Overview of OTC Options for Managing Cold and Flu Symptoms

With the ongoing cold and flu season combined with spiking COVID-19 cases, patients are increasingly reaching out to pharmacists asking for OTC recommendations. Symptoms such as a stuffy nose or sore throat are common and can typically be treated with OTC products.

Some examples of drug classes these products typically contain are cough suppressants, antipyretic, antihistamines, nasal decongestants, or a combination of these products to provide multi-symptom relief. Before making recommendations there are a few things a pharmacist should verify to provide the best care.

When first beginning an encounter with a patient, it is important to determine which products can help with symptom management. When assessing possible treatments, it is important for the pharmacist to consider not only the patient’s current medication treatments, but also other OTCs and disease states.

It is also important to counsel patients on the risk of duplicate therapy to avoid exacerbating possible adverse effects. After gathering information regarding the patient’s current medications and allergies, the pharmacist can then consider OTC options.

It is important to note that many of these products are sold as morning and nighttime due to the ingredients contained. Morning formulations typically contains a mucus expectorant, such as guaifenesin, to help break up mucus.

This is opposed to nighttime formulations which tend to exclude a nasal decongestant due to the stimulating effects that may cause difficulty falling asleep. Instead, antihistamines, specifically first generation which have the greatest risk of sedation are used at bedtime to help promote sleep.

Examples of commonly used ingredients:

• Anti-pyretic/pain reliever (acetaminophen), AM/PM use
• Anti-pyretic/pain reliever (ibuprofen), AM/PM use
• Cough suppressant (dextromethorphan), AM/PM use
• Nasal decongestant (phenylephrine), AM use
• Antihistamine (doxylamine, chlorpheniramine), PM use

Note: if symptoms worsen or last longer than 10 days advise the patient to speak to a physician.

Other helpful interventions include:

• Nasal saline for dry nose
• Chapstick for dry lips
• Gargling salt water
• Drinking hot tea or using cough lozenges to sooth sore throat
• Drinking plenty of water or using Pedialyte if vomiting or diarrhea occur and electrolyte replenishment is necessary.
• Using a cool mist humidifier to help reduce respiratory irritation.
• Resting as much as possible.

Listed in below are some key points to keep in mind when recommending products for patients that are considered a special population or if there are certain disease states present.

Special considerations

• Hypertension
  • Avoid nasal decongestants (pseudoephedrine, ephedrine, phenylephrine, naphazoline, oxymetazoline).
  • Be aware of possible high sodium content.
  • Recommended: Coricidin HBP or generic equivalent for multi-symptom relief.
• Pain management
  • Tylenol content plus mixing OTC amount: Important for patients who take medications that contain acetaminophen, such as hydrocodone/APAP, oxycodone/APAP, or use Tylenol frequently for pain management.
  • Max daily dose: Less than 4 grams of acetaminophen.¹
• Pregnancy
  • In general, patients should avoid using non-steroidal anti-inflammatory drugs while pregnant and avoid alcohol-containing products when possible. Patients should use products that address specific symptoms.²
• Pediatric
  • No salicylate derivatives/aspirin.
  • This can lead to Reye syndrome, commonly linked to pediatric patients recovering from the flu or chicken pox. Symptoms include nausea, vomiting, headache, excitability, delirium, combativeness, and coma.^3,4
  • Recommended: Children’s Tylenol or generic, dosing is based on weight.⁵

Sources:

1. https://reference.medscape.com/drug/tylenol-acetaminophen-343346
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377219/
3. https://www.aafp.org/afp/2009/1215/p1472.html
4. https://www.uptodate.com/contents/aspirin-pediatric-drug-information
5. https://medlineplus.gov/ency/patientinstructions/000783.htm

About the Authors

Tiffany DiMaggio is a PharmD Candidate at Duquesne University in Pittsburgh, PA, anticipated to graduate in Spring 2022.

Jonathan Ogurchak, PharmD, CSP, is the CEO and cofounder of STACK, a pharmacy information management platform, and serves as preceptor for a virtual Advanced Pharmacy Practice Experiential Rotation for specialty pharmacy, during which this article was composed.