Hi Marlo-thanks for inviting me to participate in this important conversation. As you know, I’ve spent years spreading the word that people are taking too many unnecessary or unnecessarily dangerous drugs, exposing themselves to more ailments than they realize every time they take a pill. Over-the-counter medicines for the common cold are one of my pet peeves – they’re mostly unnecessary, and people often take even more medicine than they need (or realize) when they choose a “combination” formula.

Here’s the background: The illness we call the common cold is caused by a virus that infects the upper respiratory tract (nose, throat, and upper airway). This creates the inflammation of the mucous membranes that leads to the miserable stuffy head, runny nose, sneezing, and, sometimes, sore throat or cough. There are no drugs available to kill that virus. A cold can’t be “cured” by anything except time, so the safest, cheapest approach is to let it run its course while you get lots of rest and drink plenty of fluids. If you need more relief than that, there are some single-ingredient over-the-counter medications that may help lessen symptoms while you wait it out – but you need to choose wisely and select only the medicines you need for your most troublesome symptoms.

And that’s the real issue: So many of the cold medicines on drugstore shelves now have far more ingredients than anyone needs, and most of the combinations don’t even make sense. For example, why would anyone need something that combines an expectorant (which thins out secretions and makes your coughs more productive, ridding your lungs of mucus) with a cough suppressant (which stops you from coughing in the first place)? That’s just one example of the shotgun approach taken by those “multi-symptom” formulas containing multiple drugs. It’s a big problem, because every medicine ingredient you take, whether or not it has any benefit for you, has some risk of side effects (which can be either sudden or cumulative). The more ingredients, the greater your risk. Your goal should always be the minimum number of medicines, at the lowest doses, to have the safest and most effective treatment.

So here’s what to do if you have a cold:

* Drink eight to 10 full glasses of (nonalcoholic) liquids a day, preferably hot or warm. Warm liquids are the best expectorants, so if you’re coughing up mucus, lots of soup and tea will help clear your airways. Coughing is a protective mechanism.

* Get plenty of rest, as much as you think you need. Your body is telling you something when you’re sick – give yourself a break, and don’t push yourself. You’ll recover faster.

* If you have a runny nose, remember that your body is draining itself of mucus, and don’t take anything to stop it.

* If you have a stuffy nose, try nose drops or sprays, not oral decongestants. (Try a simple sterile-saline nasal solution first before you use medicated drops or sprays.) The reason to choose medicated sprays and drops over oral medications is that they provide a much smaller dose of medicine, in exactly the right place (your nose). Oral formulas contain 25 times as much medicine, and they circulate that medicine throughout your entire body for no reason. Instead, look for these safe, effective ingredients:

o oxymetazoline hydrochloride (found in Afrin)
o xylometazoline hydrochloride (found in Otrivin)
o phenylephrine hydrochloride (found in Neo-Synephrine)

Get the store brand or generic versions of these three to save money; the store brands and generics are equally effective as long as the ingredients are the same. Don’t use drops or sprays for more than three days, though, since overuse can actually cause irritation and more congestion.

* If you have a headache or body ache, take simple aspirin (unless you are under 40-due to the risk of Reye’s syndrome, a rare but potentially fatal disease) or acetaminophen in the smallest amount that affords relief.

What NOT to do when you have a cold:

* Don’t take an antihistamine or any medicine that contains one for treating a cold. Although antihistamines are appropriate and effective for some allergies since they combat histamines (which your body releases during an allergic reaction), they make no sense for a cold at all!

* Don’t take oral decongestants such as pseudoephedrine (found in Sudafed, Contac, and many other products). They’re no more effective than nasal sprays or drops, and, because of the higher dose, they can have significantly more side effects and risks.

* Don’t take the expectorant guaifenesin (found in Robitussin preparations and Mucinex). There are serious doubts about its effectiveness, so why take it?

* Don’t take the cough suppressant dextromethorphan, found in many preparations such as Delsym and Robitussin DM (for DextroMethorphan); it is not effective in either children or adults and has some side effects.

* Don’t take combination formulas of any kind – treat only the symptom you have.

* If you are under 40, do not use aspirin because you may have influenza rather than a cold. There is strong evidence that young people who take aspirin when they have the flu (or chicken pox) have a greatly increased risk of later getting Reye’s syndrome.

Call your doctor if a fever climbs above 103°F (39.4°C), or if a fever at or above 100°F (38°C) lasts for more than four days. Under either of these circumstances, you probably do not have a cold.

Other problems that may mean you have something more serious than just a cold includechills and coughing up thick phlegm (especially if greenish or foul-smelling), sharp chest pain when taking a deep breath, rapid breathing, or an extremely severe and persistent sore throat.

Otherwise, remember the old saying: If you don’t treat a cold, it will last seven days. If you treat it, it will be gone in a week. It may be uncomfortable, but it’s not serious – don’t take medicine that has the potential to make it worse than it is!



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