Cold medicines are a group of medicinal taken individually or in Combination drug as a treatment for the symptoms of the common cold and similar conditions of the upper respiratory tract. The term encompasses a broad array of drugs, including , and , among many others. It also includes drugs which are marketed as cough suppressants or antitussives, but their effectiveness in reducing cough symptoms is unclear or minimal.
While they have been used by 10% of American children in any given week, they are not recommended in Canada or the United States in children six years or younger because of lack of evidence showing effect and concerns of harm.
Types
There are a number of different cough and cold medications, which may be used for various coughing symptoms. The commercially available products may include various combinations of any one or more of the following types of substances:
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Mucokinetics, or mucolytics, are a class of drugs which aid in the clearance of mucus from the airways, lungs, bronchi, and trachea. Examples are carbocisteine, ambroxol, and bromhexine.
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are substances claimed to make coughing easier while enhancing the production of mucus and phlegm. Two examples are acetylcysteine and guaifenesin.
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Antitussives, or cough suppressants, are substances which suppress the coughing itself. Examples are dextromethorphan, benzonatate, codeine, hydrocodone, pholcodine, noscapine, cloperastine, and butamirate.
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, for allergic rhinitis, may produce mild sedation and reduce other associated symptoms, like rhinorrhea and watery eyes. Examples are diphenhydramine, chlorpheniramine, brompheniramine, loratadine, and cetirizine.
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may improve nasal congestion in sinus infections. Examples are ephedrine, phenylephrine, pseudoephedrine, and oxymetazoline.
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Antipyretic or Analgesic medication. Examples are paracetamol (acetaminophen) and NSAIDs such as ibuprofen or naproxen.
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Also employed are various substances supposed to soften the coughing, like honey or supplement syrup.
An example combination is guaifenesin with codeine.
Effectiveness
The efficacy of cough medication is questionable, particularly in children.[Medsafe cough and cold group ][ A 2014 Cochrane review concluded that "There is no good evidence for or against the effectiveness of OTC over medicines in acute cough".][ There is not enough evidence to make recommendations for those who have a cough in cancer.]
Medications
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Dextromethorphan (DXM) may be modestly effective in decreasing cough in adults with viral upper respiratory infections. However, in children, it has not been found to be effective.
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Codeine was once viewed as the "gold standard" in cough suppressants, but this position is now questioned.
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A number of other commercially available cough treatments have not been shown to be effective in viral upper respiratory infections. These include for adults: antihistamines, antihistamine-decongestant combinations, benzonatate, anti asthmatic-expectorant-mucolytic combinations, expectorant-bronchodilator combinations, leukotriene inhibitors, ambroxol, and guaifenesin, sometimes with analgesics, antipyretics, anti inflammatories, and anticholinergics; and for children: antihistamines, decongestants for clearing the nose, or combinations of these and leukotriene inhibitors for allergy and asthma.
Alternative medicine
A small study found honey may be a minimally effective cough treatment due to "well-established antioxidant and antimicrobial effects" and a tendency to soothe irritated tissue.[ Honey's use as a cough treatment has been linked on several occasions to infantile botulism and accordingly should not be used in children less than one year old.]
Many alternative treatments are used to treat the common cold, though data on effectiveness is generally limited. A 2007 review states that, "alternative therapies (i.e., Echinacea, vitamin C, and zinc) are not recommended for treating common cold symptoms; however, Vitamin C prophylaxis may modestly reduce the duration and severity of the common cold in the general population and may reduce the incidence of the illness in persons exposed to physical and environmental stresses."
Evidence supporting the effectiveness of zinc is mixed with respect to cough.
Recreational usage
Cough medicines, especially those containing dextromethorphan and codeine, are often abused as recreational drugs.[ Abuse may result in hallucinations, loss of consciousness and death. Many cough syrups can contain acetaminophen which will cause liver damage in recreational users. ]
Adverse effects
A number of accidental overdoses and well-documented adverse effects suggested caution in children.
Decongestants are possibly harmful to people with high blood pressure or a heart disease because these substances can constrict the blood vessels.
History
Heroin was originally marketed as a cough suppressant in 1898.
Society and culture
Brands
Some brand names include: Benylin, Sudafed, Robitussin and Vicks among others.[ The Thai company Hatakabb produces the Takabb Anti-Cough Pill, which is a Chinese herbal medication.]
Sudafed is a brand manufactured by McNeil Laboratories. The original formulation contains the active ingredient pseudoephedrine, but formulations without pseudoephedrine are also being sold under the brand. In 2016, it was one of the biggest selling branded over-the-counter medications sold in Great Britain, with sales of £34.4 million.
Gee's Linctus is a cough medicine which contains opium tincture.
Coricidin, Coricidin D, or Coricidin HBP, is the brand name of a combination of dextromethorphan and chlorpheniramine maleate (an antihistamine). Varieties may also contain acetaminophen and guaifenesin.
Codral is a brand name manufactured by Johnson & Johnson and sold primarily in Australia and New Zealand. Codral is the highest-selling cold and flu medication in Australia.
Economics
In the United States, several billion dollars are spent on over-the-counter products per year.
Poisoning
According to The New York Times, at least eight mass poisonings have occurred as a result of counterfeit cough syrup in which medical-grade glycerin has been replaced with diethylene glycol, an inexpensive, yet toxic, glycerin substitute marketed for industrial use. In May 2007, 365 deaths were reported in Panama, which were associated with cough syrup containing diethylene glycol.
In 2022, the US Food and Drug Administration issued a warning against cooking foods in cough syrup after a video of someone preparing "NyQuil chicken", sometimes also called "sleepy chicken", became popular on social media. Cough syrup is designed to be stored at room temperature and its properties can change when it is heated, making it potentially deadly. Heated cough syrup can also vaporize, leading to inhalation hazards.
See also
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Nin Jiom Pei Pa Koa, a Chinese herbal cough syrup
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Throat lozenge
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Toxic cough syrup
