Analyzing the OTC Options for the Common Cold

DECEMBER 01, 2006
Monica Holmberg, PharmD

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Nearly everyone has experienced the discomfort of a scratchy throat, a stuffy nose, a hacking cough, and a pounding head. The common cold is estimated to occur a billion times each year.1 Fortunately, OTC remedies are available to alleviate or even shorten the duration of these nagging symptoms. Appropriate counseling by the pharmacist can guide the patient to select the right product to improve quality of life.

Etiology of the Common Cold

Over 100 different strains of rhinovirus have been attributed to the common cold. Infection usually begins when the virus enters the body through mucosa of the eye or nasal passages. From there, the virus is transported by cilia to the posterior nasopharynx and the epithelium of the nasal mucosa, where the virus quickly replicates. Cold symptoms usually manifest within 10 to 12 hours of initial infection.1

Traditional OTC Options

Patients suffering from the common cold can choose from a wide range of OTC products. Each class focuses on relieving specific symptoms of the common cold. It is important to note that these OTC agents are useful only in decreasing the discomfort of the cold symptoms and will not affect the virus or the duration of the cold.

•Analgesics (nonsteroidal antiinflammatory drugs, acetaminophen) offer relief of headache or body aches. Caution should be used in patients with renal or hepatic impairment, in patients using certain medications, or in patients with a history of or predisposition to gastrointestinal upset.2

•Oral or topical nasal decongestants (pseudoephedrine, phenylephrine, oxymetazoline) can alleviate sinus pressure or the "stuffed-up" feeling. These products should not be used by people with heart disease, hypertension, thyroid disease, diabetes, or enlarged prostate or by people using a monoamine oxidase inhibitor.3

•Antihistamines (chlorpheniramine, diphenhydramine, doxylamine) can relieve rhinitis. Patients using antihistamines should be aware of their sedating potential. understand the purpose of the medication

•Address any concerns or apprehensions the parent or child might have about the drug therapy

•Provide clear and thorough instructions on appropriate dose, administration, and storage conditions

•Describe how to identify potential adverse drug reactions and what to do if they should occur

•Explain what to do when a dose is missed

•Add a flavoring agent or recommend liquid or chewable tablet dosage forms

•Advise parents to check with a physician or pharmacist prior to using any other medications to prevent possible drug interactions

•Reinforce the importance of completing the entire course of therapy even if the child feels better

•Recommend the use of medication compliance devices such as pillboxes or timers

•Encourage the use of calibrated measuring devices to ensure accuracy of dosing

The American Academy of Pediatrics highly recommends the use of calibrated measuring devices for the administration of liquid medications.3 Parents and patients should be counseled on the appropriate use of these devices. Parents should always be reminded to read all labels and confirm the strength of all medication prior to administration because many nonprescription products formulated for infants are in the concentrated form. Failure to read labels can result in serious medication overdosages. Parents also should be reminded to check the expiration dates of medications prior to administration.

In addition to the many medications manufactured specifically for the pediatric population, the growing field of compounding pharmacy can meet some of the needs of the pediatric population by providing alternative dosage forms when applicable.


Through effective pharmaceutical counseling, the pharmacist can optimize therapy outcomes in the pediatric patient population. Pharmacists should always be prepared to meet the specific therapeutic needs of the pediatric patient population by making appropriate clinical assessments. It is imperative that pharmacists be responsible for thoroughly educating both the parent and child about the proper administration of the drug therapy. Patients also should be encouraged to adhere to the instructions provided to them to reduce the incidence of drug errors. When pediatric patients and their parents are equipped with the essential knowledge about the condition and the drug therapy, they become empowered and remain committed to being proactive with regard to their health.

Dr. Holmberg is a pharmacist with Phoenix Children's Hospital, Phoenix, Ariz.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Rybovic, Pharmacy Times, Ascend Media Healthcare, 103 College Road East, Princeton, NJ 08540; or send an e-mail request to:

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