A Pharmacist's Guide to OTC Therapy

FEBRUARY 01, 2007
Yvette C. Terrie, BSPharm, RPh

Cough, Cold, and Flu Products

A multitude of nonprescription products are currently available for alleviating the discomfort from the symptoms associated with the common cold or the flu, which include coughing, fever, chills, sore throat, nasal and chest congestion, sneezing, extreme fatigue, and aches. Product formulations are marketed as single-entity products or multisymptom relief products (Table).

Although, traditional dosage forms such as liquids, tablets, and capsules are still widely used, product manufacturers have also developed formulations such as oral disintegrating tablets, chewable tablets, nasal swabs, nasal strips, topical vapor patches, and dissolvable medicated strips that are applied to the tongue. Examples of new cold products include Mucinex Mini-Melts (Adams Respiratory Therapeutics Inc) for children, which are innovative, quick-dissolving flavored granules that are easy to swallow; Zicam's Cold Rapid Melts with Vitamin C (Matrixx Initiatives Inc); and Theraflu's Warming Relief Syrups (Novartis Consumer Health Inc). In addition, McNeil Consumer Health Inc has a few new Tylenol Cold formulations.

These new formulations meet the needs of many patients by providing convenient administration, accurate dosing, and easy-to-use drug delivery systems to accommodate busy schedules. Whereas formulations of cold products containing pseudoephedrine are available behind the counter, many manufacturers have also added new formulations that contain phenylephrine instead of pseudoephedrine.

Selection of these products should be based upon the patient's symptoms, concomitant medical conditions, and current drug regimen, as well as lifestyle and personal preferences. Pharmacists should always screen for potential drug interactions, as well as possible contraindications, and make recommendations accordingly. It is important to ensure that patients are thoroughly counseled on the proper use of these products, especially products for the pediatric patient population. To ensure accuracy, patients should be reminded to always utilize calibrated measuring devices when administering liquids. To prevent serious medication errors, parents and caregivers should always be reminded to read labels prior to administration, since many infant drops are in concentrated form.

In addition to assisting consumers in the proper selection of cough, cold, and flu products, pharmacists can reinforce the importance of utilizing nonpharmacologic measures to provide relief of cold and flu symptoms, such as vaporizers or humidifiers, nasal irrigation solutions, and adequate hydration and rest. Also, it is beneficial to make patients aware of methods to potentially reduce or prevent further transmission of colds or influenza, such as routine hand washing, avoiding direct contact with an individual with a cold or the flu, and always sneezing or coughing into a tissue and not into the hand. Patients should be referred for medical attention from their primary health care provider when necessary, especially if symptoms appear to worsen or linger.

Wound Care Products

In general, the self-treatment of minor wounds is acceptable for many patients if cared for properly. Pharmacists are in a pivotal position to guide patients on the proper selection of products, as well as to ascertain the appropriateness of self-treatment and to direct patients to seek medical attention when warranted. Currently there are a variety of nonprescription products available for the treatment of minor wounds. These wound care products include topical antibiotics, wound irrigants, wound antiseptics, various types of bandages, and products that aid in reducing the appearance of scars (Table). The overall goals of wound care treatment are to promote healing, prevent infection or further complications, and minimize the effects of scarring.1

Overall, wounds that can be self-treated include minor scrapes, scratches, cuts, and insect bites. General care of minor wounds typically includes the following 3 steps:

1. Cleanse the affected area thoroughly with soap and water.

2. Apply an antibiotic ointment to the wound to prevent infection.

3. Cover it with a sterile bandage to create a moist healing environment to promote healing and minimize incidence of scarring.

Role of the Pharmacist

When counseling patients about wound care products, it is imperative for pharmacists to ensure that patients are thoroughly educated about the proper use of these products, including the recommended duration of use. For years, many individuals believed that minor wounds should be left uncov- ered to heal more quickly. Research has shown, however, that uncovered wounds increase chances of scarring and possible infection and reinjury. Recent research has demonstrated that a moist healing environment will accelerate healing and may minimize scarring as well as reduce incidence of infection.2,3 Therefore, it is important to remind patients to properly cover minor wounds with appropriate wound dressing products, such as Johnson & Johnson Band-Aid, Nexcare, or Curad products.

It is also important for pharmacists to remind patients with diabetes or those individuals currently taking medications that may impair the healing process to adhere to minor wound care protocols and to encourage them to seek the advice of their primary care provider. Individuals should always be advised to seek medical care for wounds that do not exhibit any signs of healing after 5 days of self-treatment or if the wound shows signs of infection, including redness or swelling.

Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.


1. Bernard D. Minor wounds and secondary bacterial infections. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006. Chapter 42:870-886.

2. Neosporin Web site. Available at: www.neosporin.com/firstaid/pdf/sciencefactsheet.pdf.

3. Wound Healing Popular Myths. Band-Aid Web Site. Available at: www.band-aid.com/popular_myths.shtml.