danike inc.

Cleanup on Aisle 5
wrote this on Jun 20, 2013

I recently went to my local pharmacy and walked down the "Cough & Cold" aisle. There were so many products to choose from that I found myself shaking my head in disbelief. I know, as a Pharmacist, that all of these products are really just a handful of drugs mixed and matched together. In some cases, the EXACT SAME drug(s) can be marketed as completely different products.

For example, do you know the difference between 'Excedrin Extra Strength' and 'Excedrin Migraine'? Hint: the answer is none. Both of these products are the combination of Tylenol 250mg, Aspirin 250mg, and Caffeine 65mg.

So why are there two different products for the exact same drug combination? Marketing. To hammer home the point, this drug combination is also used in Pamprin Max (for PMS symptoms).

Here's another example. What's the difference between the following drugs?

- Benadryl
- Alka-Seltzer Plus Allergy
- Sominex
- Unisom Sleepgels
- ZzzQuil

If you said nothing, then you're catching on. That's right. All of these drugs contain the same ingredient (diphenhydramine).

Here's another fact that is used by drug companies as a way to market "targeted" therapies: antihistamines can make you tired while decongestants can give you energy.

Knowing this, what do you think is the difference between Dayquil and Nyquil? As the names imply, Dayquil is meant for daytime use while Nyquil is meant for nighttime use. If you said Dayquil uses a decongestant (gives energy) while Nyquil uses an antihistamine (makes you tired), then I'm doing my job. Nice work, you're correct. There's no other magic at play here.

In fact, almost every product that is marketed as "non-drowsy" simply uses a decongestant OR takes out the antihistamine.

Let's talk about decongestants for a second. Decongestants can raise blood pressure and/or heart rate. That is why decongestants should typically be avoided if you have high blood pressure or heart problems. The makers of Coricidin HBP use this to their advantage. They simply leave out the decongestant from their multi-ingredient products and market them as "blood pressure safe". Hence the name Coricidin HBP (high blood pressure).

What am I trying to get at here? The point is this. You can save yourself a lot of time and money by just purchasing the three or four separate ingredients specific to your symptom(s) and medical history.

For example, if you purchase Dayquil to treat a cold then you're actually taking three drugs: a fever/pain reducer, a cough suppressant, and a decongestant. What happens next month when you just have a fever? Or just a cough? Or just a stuffy nose? Do you really need to take Dayquil (i.e. three drugs) if you only have one symptom? If you purchased these ingredients separately, then you could just pick and choose which drug was right for your current symptoms.

Finally, I want to talk about acetaminophen (Tylenol). For some reason almost every cough/cold product comes with Tylenol as one of its many ingredients. This can be dangerous if you unknowingly take different medications that contain Tylenol; possibly resulting in an unintentional overdose. Too much Tylenol can actually result in liver damage. This is becoming such a large problem that the FDA recently worked with many drug companies to lower the amount of Tylenol in certain pain medications. The FDA believes this may reduce the amount of unintentional Tylenol ingestion.

Personally, I almost never purchase combination cough/cold products for these reasons. It rarely makes sense to do so.

To help YOU make the right decisions when selecting individual cough/cold products, I am going to walk through SOME of the most commonly used ingredients and provide helpful information so you can better stock your medicine cabinet.

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**Disclaimer: Please follow all typical warnings on the product's packaging and always discuss these medications with your local Doctor or Pharmacist prior to use**

PAIN RELIEVERS/FEVER REDUCERS

These medications are commonly referred to as "analgesics". They are used to treat fever or aches/pains associated with illness.

- Acetaminophen (Tylenol)

- Ibuprofen (Advil/Motrin)

DECONGESTANTS

Decongestants are great for stuffy, but not runny noses. They should generally be avoided in patients with high blood pressure, glaucoma, urinary hesitancy (e.g. BPH or enlarged prostate), and thyroid disorders.

- Pseudoephedrine (Sudafed): this is generally stronger and more effective than phenylephrine. In addition, pseudoephedrine can easily be turned into methamphetamine by skilled, illicit, drug makers. Therefore, it's typically harder to purchase in large quantities.

- Phenylephrine (Sudafed PE)

ANTIHISTAMINES

Antihistamines are versatile. They can be used for allergy symptoms (runny nose, watery eyes, itching/hives), insomnia, and nausea...including motion sickness. These drugs should generally be avoided in patients with glaucoma, severe constipation, and urinary hesitancy (e.g. BPH).

- Diphenhydramine: probably the strongest of the group (most sedating as well, which is why it is commonly used to treat insomnia)

- Chlorpheniramine (Chlor-Trimeton)

- Clemastine (Tavist)

- Doxylamine (Various)

Newer antihistamines are less sedating and include:

- loratadine (Alavert, Claritin)

- fexofenadine (Allegra)

- cetirizine (Zyrtec): probably the highest sedation potential

COUGH SUPPRESSANT

Cough suppressants relieve non-productive (e.g. annoying/dry) coughs. They should not be used to treat productive coughs since you want to expel the mucus through the action of coughing.

- Dextromethorphan (Delsym, Robitussin, Various)

EXPECTORANT

Expectorants are used to help break up mucous in the lungs. This makes it easier to cough up the mucous and expel it from the body.

- Guaifenesin (Mucinex, Various): This medication has questionable efficacy. In other words, it is not known if this drug really works that well. In general, when treating the common cold or flu symptoms it may not be worth the cost to purchase this drug.

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That pretty much sums it up. In case you were curious, my medicine cabinet is usually stocked with:

- Diphenhydramine (Benadryl)
- Phenylephrine (Sudafed PE)
- Acetaminophen (Tylenol)

With these three drugs, I am able to treat insomnia, allergies, hives, runny nose, stuffy nose, fever, aches/pains, and more. Better yet, these three drugs cost less than $15 combined. So I am saving money while allowing myself the flexibility to treat only the symptoms that I have.

If you have any questions, feel free to send an email to PocketPharmacist [at] Danike.com.

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