Ray D’Alonzo, Ph.D., is Manager of Doctoral Recruiting & University Relations and a former Associate Director of Research and Development at Procter & Gamble Pharmaceuticals where he has worked for 30 years.  He has led research programs in bone metabolism, infectious disease, respiratory disease, arthritis, and nutrition and has published scientific papers on a wide variety of topics from the chemical composition of fats and oils to the pharmacoeconomics of osteoporosis. Dr. D’Alonzo is the recipient of the Chancellor’s Medal from the University of Massachusetts, Amherst, in part, for his contributions to the development of new pharmaceutical agents. As both a patient and scientist, he has made a personal effort to increase the awareness of Chiari in the health care sector and to assist others afflicted with the syndrome.  He has published the story of his personal struggle with Chiari in a book, Contents Under Pressure, with 100% of royalties going towards Chiari education, awareness, and research programs.

November 30, 2007

Having an acute illness on top of Chiari can be a miserable situation and this time of year we are talking about the common cold and flu.  Having the common cold with Chiari can be particularly draining as only a Chiarian can understand.

So, what is the best way to get relief should you contract the cold or flu this winter?  Of course, you can always go to the doctor but most people don't, particularly if it is just the common cold.  So we typically find ourselves at the drug store trying to choose an OTC medication.  This can be an overwhelming task given the large number of products available and it is even harder to select a product when you are not feeling well.  So, I thought I would provide some information about cough cold products in a manner that simplifies this problem.

While there are many different products, there are only a handful of active ingredients.  When you understand what the active ingredients are it makes the task much easier until of course you bring comparative cost into the equation which is beyond the scope of this article.

There are 5 classes of cough/cold active ingredients as outlined below.  I have also listed the most common active ingredients in each class and the symptoms they treat.

The analgesics are all effective so select the one that provides you the most relief.  Be aware that they can cause GI side effects including ulcers although acetaminophen is the most stomach safe of the group.  It is also important to restrict alcohol intake when taking acetaminophen.  Do not take analgesics separately if you are taking a cough/cold product containing an analgesic to avoid over dosing.

Antitussives such as dextromethorphan are not very effective.  Also, the concept of suppressing cough is controversial as cough is the body's natural defense to expel foreign material and clear congestion.

The expectorant, guaifenesin, is not particularly effective.  In fact, the evidence that it works at all is scant and that's being generous.  Guaifenesin is an extremely old drug that was in widespread use long before the FDA came into existence.  It's approval by the FDA is on the basis of a single, old, and poorly designed study whose results have never been duplicated.  Other studies in the published medical literature are either seriously flawed or show that the drug doesn't work.  It is very safe on the other hand.  If you feel compelled to try it, at least buy the cheapest generic version you can find.  Given how old this drug is and the scant evidence of its effectiveness, the price of many products containing it borders on the outrageous.  The concept of a drug that helps expel mucus or thickened secretions is a great one but it needs to be more than a concept.  Doctors are very attracted to this concept but most have never seen the clinical data supporting its effectiveness.  This is also true of nearly all pharmacists.

There are only two decongestants on the market.  Of these, pseudoephedrine is more effective.  While it is approved as an OTC drug, you will not find it among the OTC products.  You have to ask the pharmacist for it as individuals are known to use the drug as a starting material for the preparation of illegal drugs.  Decongestants can increase heart rate and raise blood pressure.

All the antihistamines are effective but only if your congestion is due to allergy.  If you do not have an allergic component to your respiratory disease using an antihistamine will not help much if any at all.  The older antihistamines like chlorpheniramine and diphenhydramine can cause drowsiness which can be a good thing if you want to sleep but a bad thing if you have to drive or operate machinery.

My recommendation is simple, if hypertension or blood pressure is not a concern and if you do not suffer from congestion due to allergy, I recommend an analgesic and pseudoephedrine.  Many products also come in long-acting dose forms.  A long-acting product generally costs more but may be worth it if you have trouble complying with the recommended dosing regimen of the immediate release dose form products.

As everyone is different and the potential exists for drug-drug and drug-disease interactions, I recommend consulting your pharmacist when selecting OTC cough/cold medications.  If symptoms persist longer than a week, see your doctor.  However for those with cough, you may want to see your doctor sooner since it can be so debilitating with Chiari.

-- Ray D'Alonzo

 ** If you would like to share your comments, thoughts, or ideas with Ray,  please send them to dalonzo.rp@fuse.net.  Due to the volume and nature of email received, individual responses are not possible. **

[Ed. Note:  The opinions expressed above are solely those of the author.  They do not represent the opinions of the editor, publisher, or this publication.  Mr. D'Alonzo is not a medical doctor and does not give medical advice.  Anyone with a medical problem is strongly encouraged to seek professional medical care.]    
 

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