It is definitely cold and flu season. Enquiries about cold medications are the most common questions that I am asked at this time of year.

Whenever I am asked to recommend a medication, I begin with asking the patient a bit about their medical history including allergies, medical conditions and if the patient is currently taking any other medications. Before I can make a recommendation, I try to rule out other possible diagnoses that may require an antibiotic such as strep throat, bacterial sinusitis, pneumonia or bronchitis. If the symptoms are mild and the onset is just within the last few days, I am usually comfortable making a recommendation for a product. Most of the products people look for are medications to help relieve cold symptoms. When selecting a medication, I try pick the product with the fewest number of medications that will help relieve all of the patient’s symptoms. Most people don’t realize that there are basically only 5 types of ingredients in cold medications. Many of the products contain the exact same combination of medications but are made by different companies.

The first ingredient in most cold products is an analgesic. Most products have acetaminophen (Tylenol) or ibuprofen (Advil). They help relieve aches, sore throat, sinus pain and fever. If a product is marketed as for the “flu”, it usually means that it contains an analgesic. Also, when products are “extra strength”, it usually means that there is an increased dose of the analgesic part of the medication, but it would have the same amount of the other medications as a “regular strength” product.

The second ingredient is a decongestant. Up until a few years ago pseudoephedrine was the most common decongestant found in oral cold medications, but recently most manufacturers have changed their formulations to contain phenylephrine instead. Decongestants can affect many medical conditions and medications, for example, increasing blood pressure in people who already have high blood pressure and affecting blood sugar in diabetic patients. An alternative to oral decongestants are nasal spray decongestants like xylometazoline or oxymetazoline. These are great because less of the medication is absorbed into the bloodstream than oral decongestants, so they can be a safer alternative. It is important to note that nasal spray decongestants should not be used for more than about 5 consecutive days because prolonged use can lead to “rebound congestion” which means that congestion worsens when the patient tries to stop using the spray.

The next type of medications are antihistamines. Antihistamines are used in nighttime formulations to make them “drowsy” to counteract the potentially stimulating effect of decongestants. Antihistamines may also help with some symptoms like running nose and sneezing, but the main reason they are used is for their sedating side effects.

Another common ingredient found in some formulations is a cough suppressant. The cough suppressant in over-the-counter cold medications is called dextromethorphan or DM. There is a bit of controversy about how effective DM really is, but it’s generally safe for most people to try. DM should only be used for a dry cough. The idea is that if a patient has a productive cough or is coughing up a lot of mucus, cough suppressants may prevent the patient from coughing up the mucus thereby allowing the mucus to settle in the chest.

The last ingredient is an expectorant. Expectorants are supposed to help break up the mucus in your chest, helping you to cough up mucus more easily. However, the effectiveness of these products are questionable. In fact, drinking lots of fluids may be just as effective as taking an expectorant.