— The unconvinced Cardiologist has actually some seasonally-appropriate cautions

by Anthony Pearson, MD January 22, 2020


Little has changed in the $8 billion civilization of useless and confusing over-the-counter (OTC) cold, flu, and sinus medications due to the fact that the unconvinced Cardiologist an initial tackled "What Cold medications Are for sure For my Heart" in 2015.

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I still recommend avoiding mix OTC cold meds and utilizing details medications for particular symptoms.

The original post covers many of the normal suspects in this greatly useless arena. I updated it in 2016 with comments ~ above a few additional OTC components. That article on Alka-Seltzer, phenylephrine, and doxylamine is included below.

Alka-Seltzer Plops right into the OTC Cold Market

I had constantly viewed Alka-Seltzer together an effervescent tablet computer for mountain reflux, however the brand (now owned by Bayer) has moved aggressively into the bewildering morass of OTC cold meds. Indeed, when Alka-Seltzer started in 1931, it was a mix of aspirin and also sodium bicarbonate (baking soda) marketed for upset stomachs. Famous commercials indigenous the 1960s featured the catchy solder (still stuck in my head) "Plop, plop, fizz, fizz. Five what a relief the is" regularly sung through Speedy, an odd humanlike creature v an Alka-Seltzer thorax and also cap. (The jingle was created by Tom Dawes the The Cyrkle <"Red Rubber Ball">, not by the dad of Julianna Margulies.)

Recently, I obtained a request from one out-of-town guest that was enduring from a cough and upper respiratory epidemic to purchase Alka-Seltzer plus in the kind of a tablet that dissolves in hot water.

At his request, Alka-Seltzer Plus work Multi-Symptom Cold and Flu was purchased in ~ the neighborhood Walgreens.

The ingredient are typical for countless of the Alka-Seltzer products:

Acetaminophen (Tylenol, for pain and also fever)Phenylephrine (decongestant)

Phenylephrine: Ineffective Substitute for Pseudoephedrine

I didn"t covering phenylephrine previously. It has taken the location of pseudoephedrine in on-the-shelf OTC cold medications.

Like pseudoephedrine, phenylephrine is a sympathomimetic drug, definition it stimulates receptor of the sympathetic nervous system. Unequal pseudoephedrine, phenylephrine is useless together a decongestant as soon as taken in the dosages accessible over the counter.

A study released in 2015 confirmed what vault studies had suggested: Phenylephrine in dosages of 10 come 40 mg daily was no more effective than placebo in reducing symptoms of nasal congestion.

An accompanying editorial referred to as on manufacturers to eliminate this useless drug from your products.

Alas, all of the Alka-Seltzer prepare that insurance claim to treat congestion utilize phenylephrine as the decongestant.

The shift to useless phenylephrine took place when pseudoephedrine was taken off the shelves and put behind the respond to to mitigate its intake in do methamphetamine.

Therefore, Alka-Seltzer to add Cold and Flu has two useless ingredients plus acetaminophen (Tylenol).

You deserve to buy a big bottle the cheap generic acetaminophen and take exactly the best dose you require for relieving fever or human body aches without payment for two useless accompanying medicine that have the potential for offering you unwanted side effects.

Sleep Aids in OTC Cold Meds

I covered the most typical drug uncovered in OTC cold meds advocated for nighttime use, diphenhydramine (Benadryl), in mine previous post.

Nighttime Alka-Seltzer products contain a comparable sedating antihistamine dubbed doxylamine succinate.

Doxylamine is the active ingredient in the brand-name sleep help Unisom and the "ZzzQuil" products from the NyQuil brand that are advocated for inducing sleep. The is accessible in cheap, share form.

According come DrugBank, "It is also the most an effective over-the-counter sedative obtainable in the U.S., and much more sedating than many prescription hypnotics. In a study, the was found to be remarkable to even the barbiturate, phenobarbital for usage as a sedative."

Note the the effective dosage encourage in different sleep aids is 25 mg, not the 12.5 mg discovered in Alka-Seltzer OTC cold meds. Thus, if you desire an efficient dosage of doxylamine to assist you sleep, you must twin the encourage dosage of Alka-seltzer"s nighttime product, i m sorry then provides you too lot acetaminophen and dextromethorphan.

Doubling these drugs raises the potential because that side effects. Usual dextromethorphan side effects include nausea/vomiting, dizziness, diarrhea, and nervousness. Too lot acetaminophen can damages the liver.

In addition, both dextromethorphan and also acetaminophen communicate with multiple other medications. Dextromethorphan is well-known to communicate with numerous medications.

Acetaminophen have the right to interfere with warfarin and increase the danger of danger bleeding.

My advice for 2020 is unmodified from 2015. As I summary previously:

"I think you room much better off avoiding these brand surname mixtures that different energetic ingredients.

Instead, you should take what you need for a details symptom in the ideal dosage and time interval.

Thus, if you have actually pain, take the minimal dose of Tylenol that relieves it and repeat once it comes back.

If you have actually a cough, identify that the OTC ingredients room no much better than placebo and are gift abused as recreational drugs. Many coughs walk away shortly; yet if one is particularly troublesome and persistent, get a cough suppressing medicine from her physician.

If you have a really runny nose v a lot of sneezing, that is most likely OK to take it pseudoephedrine also if you are a love patient or have actually high blood pressure. Take it together I described above. Begin with 30 mg the the small red pseudoephedrine pills. Wait one hour come see how you feel. Take a 2nd if it has actually not to be effective. Repeat at 4 to 6 hour intervals together needed. Take your blood pressure at the very least once after starting it.

Don"t purchase the multi-symptom multiple ingredient combinations, which are simply a marketing tool to acquire you to spend more money top top something from which girlfriend won"t benefit."

Consumer Reports appears to agree with me in a 2017 write-up on this object (which doesn"t credit me).

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Anthony Pearson, MD, is a private practice noninvasive cardiologist and medical manager of echocardiography in ~ St. Luke"s Hospital in St. Louis. He blog on nutrition, cardiac testing, quackery, and also other things worthy of suspicion at The skeptical Cardiologist, where a variation of this post an initial appeared.