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Common Cold Medications
Whether it is common cold or flu, the infection can only be cured by our own immune system producing specific antibodies against the virus. In the vast majority of cases the infection will resolve in 4-7 days with or without treatment. If the symptoms of infection do not bother you then there is no need for any treatment but if you want some relief from severe symptoms then there are some very effective medications available directly from the pharmacy or supermarket.
Headache, sore throat, sinus pain, feverishness
Pain killers such as aspirin, paracetamol and ibuprofen are very effective as monoproducts for the relief of pain related symptoms such as headache, sinus pain, sore throat, and muscle aches and pains. They are also very effective in controlling fever and would be the first line treatments for the early symptoms of influenza.
Paracetamol and ibuprofen medications are available as liquid suspensions for infants and children. Paracetamol can be safely used for infants down to 3 months of age to control fever. Ibuprofen is suitable for use in children aged over one year, whereas aspirin is not recommended for children under 12 years of age except on medical advice.
In general there is little to choose between the pain killers as they all effectively control the pain related common cold symptoms. Aspirin and ibuprofen are more prone to cause gastric disturbance than paracetamol and should not be used by patients with peptic ulcer or those who are sensitive to aspirin or ibuprofen.
A blocked nose is one of the most bothersome symptoms of common cold and flu but this symptom can be rapidly relieved with nasal sprays containing medications such as xylometazoline or oxymetazoline. Nasal congestion is caused by swelling of the large veins in the lining of the nose as inflammation causes an increased blood flow in the nose. When a nasal spray is applied to the nose the medications such as oxymetazoline rapidly diffuses to the nasal veins and causes them to contract and therefore opens up the nasal airway.
The use of a nasal spray is particularly beneficial in the evening as a blocked nose disturbs sleep. In general the oral decongestants such as pseudoephedrine are not as effective as the nasal sprays in treating nasal congestion. However they are useful in combination with pain killers such as ibuprofen and paracetamol for the simultaneous relief of pain related symptoms and nasal congestion, especially for sinusitis. Oral decongestants should be used with caution by patients with a history of any heart disease or high blood pressure.
The treatment of nasal congestion in infants and children under six years is difficult as most of the nasal sprays and oral decongestants are not recommended for this age group. Relief from nasal congestion in this age group can be obtained from a variety of products containing menthol and essential oils. Menthol causes a pronounced sensation of nasal clearness and coolness but it does not open up the nose like a decongestant.
Runny nose, sneezing
Antihistamines such as chlorpheniramine and doxylamine are widely used in common cold medications but their usefulness is not related to their antihistamine properties. Histamine is responsible for many of the symptoms of hay fever but there is no evidence that it has a major role in common cold symptoms.
Antihistamines help to relieve the symptoms of sneezing and runny nose as they help to dry up secretions and also have a sedative action. The antihistamines are found in multi symptom products in combination with pain killers and nasal decongestants, especially as night time medications. It can be argued that a combination medication may provide unnecessary medication if only one or two symptoms require treatment. However, combination medications are extremely convenient and much more economical than the separate purchase of three or more single active medications.
Cough is a very irritating symptom and although many cough medications contain active ingredients such as dextromethorphan and codeine there is very little evidence to support their effectiveness in treating cough associated with common cold. In general cough medicines provide only around 15% more benefit than inactive placebos. Some relief can be obtained from the dry cough associated with common cold with hot drinks and lozenges containing menthol and essential oils. There is a wide range of cough medicines that claim to be beneficial in the treatment of chesty cough associated with common cold but again there is very little evidence to support their effectiveness. These chesty cough medicines often contain guaifenesin, but there is little evidence that this medicine provides any benefit in the treatment of cough
Any form of hot drink will provide relief from the symptoms of sore throat and cough. The hot fluid has a demulcent and soothing action and tasty drinks containing slightly bitter flavours such as lemon and citric acid are particularly beneficial. Spicy foods and hot soups are also beneficial as they promote airway secretions which have a calmative action on an inflamed throat. Hot drinks in combination with paracetamol provide long lasting relief from pain related symptoms and fever. There is little evidence to support the effectiveness of the small doses of oral decongestant and vitamin C contained in many of the hot drink formulations.
Some useful references
Mossad SB. Fortnightly review - Treatment of the common cold. British Medical Journal 1998; 317:33-36.
Eccles R. Placebo effects of antitussive treatments on cough associated with acute upper respiratory tract infection. In: Chung KF, Widdicombe JG, Boushey HA, eds. Cough, causes, mechanisms and therapy. Massachusetts: Blackwell Publishing Ltd, 2003:259-268.
Eccles R. The Powerful Placebo. Pulm Pharmacol Ther 2002; 15:303-308.
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