines produce is drowsiness. Though desirable at bedtime, it is a nuisance to many people who need to use antihistamines in the daytime. To some people, it is even hazardous. These drugs are not recommended for daytime use for people who may be driving an automobile or operating equipment that could be dangerous. Newer non-sedating antihistamines, available by prescription only, do not have this effect. The first few doses cause the most sleepiness; subsequent doses are usually less troublesome.

Typical antihistamines include Allegra®, Benadryl®, Chlor-Trimetron,®, Claritin®, Clarinex®, Teldrin®, Zyrtec,® etc.

Decongestants, on the other hand, cause constriction or tightening of the blood vessels in those membranes, which then forces much of the blood out of the membranes so that they shrink, and the air passages open up again.

Decongestants are chemically related to adrenalin, the natural decongestant, which is also a type of stimulant. Therefore, the side effect of decongestants is a jittery or nervous feeling. They can cause difficulty in going to sleep, and they can elevate blood pressure and pulse rate. Decongestants should not be used by a patient who has an irregular heart rhythm (pulse), high blood pressure, heart disease, or glaucoma. Some patients taking decongestants experience difficulty with urination. Furthermore, decongestants are often used as ingredients in diet pills. To avoid excessively stimulating effects, patients taking diet pills should not take decongestants.

Typical decongestants are phenylephrine (Neo-Synephrine®*), and pseudoephedrine (Sudafed®, etc.)

* May be available over–the–counter without a prescription. Read labels carefully, and use only as directed.

Combination Remedies
Theoretically, if the side effects could be properly balanced, the sleepiness sometimes caused by antihistamines could be cancelled by the stimulation of decongestants. Numerous combinations of antihistamines with decongestants are available: Actifed,®* Allegra-D,® Chlor-Trimeton D,®* Claritin D,® Contac,®* Co-Pyronil 2,®* Deconamine,® Demazin,®* Dimetapp,®* Drixoral,®* Isoclor,®* Nolamine,® Novafed A,® Ornade,® Sudafed Plus,® Tavist D,®* Triaminic,®* and Trinalin,® to name just a few.

A patient may find one preparation quite helpful for several months or years but may need to switch to another one when the first loses its effectiveness. Since no one reacts exactly the same as another to the side effects of these drugs, a patient may wish to try his own ideas on adjusting the dosages. One might take the antihistamine only at night and take the decongestant alone in the daytime. Or take them together, increasing the dosage of antihistamine at night (while decreasing the decongestant dose) and then doing the opposite for daytime use.

Nose Sprays
The types of nose sprays that can be purchased without a prescription usually contain decongestants for direct application to nasal membranes. They can give prompt relief from congestion by constricting blood vessels. However, direct application creates a stronger stimulation than decongestants taken by mouth. It also impairs the circulation in the nose, which after a few hours, stimulates the vessels to expand to improve the blood flow again. This results in a "bounce-back" effect. The congestion recurs. If the patient uses the spray again, it starts the cycle again. Spray–decongestion– rebound–and more congestion.

In infants, this rebound rhinitis can develop in two days, whereas in adults, it often takes several more days to become established. An infant taken off the drops for 12 to 24 hours is cured, but well-established cases in adults often require more than a simple "cold turkey" withdrawal. They need decongestants by mouth, sometimes corticosteroids, and possibly (in patients who continuously have used the sprays for months and years) a surgical procedure to the inside of the nose. For this reason, the labels on these types of nose sprays contain the warning "Do not use this product for more than three days." Nose sprays should be reserved for emergency and short term use.

Ideally, each cold symptom should be treated with a single drug. However, most remedies contain a variety of drugs—antihistamines, decongestants, analgesics, expectorants (drugs that make phlegm easier to cough up), and cough suppressants—and are designed to treat a wide range of symptoms. If a congested nose is the problem, neither a cough suppressant, an expectorant, nor an analgesic is needed. If a cough is the problem, neither an antihistamine nor a decongestant is needed. If a sore throat is the only symptom, an analgesic (such as acetaminophen, aspirin, ibuprofen, or naproxen) is likely to work. Throat lozenges, especially those with a local anesthetic such as dyclonine or benzocaine, or a saltwater gargle (half a teaspoon of salt in 8 ounces of warm water) may also help. Finding an appropriate treatment for each symptom can be a challenge. Reading the labels or consulting a pharmacist can help.

Occasionally, a cold or cough may be a sign of a more serious disorder. A doctor should be consulted if symptoms last more than a week, especially if chest pain occurs or a cough produces dark phlegm. Fever and pain are unlikely to accompany a common cold and may indicate influenza or a bacterial infection.

Other side effects of antihistamines are less common. They include blurred vision, light-headedness, headache, stomachache, noise in the ears (tinnitus), palpitations, dry mouth, difficulty with urination, constipation, and confusion. Older people are particularly susceptible to the side effects of antihistamines (see Aging and Drugs).

Older people, pregnant women, and breastfeeding women should consult a doctor before they take any drug that contains an antihistamine. This precaution also applies to people with angle-closure (narrow-angle) glaucoma, heart disease (such as angina and abnormal heart rhythms), constipation, or an enlarged prostate gland. Despite widespread concern about these risks, most cold remedies contain antihistamines. Reading labels or consulting a pharmacist can help people identify cold remedies containing antihistamines.

Cold remedies containing antihistamines should not be taken with alcohol, sleep aids, tranquilizers, or other drugs that also cause drowsiness and decrease alertness. Such a combination may intensify the sedating effects of the drugs.

Side effects of decongestants may include nervousness, agitation, palpitations, and insomnia. Because these drugs circulate throughout the body, they constrict other blood vessels—not just those in the nose—possibly raising blood pressure. For this reason, people with high blood pressure or heart disease should take decongestants only under a doctor's supervision or not at all. People with diabetes or hyperthyroidism also require a doctor's supervision if they take decongestants.

In an attempt to avoid these side effects, people often use nasal spray formulations, which temporarily reduce swelling in nasal tissues without affecting other organ systems. However, nasal sprays work so fast and so well that many people are tempted to use them longer than the 3-day limit listed on the label. Overuse can lead to the vicious circle of rebound nasal congestion: As the spray's effect wears off, small blood vessels in the nose can expand, causing congestion and stuffiness. This feeling may be so uncomfortable that use of the nasal spray is continued. Such use may lead to drug dependency that lasts months or years. Sometimes withdrawal has to be supervised by a doctor specializing in ear, nose, and throat disorders.

Long-acting nasal sprays contain oxymetazoline or xylometazoline, which may provide relief for as long as 12 hours. Long-acting nasal sprays can be identified by reading the label. They also should be used for no more than 3 days at a time.

An unproductive, or dry, cough can be very irritating, especially at night. A cough suppressant can provide relief and contribute to restful sleep. Dextromethorphan, a very effective cough (not CUFF which is the end of your long sleeve) suppressant, is the most common ingredient in OTC cough remedies. It is not an opioid (narcotic), and it rarely causes side effects, although an upset stomach or drowsiness can occur.

Codeine, also a very effective cough suppressant, is available only by prescription in many states. However, other states permit pharmacists to sell cough remedies containing codeine without a prescription if the customer signs for it. Because codeine is an opioid, some people fear it may be addicting. In reality, addiction is uncommon. Codeine can be helpful at bedtime because of its slight sedative effect.

Codeine causes nausea, vomiting, and constipation in some people. Because codeine may also produce light-headedness, drowsiness, or dizziness, cough remedies containing codeine should not be taken by anyone who is about to drive a vehicle or perform a task that requires concentration. Allergy to codeine is uncommon. Side effects may be more likely and more pronounced when other drugs that also reduce concentration (such as alcohol, sedatives, sleep aids, antidepressants, and certain antihistamines) are taken at the same time as codeine. Consequently, such a combination should not be taken except under a doctor's supervision.

To choose a cough remedy suitable for their symptoms, people should check the list of active ingredients on the package and talk with their pharmacist. They may need a product to help them cough up phlegm (a product containing guaifenesin), to suppress the cough (a product containing codeine or dextromethorphan), or to do both. A remedy containing codeine may be useful when a cough interferes with sleep, although codine may be addictive.

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