Pharmacy shelves bear a bewildering array of cough, cold and flu relief products that typically claim to treat various combinations of symptoms. If you're prepared to give them a try, the following list of key symptoms and the drugs designed to address them may help.
For a loose, chesty cough: Expectorants and mucolytics
Loose coughing is a good thing, as it removes mucus from your chest. Expectorants increase mucus production in the lungs, making secretions easier to remove by coughing , and include guaiphenesin, ammonia and senega . Bromhexine is a mucolytic, which has a slightly different action to expectorants – they thin mucus in the lungs rather than stimulate production.
- Cough liquids indicated for “chesty” coughs (such as Duro-Tuss Chesty Cough , Bisolvon Chesty and Benadryl Chesty Forte ) contain expectorants and/or mucolytics.
For a dry cough: Suppressants
Suppressants such as codeine, pholcodine and dextromethorphan are designed to act on the cough centre in the brain to reduce coughing. However, the effect is little better – if at all – than a placebo. Suppressants should only be used if you have a painful, dry and persistent cough. Using suppressants for chesty coughs could delay recovery.
- Many cough, cold and flu tablets contain cough suppressants – look for the ingredients listed above on the label. Cough liquids labelled for “dry cough” also contain suppressants.
- We found some medications, including Robitussin Cough & Chest Congestion, which contain both an expectorant and a suppressant. "If", as one expert pointed out, "these combinations were actually effective, the patient's airway would rapidly fill up with secretions while their ability to cough these secretions out of the airway was suppressed!"
For a blocked nose: Decongestants
Decongestants constrict blood vessels in the nose, throat and sinuses, which reduces swelling and mucus formation. They’ve been shown to be only somewhat effective, meaning you may or may not experience any noticeable difference.
- Pseudoephedrine, as found in Demazin Cold & Flu and Cough, Cold & Flu as well as in Duro-Tuss Cough Liquid & Nasal Decongestant (both Dry and Chesty formulas), is a decongestant, but it’s kept behind the counter because it can be used to make methamphetamine. If you want to purchase it you will have to ask the pharmacist for it and show ID.
- Phenylephrine (look for PE on the label of products – eg. Sudafed PE) has been marketed as a substitute for pseudoephedrine, but is not as effective .
Side effects of decongestants may include increased blood pressure, sleeplessness, anxiety and dizziness. If you have heart disease, diabetes, high blood pressure or thyroid conditions, check with your doctor before taking them.
Topical decongestants are faster-acting than oral decongestants and have fewer side effects. They should only be used sparingly – continued use can cause a rebound effect, where your congestion becomes worse.
Nasal sprays containing topical decongestants include Dimetapp, which contains oxymetazoline, and Otrivin, which contains xylometazoline.
For a runny nose: Antihistamines
Antihistamines such as diphenhydramine, brompheniramine, doxylamine and chlorpheniramine are often present in night-time formulations. They help dry up a runny nose and make sleeping easier, and may help counter the stimulating effects of decongestants. However, they may also make your eyes and mouth feel dry and cause drowsiness during the day. People with narrow-angle glaucoma or an enlarged prostate should avoid using them.
Codral Day & Night, Dimetapp Daytime/Nightime, Sudafed PE Sinus Day & Night and Demazin Day & Night Cold & Flu tablets all contain antihistamines in their night-time preparations.
- Tablet products not specifically marketed for night-time use that contain antihistamines include Demazin 6 Hour Relief and Cold & Flu tablets, and Amcal Cold Relief tablets. Bear in mind that these may cause drowsiness.
- Liquids containing antihistamines include Demazin Cold Relief Syrup and Cough & Cold Elixir; Dimetapp Elixir and DM Cold & Cough Elixir; and Benadryl Original Cough Medicine and Nightime Cough Suppressant + Antihistamine.
Atrovent Nasal Spray contains ipratropium bromide (which is an anticholinergic), which can help dry up a runny nose and is also recommended for allergies. Otrivin Plus nasal spray contains ipratropium bromide to aid symptoms of a runny nose as well as a decongestant (xylometazoline) to reduce stuffiness.
For aches, pains and fever: Paracetamol
Many cough and cold medicines contain paracetamol for pain relief and to reduce fever, so check the ingredients before use to avoid the risk of overdose if you are also taking regular paracetamol. Mild fever doesn’t need to be “treated”; in fact, it may help your body fight the infection.
Children: a special case
A recent review of worldwide research into children’s cough and cold medicines has not found robust evidence that these medicines are effective for children, and has found that using them creates unnecessary risks. Some countries, including Canada and the UK, have labelling laws requiring manufacturers to state that these medicines should not be used for children under 6 years of age.
At present in Australia, cough and cold medications are not recommended for children under 2. However, a Therapeutic Goods Administration (TGA) report recommended that cough and cold medicines be restricted for children aged under 6, and administered to children aged 6-12 only on the advice of a doctor or pharmacist. The TGA is currently reviewing stakeholder responses to these recommendations with the view to changing existing guidelines.