Primary Care in Rochester and Kasson

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OTC safety: What to know during cold & flu season

3/8/2018 by Lindsey Greiner, PharmD, RPh


With cold and influenza (flu) season in full swing, you may be looking for over-the-counter (OTC) medications to treat your symptoms. Cough and cold medications can help alleviate these symptoms, but before taking them, it’s important to:

  • Read the labels so you know exactly what you’re taking. Many products contain several ingredients, and you may not need all of them.
  • Understand possible risks and side effects.
  • Ask your care team if these products are safe to take with your prescription medications.

Here are some of the main types of OTC medications for treating cold and flu symptoms:


OTC decongestants are taken for the temporary relief of congestion or “stuffiness”. Many products labeled “PE” contain a decongestant. Two common ones are pseudoephedrine and phenylephrine. Pseudoephedrine is more effective than phenylephrine. It’s available without a prescription, but sold behind the pharmacy counter and requires a photo ID to buy it.

If you have high blood pressure, heart disease or are at risk for heart disease, use decongestants with caution. Side effects include high blood pressure, palpitations, a fast heartbeat, insomnia, and increased anxiety. Older patients may be more likely to get these side effects.

Nasal spray formulations, such as oxymetazoline (Afrin), can relieve congestion with less impact on blood pressure, but are associated with “rebound” congestion if used more than five days. Other side effects include sneezing, nasal irritation and a dry nose.


Antihistamines sometimes are used for sneezing or a runny nose. Diphenhydramine (Benadryl), chlorpheniramine and clemastine are older antihistamines often found in cough and cold products, including “nighttime” formulations to help you sleep. Side effects include confusion, dry mouth, constipation, sleepiness and falls in older people. Antihistamines also can cause palpitations and a fast heart rate. People with a history of high blood pressure or heart disease should use them with caution.

Newer antihistamines, such as loratadine, cetirizine and fexofenadine, generally aren’t effective treating coughs from an upper respiratory infection and aren’t recommended.

Cough suppressants

Decongestants and antihistamines treat your cough by reducing post-nasal drainage, nasal congestion and discharge. But non-medication options, including nasal saline rinses or chamomile tea with honey and lemon, also can be effective in easing your cough. Saline rinses should be mixed according to package instructions and administered through a clean squeeze bottle or neti pot to wash away debris or mucus. A saline nasal spray doesn’t reach the back of the nose as well as a rinse.

Dextromethorphan, often noted as “DM” on the label, may be helpful in treating a cough, but studies on its effectiveness are mixed. For liquid formulations, be sure to use the dosing cup provided with the bottle, which will give you an accurate dose. If you have diabetes, look for sugar-free cough formulations to avoid increasing your blood sugar.

People who take certain medications for depression may experience a rare side effect called serotonin syndrome. Contact your care team or seek immediate medical attention if you develop symptoms such as confusion, sweating, muscle spasms, fast eye movements, fever, a rapid heartbeat, vomiting or diarrhea.

Guaifenesin (Mucinex) generally doesn’t help loosen chest congestion and should be avoided. Cough drops aren’t helpful, either, for treating your cough and can lead to air swallowing and acid reflux.

Homeopathic & natural products

While homeopathic products may be marketed for cold symptoms, they often lack data about safety or effectiveness. In general, it’s best to avoid them. There is very limited evidence to support the use of other natural products, but some have the potential to be beneficial. Taking vitamin C at the onset of a cold may decrease the length of cold symptoms by one to one-and-a-half days, but taking it daily doesn’t reduce the risk of catching a cold. Honey, either alone or when used with chamomile tea and lemon, may help relieve your symptoms.

When you’re sick…

To avoid spreading germs, stay home from school or work when you have symptoms of a cold, fever or the flu. Wash your hands frequently with soap and water or hand sanitizer, and cover your coughs and sneezes. Get plenty of rest and stay well hydrated with water to help your body recover.

Be sure to contact your care team if your cold symptoms last for more than one week or if you develop a fever, rash or persistent headache.

If you’re not sick, it’s not too late to get your flu shot!

Lindsey Greiner, PharmD, RPh, is a clinical pharmacist working in Employee and Community Health’s Division of Primary Care Internal Medicine (PCIM). She enjoys answering medication-related questions and working with patients to help them get the most out of their medications.