December Newsletter Quintarious Perdue Pharm. D Candidate 2017

PharmPhacts: OTC

Cough and Cold Products for Patients with High Blood

Pressure

As we all know, cough and cold season is upon us once again. On average, adults get the common cold about 4 to 6 times per year. More In this Issue than 200 viruses are associated with causing the common cold and its symptoms. The common cold can last anywhere between 7 to 14 days. If Cough and Cold Symptoms symptoms persist beyond 14 days or if a fever Overview…………………1-2 (temp of ≥101˚F) develops during any time, it is Available Products……..3-4 best to go to the doctor as these are signs of an Products for Patients with infection. There are numerous symptoms that High Blood Pressure…….5-6 accompany the common cold including: References……………….6 cough, head and chest congestion, and sneezing/runny nose. It is difficult to find the best product(s) to treat the common cold especially when there are products that should be avoided based on your health conditions.

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Cough

A cough is an involuntary response and attempt by the body to remove irritating substances from the airways before reaching the lungs. Common causes of cough with the common cold is often due to sinus drainage and the attempt to clear mucus from the chest and airways. There are two types of coughs. A dry cough is a persistent cough that does not produce any mucus, whereas a productive cough is the opposite. Productive coughs should not be suppressed because that is your body’s way of clearing out germs in your airways. It is safe to suppress a dry cough; however, productive coughs should only be suppressed when it is preventing you from performing day to day activities or sleeping soundly at night.

Common products used to treat a dry cough are cough suppressants such as Delsym and antihistamines such as Benadryl. Productive coughs produce mucus and the best product for a productive cough is Mucinex. Mucinex contains guaifenesin which works to thin the mucus, thus making it easier for you to cough it up and clear it from your airways.

Congestion

Congestion occurs when the nasal passages become swollen which makes it difficult to breathe. Runny nose occurs commonly with congestion. These symptoms can be treated with oral decongestants and nasal sprays, such as Sudafed and Afrin, antihistamines, and expectorants such as Mucinex. Congestion also causes headaches due to the pressure in your nasal passages. Available products to treat the headache are Motrin, Advil, Aleve, and Tylenol.

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Sneezing PRODUCTS Sneezing is an involuntary response similar to coughing that is an attempt by the body to

remove certain irritating substances from the Cough Suppressants airways. Sneezing along with an itchy throat is one  Delsym of the common signs of the beginning of a cold. It  Mucinex DM is important to note the difference between  Robitussin DM sneezing due to a cold versus seasonal allergies as

sneezing is a common symptom for both. Seasonal allergies are often accompanied with itchy and Decongestants watery eyes whereas these symptoms are absent  Sudafed with the common cold, and the sinus drainage in  Afrin  Sudafed PE the back of the throat usually occurs before the  Neo-Synephrine sneezing with the common cold.

Antihistamines

Available Products  Benadryl  Zyrtec  Claritin  Allegra There are numerous products available for treating  Chlor-Trimeton cough and cold symptoms. Common cough

suppressants contain the active ingredient dextromethorphan which works to suppress the Anesthetics cough. Common decongestants contain either  Tylenol phenylephrine or pseudoephedrine. These active  Advil ingredients work to decrease the swelling in the  Motrin  Aleve nasal passages caused by the inflammation from the common cold. Antihistamines work by “drying up” the drainage from the sinuses and also reducing the sneezing. Certain antihistamines such as Benadryl and Chlor-Trimeton can cause drowsiness, dry mouth, and trouble going to the bathroom. However, Zyrtec, Claritin, and Allegra

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are newer antihistamines that are not associated with those side effects and will work to do the same thing. Occasionally, a sore throat may develop from the frequent coughing during the cold. Pain relievers include Tylenol, Advil, Motrin, and Aleve which work to reduce and relieve the pain. It is important to follow the instructions available on the back of the boxes and to ask your pharmacist if you need assistance on how to use the products.

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High Blood Pressure Cough and Cold Products

Generally all cough and cold products are safe to take in patients with high blood pressure. However, decongestants that are taken by mouth such as pseudoephedrine and phenylephrine can raise blood pressure when used. Typically oral decongestants should be avoided during product selection unless a physician has decided that your blood pressure is safely controlled on blood pressure medication. When it comes to pain relievers, Tylenol is the best and safest for patients with high blood pressure unless a physician has given permission for you to take other products such as Advil and Aleve. Advil and Aleve contain Ibuprofen and Naproxen respectively. These medications are known as NSAIDs and can also raise blood pressure from long-term use.

Do not worry as there are some safer alternatives…

Afrin

Afrin contains the active ingredient oxymetazoline. Oxymetazoline works the same as pseudoephedrine and phenylephrine. The only difference is that it is a nasal spray decongestant instead of oral which decreases the risk of raising blood pressure. Afrin is used twice daily for no more than three days. The reason for this specific duration is that oxymetazoline can cause congestion to return or worsen with long-term use beyond 3 days.

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Neo-Synephrine

Neo-Synephrine contains phenylephrine in the form of a nasal spray. Neo- Synephrine can be used more frequently throughout the day (up to 6 times) than Afrin. However, Neo-Synephrine should not be used more than three days for the same reason as Afrin.

Tylenol

Tylenol is a common known pain reliever that contains acetaminophen. Acetaminophen works to relieve pain without the risk of raising blood pressure. Acetaminophen can be taken every 4 to 6 hours a day, and it is important not to exceed no more than 3,000 mg/day. It is also important to take note of combination products, both prescription and OTC, that contain acetaminophen as that can add to the daily dose as well. Tylenol is available in regular strength (325mg) and extra strength (500mg). It is important to know which strength you are taking to avoid exceeding the maximum dose.

Coricidin HBP Products

Coricidin is a brand product that is decongestant free specifically for patients with high blood pressure. Coricidin usually contains a combination of a pain reliever, cough suppressant, antihistamine, and an expectorant depending on which product you are purchasing. The expectorant that is in these products is guaifenesin and the medication works by breaking up the mucus in the chest, making it easier to cough up and relieve chest congestion. It is important to drink plenty of water while using products containing guaifenesin.

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References http://www.mayoclinic.org/diseases-conditions/common-cold/symptoms-causes/dxc-20199808

Worrall, Graham. “Common Cold.” Canadian Family Physician 57.11 (2011): 1289–1290. Print. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215607/ http://www.webmd.com/cold-and-flu/cold-guide/

Acetaminophen [updated 2016] Oxymetazoline [updated 2016] Phenylephrine [updated 2016]. In Lexi-Drugs. [AUHSOP Intranet] Hudson (OH): Lexi-Comp, Inc,; [accessed 12/10/16] http://online.lexi.com/lco/action/home

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