Cough and Cold Medicines

I have just the thing for that cold … Over-the-Counter Cough and Cold Medicines

When you are suffering from a terrible cold, that long aisle at the drugstore with its myriad cough and cold remedies appears promising. The various pills and syrups promise to improve your stuffed-up or runny nose, your hacking cough, your scratchy throat, or all of the above. Yes, please! But you may find it hard to know which one will work best. What might be even harder to grasp is that none of these medicines will actually cure your cold. Colds and coughs are almost always caused by viruses, and none of the medicines on the drugstore shelf are designed to kill viruses. Instead, they are supposed to help with your symptoms, such as making your nose run less or relieving your congestion.

Antihistamines are one type of medicine commonly used to treat the symptoms of the common cold. When scientists looked at combined results from thirty-two studies of antihistamines involving almost 9,000 people, they do not find any improvement overall from using an antihistamine by itself for either children or adults. In the small subset of patients who did report some improvement after taking an antihistamine, 81 percent of the patients still had cold symptoms even with this improvement. For children, antihistamines did not perform any better than a placebo in any of the studies.

Many over-the-counter cough and cold medicines are combined medicines that include both an antihistamine and a decongestant. In studies involving children, these combined antihistamines and decongestants did not have any effect; they simply did not improve cold symptoms for children under five. For older children and adults, though, there was a small benefit. Similarly, decongestants alone seem to have some benefit for patients with colds. So, if you want to improve your nasal stuffiness or congestion, a combined antihistamine and decongestant or a decongestant alone might help you, but an antihistamine alone will not make a difference.

Some studies have shown that nasal sprays can relieve congestion for approximately one day, but there is no evidence that using them again and again will help you. In fact, many people develop a “rebound” runny nose or congestion when they use these nasal decongestants for more than one or two days.

When it comes to medicines that relieve your cough (antitussives), we again find that most do not work when you look at the science. A review of studies evaluating what helps or does not help with coughs in adults found that codeine did not help with coughs any more than a placebo or fake medicine did. Another common anti-coughing medicine called moguisteine did not work either. There was some evidence that a medicine called dextromethorphan (you see this in medicines labeled “DM”) did help with coughs; two of the studies showed that dextromethorphan worked better than a placebo, though one study did not show that dextromethorphan helped at all. That is not a ringing endorsement for dextromethorphan, but at least there is the possibility that it works. For children, none of these anti-coughing medicines seems to work at all, including codeine and dextromethorphan. Studies of other pediatric cough syrups did not show any benefits for children’s coughs or other symptoms.

Another kind of medicine for coughs is an expectorant. An expectorant helps to dissolve or thin your mucus, which may make it easier to cough up that nasty stuff in your lungs. For adults, one type of expectorant called guaifenesin seems to help those who take it four times a day to cough less hard and less often; however, there is no evidence that this type of medicine works for children.

You may have noticed that children do not seem to benefit from any of these medicines. Although over-the-counter cough and cold medicines are frequently used in children, the scientific data suggest that they do not actually work! In six randomized placebo-controlled studies testing the use of cough and cold medicines in children under the age of twelve, the scientists could not find any difference between taking a cough and cold medicine or taking a placebo medicine. No one knows exactly why these medicines do not work for kids, but the science is clear that they do not!

Even worse than not working, these medicines have a higher risk of negative side effects in children, especially in the youngest children. In safety data from the United States Food and Drug Administration (FDA) that report on the use of these medicines over the course of thirty-seven years (1969–2006) for children younger than six, fifty-four children were deemed to have died because of side effects from decongestants and sixty-nine died from side effects from antihistamines. Usually, an overdose of these medicines was responsible for the child’s death. Children can actually die from these medicines! Many more children have bad side effects from these medicines that do not kill them, but that require medical treatment. In the United States in 2004–2005, 1,519 children under the age of two had to go to the emergency room for treatment because of negative side effects from over-the-counter cough and cold medicines. These side effects can include serious conditions like abnormal heart rhythms and loss of consciousness. Because of these bad side effects (and also because these medicines don’t work!), the FDA has issued more strict advisories cautioning against the use of these medicines in young children, especially for children less than two years old. As pediatricians, we advise you not to give your babies and toddlers these medicines. And talk to your doctor before you administer them to your older children.

In conclusion, no over-the-counter medicines for colds and cough are effective for kids, and many are not effective even for adults. Dextromethorphan and guiafenesin for cough, antihistamine-decongestant combinations for general symptoms, and at least the first dose of nasal decongestants may offer some benefit for adults. For children, none of these medicines offers clear benefits and many have been associated with bad side effects, so they are best avoided altogether.