Common Cold Medicines: Choose (Only) Medicines You Need!

As we know, now there are plenty of common cold medicines in market, and most of them is available over-the-counter. But do you know what are the active ingredients of each medicines? Are they suitable with your symptoms? In this article, I will describe some active components in common cold medicines, with the analysis of each benefits of them.

1. Paracetamol (or Acetaminophen)
Acetaminophen is an NSAID (nonsteroidal antiinflammatory drugs) which possesses predominantly antipyretic effect (defervescent effect). Acetaminophen also possesses analgesic effect (pain killer). But its anti-inflammatory effect is not really significant. This is the main reason, why acetaminophen is not used to alleviate inflammation; but is more used to lower the fever or relieve the headache which are appeared in common cold.
Recommended dose for acetaminophen in common cold medicine combination is about 10-15 mg for each kg of body weight; or in adults equal to 500-600 mg. Usually, a common cold medicine contains acetaminophen in this amount, except when more than antipyretics or analgesics are used concomitantly (i.e, dose of acetaminophen will be lower, about 250-300 mg).


2. Acetylsalicylic acid (acetosal)
Other name: salicylamide. Acetosal is usually used as thrombolytic in small dose, but in larger dose its benefit is more used as an antipyretic and analgesic. Several common cold medicines combine acetosal and paracetamol (in reduced doses for each active ingredients, about 200-250 mg each). This combination offers defervescent and analgesic effect. Due to safety concern, acetosal-contained common cold medicine should be used carefully if given to children.


3. Dextromethorphan
Dextromethorphan (DM, DMP) is an antitussive, which works as central cough suppressant (i.e. raises threshold of cough). DMP does not affect respiratory cilia. That is the reason why this medicine should be used only for dry coughs. DMP is not recommended anymore in several developed countries and not recommended to suppress night-time cough-attack. DMP is only recommended for coughs in bronchitis; where cough attack must be suppressed to avoid further irritation to the respiratory tract, thus worsening the disease's progress.  Recommended dose is about 7.5-15 mg, 3 times daily, and this dose should not be exceeded.


4. Guaifenesin
Other name: glyceryl guaiacolate. This medicine is an expectorant, which increases fluid production from respiratory tract and also activate respiratory cilia movement. These mechanisms are useful to aid mucous excretion. So, this medicine is suitable for productive cough. Unfortunately, there is no clinical data about guaifenesin efficacy. Its benefit is more known empirically. Recommended dose is about 50-100 mg, to be taken 2-3 times daily.


5. Pseudoephedrine
This medicine is a stimulator of alpha and beta adrenergic receptor, which results in vasoconstriction effect and bronchial relaxation. Vasoconstriction may lead to alleviation of nasal congestion. This medicine is suitable for common cold with stuffed nose, with the dose about 30 mg 3 times daily. This medicine is also considerably safe for normotensive to mild hypertensive patients; but for more individualized choice of therapy, consult with your doctor.


6. Antihistamine
Antihistamine is more suitable for cough and cold due to allergic process. This medicine alleviate allergic reaction on respiratory tract, by reducing mucous production (alleviate runny nose) and reducing itching sensation on throat. Antihistamine does not alleviate stuffed nose. But actually, antihistamine is also given to cough and cold cases even when allergic process is hardly exist or absent. Maybe this component is used as synergic "partner" with pseudoephedrine, since antihistamine can enhance alleviation-of-stuffed-nose effect from pseudoephedrine with allergic suppression. Usual component to be used is chlorpheniramine maleate or CTM, with small dose of 1 or 2 mg.


7. Phenylpropanolamine

Other name: PPA. This medicine has similar structure with pseudoephedrine, also works as decongestant. That is the reason why this medicine is suitable for common cold with stuffed nose. In US, large dose of PPA had been withdrawn due to stroke risk. PPA for common cold dosage is not banned, but the dose is reduced to 15 mg (Kompas, March 16, 2009).


8. Classic cough syrup (black and white)

Main component of black cough syrup is succus liquiritae, which is an expectorant; is suitable for productive cough. Meanwhile, white cough syrup is mostly consist of oleum menthae piperithiae, which is usually used for children's cough. Both of these classic cough syrup are not available anymore for daily use. White cough syrup is not storable, due to fast denaturation.


Recommendation

1. Antihistamine with sedative effect is considered to be more suitable for common cold; due to presumably stronger decongestant effect.
2. Central cough suppressant is not recommended for common cold patients. This group of medicine is more suitable for bronchitic cough.
3. US has prohibited the use of over-the-counter common cold medicines, especially with DMP, for children under 4 years old.
4. Theoritically, common cold is a self-limited disease. Drink enough, rest enough, and eat properly; and the disease should resolve itself.
5. Watchful waiting for 3 days is recommended in common cold. If the fever gets higher, or if the patient's general condition is worsening; consider influenza. Influenza is a more serious condition, which needs more intensive care.
6. The clinical supplementation with zinc for common cold is still controversial, due to uncertainty data from clinical trials and many different forms of zinc used in clinical trials.


References:
Clinical Drug Data 11th edition, 2010
Rang & Dale's Pharmacology 7th edition, 2011