It is cold and allergy season again. As we cough, sneeze and scratch our way through fall and winter, drug companies predictably will overwhelm us with their pitches to buy their brand of OTC drugs for relief. Unfortunately, shopping for OTC medications by brand name is unnecessarily expensive and often leads to the consumption of unnecessary and potentially dangerous drugs. Despite the dizzying array of over the counter (OTC) medications available to treat allergies and the common cold, the educated consumer really needs only to make a few, well informed choices to both effectively treat symptoms and to save money. Unfortunately, drug manufacturers complicate what should be a relatively simple selection by creating innumerable mixed drug formulations and promoting their products using a complicated and illogical set of brand names. In order to dissect the OTC market for colds and allergies, one must understand a few basic principles. Firstly, unlike food supplements (about which I will write in the future), OTC medications are reviewed and approved by the FDA, and are considered generally safe and effective when taken as directed. All OTC medications have a unique chemical or generic name, a set of FDA approved indications, and an FDA approved OTC dosing. “Old” OTC medications are generally “off patent” and are available in multiple products, in multiple formulations, and are marketed under a variety of brand names. More recently approved OTC medications, often converted from prescription to OTC, may still be covered by a patent allowing the parent company to market the drug exclusively (at a much higher price). Note also that approved OTC drug doses are often half of those approved for “prescription strength” versions of the same medications that one can often achieve “prescription strength” by doubling the approved OTC dose (not recommended except on the advice of your physician). One also needs to understand that once a given generic medicine is approved for OTC use and is off patent, any drug company may produce and/or incorporate it into its branded (or unbranded) OTC medications. Appended to this post is a table designed to help demystify the dizzying array of OTC drugs marketed for allergies and colds. Note that drug company marketing language is often a clue to the classes of medications included in their particular branded formulation:
- “Runny nose and itching from a cold” -> first generation antihistamine
- “Non-sedating runny nose and itching from allergies” -> second generation antihistamine
- “Attacks multiple causes of nasal allergies, not an antihistamine” -> intranasal corticosteroid spray
- “Nasal stuffiness and congestion” -> sympathomimetics, usually phenylephrine
- “Fever, aches and pains” -> acetaminophen and/or other non-steroidal anti-inflammatory drugs (NSAIDs)
- “Cough” -> dextromethorphan and/or guaifenesin
Treating more symptoms is NOT always better than targeted therapy. Also, targeted therapy is often a lot more inexpensive. For colds or URIs (upper respiratory infections), an informed consumer should consider purchasing separately 1) a generic version of a 1st generation antihistamine, 2) generic psuedoephedrine, 3) either acetominophen or another OTC NSAID, and (possibly) 4) dextromethorphan +/- guaifenesin. Then these four medicines can be selected and taken together to treat the exact symptoms that one is experiencing. Also the 1st generation antihistamine can be combined with acetominophen or any of the other NSAIDs to create a “pm” or “nighttime” version of the pain reliever. Finally, for non-infectious, allergic symptoms, one can combine a second generation antihistamine with a decongestant to find rapid acting relief. However, if one can wait for two to three days for maximum effect, or one can anticipate the timing for the exposure to the allergen, nasal corticosteroid sprays are almost always more effective and better tolerated than the oral medications. For a detailed description of the various OTC medications used to treat allergies and colds, please review the appended table that I have prepared. Note that despite the marketing claims, not all of the OTC medications are equally effective at treating the symptom that they claim to mitigate.