Cold medicine

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Cold medicine
Cough medicine.jpg
Cough medicine often contains cough suppressants and expectorants.
Other namesCough and cold medicine, cough syrup, lin, lean

Cold medicines are a group of medications taken individually or in combination as a treatment for the symptoms of the common cold and similar conditions of the upper respiratory tract. The term encompasses a broad array of drugs, including analgesics, antihistamines and decongestants, among many others. It also includes drugs which are marketed as cough suppressants or antitussives, but their effectiveness in reducing cough symptoms is unclear or minimal. [1] [2] [3]

Contents

While they have been used by 10% of American children in any given week, they are not recommended in Canada or the United States in children six years or younger because of lack of evidence showing effect and concerns of harm. [4] [5]  

Types

There are a number of different cough and cold medications, which may be used for various coughing symptoms. The commercially available products may include various combinations of any one or more of the following types of substances:[ citation needed ]

An example combination is guaifenesin with codeine.

Effectiveness

The efficacy of cough medication is questionable, particularly in children. [6] [3] A 2014 Cochrane review concluded that "There is no good evidence for or against the effectiveness of OTC [over the counter] medicines in acute cough". [1] Some cough medicines may be no more effective than placebos for acute coughs in adults, including coughs related to upper respiratory tract infections. [7] The American College of Chest Physicians emphasizes that cough medicines are not designed to treat whooping cough, a cough that is caused by bacteria and can last for months. [8] No over-the-counter cough medicines have been found to be effective in cases of pneumonia. [9] They are not recommended in those who have COPD, chronic bronchitis, or the common cold. [10] [2] There is not enough evidence to make recommendations for those who have a cough in cancer. [11]

Medications

Alternative medicine

A small study found honey may be a minimally effective cough treatment due to "well-established antioxidant and antimicrobial effects" and a tendency to soothe irritated tissue. [21] A Cochrane review found there was weak evidence to recommend for or against the use of honey in children as a cough remedy. [22] In light of these findings, the Cochrane study they found honey was better than no treatment, placebo, or diphenhydramine but not better than dextromethorphan for relieving cough symptoms. [22] Honey's use as a cough treatment has been linked on several occasions to infantile botulism and accordingly should not be used in children less than one year old. [23]

Many alternative treatments are used to treat the common cold, though data on effectiveness is generally limited. A 2007 review states that, "alternative therapies (i.e., Echinacea, vitamin C, and zinc) are not recommended for treating common cold symptoms; however,...Vitamin C prophylaxis may modestly reduce the duration and severity of the common cold in the general population and may reduce the incidence of the illness in persons exposed to physical and environmental stresses." [24] A 2014 review also found insufficient evidence for Echinacea, where no clinical relevance was proven to provide benefit for treating the common cold, despite a weak benefit for positive trends. [25] Similarly, a 2014 systematic review showed that garlic may prevent occurrences of the common cold but there was insufficient evidence of garlic in treating the common cold and studies reported adverse effects of a rash and odour. [26] Therefore, more research needs to be done to prove that the benefits outweigh the harms.

A 2009 review found that the evidence supporting the effectiveness of zinc is mixed with respect to cough, [12] and a 2011 Cochrane review concluded that zinc "administered within 24 hours of onset of symptoms reduces the duration and severity of the common cold in healthy people". [27] A 2003 review concluded: "Clinical trial data support the value of zinc in reducing the duration and severity of symptoms of the common cold when administered within 24 hours of the onset of common cold symptoms." [28] Zinc gel in the nose may lead to long-term or permanent loss of smell. The FDA therefore discourages its use. [29]

Recreational usage

Cough medicines, especially those containing dextromethorphan and codeine, are often abused as recreational drugs. [30] [31] Abuse may result in hallucinations, loss of consciousness and death. Many cough syrups can contain acetaminophen which will cause liver damage in recreational users. [31]

Adverse effects

A number of accidental overdoses and well-documented adverse effects suggested caution in children. [23] The FDA in 2015 warned that the use of codeine-containing cough medication in children may cause breathing problems. [32] Cold syrup overdose has been linked to visual and auditory hallucinations as well as rapid involuntary jaw, tongue, and eye movements in children.[ medical citation needed ]

Decongestants are possibly harmful to people with high blood pressure or a heart disease because these substances can constrict the blood vessels. [33]

History

Heroin was originally marketed as a cough suppressant in 1898. [34] It was, at the time, believed to be a non-addictive alternative to other opiate-containing cough syrups. This was quickly realized not to be true as heroin readily breaks down into morphine in the body. Morphine was already known to be addictive.[ citation needed ]

Society and culture

Brands

Some brand names include: Benylin, Sudafed, Robitussin and Vicks among others. [35] Most contain a number of active ingredients. [4] The Thai company Hatakabb produces the Takabb Anti-Cough Pill, which is a Chinese herbal medication. [36]

Sudafed is a brand manufactured by McNeil Laboratories.[ citation needed ] The original formulation contains the active ingredient pseudoephedrine, but formulations without pseudoephedrine are also being sold under the brand.[ citation needed ] In 2016, it was one of the biggest selling branded over-the-counter medications sold in Great Britain, with sales of £34.4 million. [37] The effectiveness of phenylephrine by mouth as a nasal decongestant is questionable. [38]

Gee's Linctus is a cough medicine which contains opium tincture. [39] New Zealand in 2019 moved it to prescription only. [40]

Coricidin, Coricidin D, or Coricidin HBP, is the brand name of a combination of dextromethorphan and chlorpheniramine maleate (an antihistamine).[ citation needed ] Varieties may also contain acetaminophen and guaifenesin.[ citation needed ]

Codral is a brand name manufactured by Johnson & Johnson and sold primarily in Australia and New Zealand. Codral is the highest-selling cold and flu medication in Australia. [41]

Economics

In the United States, several billion dollars are spent on over-the-counter products per year. [42]

Poisoning

According to The New York Times , at least eight mass poisonings have occurred as a result of counterfeit cough syrup in which medical-grade glycerin has been replaced with diethylene glycol, an inexpensive, yet toxic, glycerin substitute marketed for industrial use. In May 2007, 365 deaths were reported in Panama, which were associated with cough syrup containing diethylene glycol. [43] In 2022, the deaths of 66 children in The Gambia were linked to four pediatric cough syrup medications that contained diethylene glycol and ethylene glycol. [44] [45]

In 2022, the US Food and Drug Administration issued a warning against cooking foods in cough syrup after a video of someone preparing "NyQuil chicken", sometimes also called "sleepy chicken", became popular on social media. Cough syrup is designed to be stored at room temperature and its properties can change when it is heated, making it potentially deadly. Heated cough syrup can also vaporize, leading to inhalation hazards. [46] [47] [48] The warning received attention from many news outlets, but some criticized the FDA's handling of the issue for amplifying the attention the topic received online and questioned if making and eating NyQuil chicken actually existed as a widespread trend. [49] [50] [51]

See also

Related Research Articles

<span class="mw-page-title-main">Sinusitis</span> Inflammation of the inner lining of the sinuses

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain.

<span class="mw-page-title-main">Paracetamol</span> Common medication for pain and fever

Paracetamol (acetaminophen) is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain. It is a widely used over the counter medication. Common brand names include Tylenol and Panadol.

<span class="mw-page-title-main">Common cold</span> Common viral infection of the upper respiratory tract

The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear in as little as two days after exposure to the virus. These may include coughing, sore throat, runny nose, sneezing, headache, and fever. People usually recover in seven to ten days, but some symptoms may last up to three weeks. Occasionally, those with other health problems may develop pneumonia.

<span class="mw-page-title-main">Cough</span> Sudden expulsion of air from the lungs as a reflex to clear irritants

A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.

<span class="mw-page-title-main">Acute bronchitis</span> Medical condition

Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi of the lungs. The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, and chest discomfort. The infection may last from a few to ten days. The cough may persist for several weeks afterward with the total duration of symptoms usually around three weeks. Some have symptoms for up to six weeks.

Vicks NyQuil is a brand of over-the-counter medication manufactured by Procter & Gamble intended for the relief of various symptoms of the common cold. All medications within the NyQuil imprint contain sedating antihistamines, hypnotics, and/or alcohol, and are intended to be taken before sleep. Its daytime counterpart is antihistamine-free DayQuil, formulated to avoid drowsiness. NyQuil is also used as a sleep aid. NyQuil was first marketed in the United States in 1966.

<span class="mw-page-title-main">Bronchiolitis</span> Inflammation of the small airways in the lungs

Bronchiolitis is inflammation of the small airways in the lungs. Acute bronchiolitis is due to a viral infection usually affecting children younger than two years of age. Symptoms may include fever, cough, runny nose, wheezing, and breathing problems. More severe cases may be associated with nasal flaring, grunting, or the skin between the ribs pulling in with breathing. If the child has not been able to feed properly, signs of dehydration may be present.

<span class="mw-page-title-main">Upper respiratory tract infection</span> Infection of the nose, sinuses, pharynx, larynx or trachea

An upper respiratory tract infection (URTI) is an illness caused by an acute infection, which involves the upper respiratory tract, including the nose, sinuses, pharynx, larynx or trachea. This commonly includes nasal obstruction, sore throat, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold. Most infections are viral in nature, and in other instances, the cause is bacterial. URTIs can also be fungal or helminthic in origin, but these are less common.

<span class="mw-page-title-main">Benadryl</span> Brand of various antihistamine medications

Benadryl is a brand of various antihistamine medications used to stop allergies, whose content varies in different countries, but which includes some combination of diphenhydramine, acrivastine, and/or cetirizine.

Vicks DayQuil is an over-the-counter combination medication product used for the temporary relief of common cold and flu symptoms. DayQuil is available in several formulations.

<span class="mw-page-title-main">Guaifenesin</span> Expectorant medication

Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication taken by mouth and marketed as an aid to eliminate sputum from the respiratory tract. Chemically, it is an ether of guaiacol and glycerine. It may be used in combination with other medications. A 2014 study found that guaifenesin has no effect on sputum production or clearance in upper respiratory infections.

<span class="mw-page-title-main">Promethazine</span> Sedating Antihistamine

Promethazine, sold under the brand name Phenergan among others, is a first-generation antihistamine, sedative, and antiemetic used to treat allergies, insomnia, and nausea. It may also help with some symptoms associated with the common cold and may also be used for sedating people who are agitated or anxious, an effect that has led to some recreational use. Promethazine is taken by mouth (oral), as a rectal suppository, or by injection into a muscle (IM).

<span class="mw-page-title-main">Dihydrocodeine</span> Opioid

Dihydrocodeine is a semi-synthetic opioid analgesic prescribed for pain or severe dyspnea, or as an antitussive, either alone or compounded with paracetamol (acetaminophen) or aspirin. It was developed in Germany in 1908 and first marketed in 1911.

<span class="mw-page-title-main">Doxylamine</span> First-generation antihistamine used as a short-term sedative and hypnotic (sleep aid)

Doxylamine is an antihistamine medication used to treat insomnia and allergies, and—in combination with pyridoxine (vitamin B6)—to treat morning sickness in pregnant women. It is available over-the-counter and is typically sold under such brand names as Equate, Unisom, or ZzzQuil, among others; and it is used in nighttime cold medicines (e.g., NyQuil) and pain medications containing acetaminophen and/or codeine to help with sleep. The medication is delivered chemically by the salt doxylamine succinate and is taken by mouth. Doxylamine and other first-generation antihistamines are the most widely used sleep medications in the world.Typical side effects of doxylamine (at recommended doses) include dizziness, drowsiness, grogginess, and dry mouth, among others.

<span class="mw-page-title-main">Dextromethorphan</span> Cough suppressant, antidepressant, and dissociative drug

Dextromethorphan (DXM), sold under the trade name Robitussin among others, is a cough suppressant used in many cough and cold medicines. It affects serotonin, norepinephrine, NMDA, and sigma-1 receptors in the brain, all of which have been implicated in the pathophysiology of depression. In 2022, the FDA approved the combination dextromethorphan/bupropion to serve as a rapid acting antidepressant in patients with major depressive disorder.

Overmedication describes the excessive use of over-the-counter or precription medicines for a person. Overmedication can have harmful effects, such as non-adherence or interactions with multiple prescription drugs.

<span class="mw-page-title-main">Pentoxyverine</span> Antitussive / cough suppressant

Pentoxyverine (rINN) or carbetapentane is an antitussive commonly used for cough associated with illnesses like common cold. It is sold over-the-counter as Solotuss, or in combination with other medications, especially decongestants. One such product is Certuss, a combination of guaifenesin and pentoxyverine. The drug has been available in the form of drops, suspensions and suppositories.

<span class="mw-page-title-main">Codeine</span> Opiate and prodrug of morphine used to treat pain

Codeine is an opiate and prodrug of morphine mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. It is found naturally in the sap of the opium poppy, Papaver somniferum. It is typically used to treat mild to moderate degrees of pain. Greater benefit may occur when combined with paracetamol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen. Evidence does not support its use for acute cough suppression in children. In Europe, it is not recommended as a cough medicine in those under 12 years of age. It is generally taken by mouth. It typically starts working after half an hour, with maximum effect at two hours. Its effects last for about four to six hours. Codeine exhibits abuse potential similar to other opioid medications, including a risk of habituation and overdose.

Migraine may be treated either prophylactically (preventive) or abortively (rescue) for acute attacks. Migraine is an complex condition; there are various preventive treatments which disrupt different links in the chain of events that occur during a migraine attack. Rescue treatments also target and disrupt different processes occurring during migraine.

In clinical guidelines chronic cough is defined as a cough lasting more than 8 weeks in adults and more than 4 weeks in children. The prevalence of chronic cough is about 10% although the prevalence may differ depending on definition and geographic area. Chronic cough is a common symptom in several different respiratory diseases like COPD or pulmonary fibrosis but in non-smokers with a normal chest x-ray chronic cough are often associated with asthma, rhinosinusitis, and gastroesophageal reflux disease or could be idiopathic Generally, a cough, for example after an upper respiratory tract infection, lasts around one to two weeks; however, chronic cough can persist for an extended period of time, often several years. People with chronic cough often experience more than one cause present. The current theory about the cause of chronic cough, independent of associated condition, is that it is caused by a hypersensitivity in the cough sensory nerves, called cough hypersensitivity syndrome. There are a number of treatments available, depending on the associated disease but the clinical management of the patients remains a challenge. Risk factors include exposure to cigarette smoke, and exposure to pollution, especially particulates.

References

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  39. ↑ "Proposal for reclassification of cough medicines containing dextromethorphan, opium tincture, squill oxymel and pholcodine to restricted medicines" (PDF). Retrieved 26 May 2019.
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  41. ↑ "Johnson & Johnson - Codral". Johnson & Johnson. 30 May 2008. Retrieved 25 February 2009.
  42. ↑ Chung, Kian Fan (2008). Pharmacology and therapeutics of cough. Berlin: Springer. p. 188. ISBN   9783540798422.
  43. ↑ Bogdanich, Walt; Hooker, Jake (6 May 2007). "From China to Panama, a Trail of Poisoned Medicine". The New York Times . Retrieved 30 April 2010.
  44. ↑ "Medical Product Alert N°6/2022: Substandard (contaminated) paediatric medicines". www.who.int. Retrieved 9 October 2022.
  45. ↑ "WHO alert over India-made cough syrups after deaths in The Gambia". BBC News. 6 October 2022. Retrieved 9 October 2022.
  46. ↑ "A Recipe for Danger: Social Media Challenges Involving Medicines". U.S. Food and Drug Administration. 15 September 2022. Archived from the original on 15 September 2022. Retrieved 1 October 2023.
  47. ↑ "Don't cook your chicken in NyQuil: FDA issues warning against social media challenge". CBS News . 20 September 2022.
  48. ↑ "Experts warn against 'sleepy chicken' cooking trend: 'It will kill you'". 7NEWS. 21 September 2022. Retrieved 17 April 2023.
  49. ↑ Anguiano, Dani (23 September 2022). "Interest in dangerous 'NyQuil chicken' videos surged after US agency warning". The Guardian. ISSN   0261-3077 . Retrieved 1 October 2023.
  50. ↑ Leighton, Mara. "TikTok's interest in 'NyQuil chicken' increased 1,400% following the FDA's warning about the dangerous trend". Insider. Retrieved 1 October 2023.
  51. ↑ Schulz, Bailey. "Were people actually eating NyQuil chicken? Viral challenge was the latest internet lore". USA TODAY. Retrieved 1 October 2023.
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