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Effectiveness of Common Over the Counter Cough and Cold Medications. By Our Student Pharmacist, Austin Cotsmire.

OTC Isle

With cold and flu season rapidly approaching, let’s take a look at common over-the-counter (OTC) medications used for treatment and their effectiveness, or potential lack thereof.

Over-the-counter medications are typically used to treat:

  • cough
  • sore throat
  • congestion
  • fever
  • numerous other symptoms that are associated with the common cold and flu

When looking for a product, it is very common to become overwhelmed with all the products available. The confusion comes from trying to decide whether to choose a single ingredient or a combination of many; different advertising for ultimately the same medication; or brand vs. generic.

At times, it can seem like a guessing game on whether or not you are getting an effective product to treat your symptoms. Hopefully, this overview can provide some clarity and help guide your decisions in the future.

Sudafed Pic

To start, let’s look at the difference between the two medications that are commonly used to treat congestion.

These go by the brand names of Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine).

Both products are available without a prescription, however, Sudafed is only available for purchase behind the pharmacy counter with a valid driver’s license. These medications are nearly identical in name, but on opposite ends of the spectrum when it comes to actually relieving sinus congestion.

I believe the following statements sum up the effectiveness of Sudafed PE (phenylephrine):

“In my experience, most pharmacists don’t know that oral phenylephrine is ineffective as a decongestant or that it is inactivated in the gut and doesn’t get into the blood.” – Randy Hatton, PharmD, FCCP, clinical professor, and director of Medication Safety & Quality Systems at the University of Florida.

Phenylephrine is a scam with false advertising; it has no decongestant effect, and the companies know it.” – Miles Weinberger, MD, FAAAI, ACAAI, professor emeritus at the University of Iowa.

On the other hand, Sudafed (pseudoephedrine), is very effective at relieving sinus congestion. Pseudoephedrine is 100% absorbed by the body which leads to higher effectiveness. It is also available in 4-6 hour, 12 hour, and now even 24 hour formulations, whereas phenylephrine must be taken every 4 hours.

The bottom line is, if you are buying a medication for nasal congestion anywhere besides from behind the pharmacy counter, you are buying an ineffective product.

Mucus DM Label

Next, we will examine two medications that are typically used to treat cough:

  • Delsym (dextromethorphan)
  • Mucinex (guaifenesin)

While both of these medications are effective for treating cough, they do so in their own ways.

Dextromethorphan is a cough suppressant and typically used for dry coughs and works to prevent coughing.

Guaifenesin is an expectorant and is used for coughs that produce mucus and helps to break up the mucus in the lungs and promote its removal from the body by coughing.

The biggest downfall of these medications is that it is very common for cough medications to contain both of these ingredients even though dextromethorphan negates the effects of guaifenesin. When there is mucus in your lungs, you want to cough it out, so using a cough suppressant like Delsym or other dextromethorphan-containing products is not recommended.

Most healthcare professionals will advise you to use either dextromethorphan OR guaifenesin but not a combination of the two.

As a patient, it is best practice to only buy medications that contain ingredients that will treat the symptoms you are experiencing and to avoid combination products when possible.

Often advertising plays a major role in decisions as consumers, so I advise you to do your best to look past advertisement and always check the active ingredients section on the drug facts label when making your decisions! In this instance, avoid products that include a “DM” at the end such as Mucinex DM and generics.

And remember, anytime you have questions about an over-the-counter medication, your pharmacist will be glad to help!

Sudafed PE Pic Small


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