Cold Advice

New Guidelines: Don't Bother With OTC Cough Meds

We've all had it: a cold with a nagging cough. So you go to the drugstore for some cough syrup.

Not so fast, suggests a new set of treatment guidelines from the American College of Chest Physicians (ACCP). Taking over-the-counter (OTC) cough medicine may do no good for a cough tied to the common cold, the report states. Adults are better off taking naproxen (sold under several brand names including Aleve) or an older antihistamine that contains ingredients found in brands such as Benadryl and Chlor-Trimeton. And children shouldn't take OTC cough and cold medications at all, states the report.

The news affects millions of people who self-treat with drugs that the new report says lack evidence proving they work. About 29.5 million doctors' visits every year in the United States are due to cough, according to the ACCP. Consumers spent about $3.4 billion on cough and cold medicines in 2004, according to the Consumer Healthcare Products Association, a trade group that represents distributors and manufacturers of OTC medicines and nutritional supplements.

But the "don't bother" advice applies only to those with coughs due to the common cold, not due to chronic conditions such as asthma or other diseases, said Richard Irwin, professor of medicine at the University of Massachusetts Medical School and chairman of the committee that revised the guidelines.

The report says that components of many OTC cough medicines and cough drops -- including expectorants (which thin mucus), suppressants (meant to block the cough reflex) and zinc -- were not effective. These ingredients include guaifenesin (found in Robitussin and other cough remedies) and dextromethorphan (found in Robitussin, Vicks, Triaminic, Sucrets and other drugs).

But the report also found that naproxen does quiet cough tied to the common cold.

This was surprising but welcome news to Richard Colgan, associate professor in the department of family medicine at the University of Maryland School of Medicine in Baltimore. "Many of us would not have reached for that pill for someone who is having a cough," Colgan said.

The guidelines, updated for the first time since 1998, make first-ever recommendations for children with common colds. Kids 14 and under shouldn't take OTC cough and cold medicines because they're not effective and may be harmful, states the report.

Some medications that have a sedating effect in adults, for instance, can cause a child to become dangerously hyperactive, putting them in a "situation where they're agitated and not thinking clearly [and] they could really get hurt," Irwin said.

The recommendations are based on an extensive review of published, randomized, controlled clinical trials. The panel evaluated only trials that met this gold-standard quality, Irwin said.

The recommendations also suggest adults up to age 65 get a new whooping cough vaccine. Cases of whooping cough (also known as pertussis) are increasing worldwide, Irwin said.

Older antihistamine and decongestant combinations (such as brompheniramine and pseudoephedrine) -- which can make you sleepy -- help relieve cough, even though they're not usually marketed for that purpose, states the report. But newer non-drowsy antihistamines -- such as loratadine, found in Claritin -- are ineffective at reducing cough tied to the common cold, Irwin said.

People considering any of these drugs need to be aware of side effects. And anyone with high blood pressure should steer clear of decongestants, which can drive up blood pressure, unless a doctor says it's okay.

Wyeth Consumer Healthcare, maker of Robitussin, defended its products, saying the drug has been found to be "safe and effective" by the Food and Drug Administration, said Fran Sullivan, a spokesman for the company. "Robitussin has a long history of consumer use and acceptance, and we don't believe that patients would purchase and repurchase this product if it didn't work for them," Sullivan said.

The Consumer Healthcare Products Association issued similar reassurances, adding that OTC cough and cold medicines "play a valuable role in helping consumers combat their cold symptoms," according to a statement from the group.

But it may not be necessary to take anything at all if your cough is due to a simple cold, experts said.

The "natural history" of the common cold means that cough is "worst in the first few days of the cold," said Irwin. If on the second or third day you take an OTC cough medicine and then, one to two days later, "you start feeling better, you think it's due to the drug," Irwin said. But studies show that your body will likely get better on its own.

Some doctors interpreted the findings to be helpful but said they shouldn't necessarily alter patients' behavior or buying habits.

"It's very reasonable to go to the drugstore and get something over the counter" when you have a cold, said Gene Colice, professor of medicine at George Washington University Medical School and director of respiratory services at Washington Hospital Center. The drugs may not work as well as prescription medications, but may still provide some relief, he said.

Patients often go to the doctor's office "looking to see that they're not taking the wrong thing," said Colgan. So if a patient with a common cold is taking one of these OTC medicines and "feel[s] like they're getting better, I'm likely to let them know that it's fine to continue taking it as long as they feel it's working," he said.

But when it comes to your child, "literature shows that not a lot works for the common cold in kids," said Irwin.

Instead, parents should try to assess if the child looks truly uncomfortable. "Is the runny nose [or] cough getting in the way of them playing, sleeping, going to school?" Colgan said. If cold symptoms aren't very "intrusive, there may not be a reason to treat it."

Parents who reach for a cough and cold medicine for their child, Colgan said, "may be doing nothing else other than making themselves feel better." ·

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