Keywords

common cold, antihistamines, decongestants, symptom management

Abstract

Background: The most common illness know is the common cold. Antibiotics are inappropriate for treating the common cold, but there are many over-the-counter medications available. These over-the-counter medications have not been shown to decrease the length of a cold, though they can ease symptoms. In this paper, we aimed to review the active ingredients in recommended OTC cold remedies for the general population and assess the evidence for their effectiveness. We hope this information will provide NPs with evidence-based strategies to help their patients be better prepared to navigate the cold and flu aisle.

Methods: The US News 2020 pharmacist survey was used to identify the most highly recommended OTC cold medications. We identified the active ingredients of each of these combination medications and reviewed the literature associated with each active ingredient, excluding antipyretics. Databases searched included CINAHL, Medline, Cochrane, and Google Scholar. Date parameters were eliminated due to the lack of recent literature on these active ingredients. We used the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide to appraise and level the quality of each article.

Results: A total of 388 articles were reviewed, and 26 were used in this review. There were three main categories of medications: Antitussives, decongestants, and antihistamines. The OTC cough medications reviewed included dextromethorphan and guaifenesin. Dextromethorphan is an effective antitussive when higher doses are used. Guaifenesin, on the other hand, has little evidence to support its use for cough in common cold patients. OTC decongestant options included pseudoephedrine and phenylephrine. While both active ingredients can be utilized for nasal congestion and rhinorrhea, the evidence for pseudoephedrine was much stronger. The OTC antihistamines reviewed included diphenhydramine (DH), chlorpheniramine maleate (CM), doxylamine succinate (DS), and loratadine. DH, CM, and DS can improve common cold symptoms, but they can cause significant drowsiness and should be reserved for nighttime use. Loratadine does not cause drowsiness, but there is little evidence that it is effective in monotherapy against the common cold. Antihistamines in monotherapy are not recommended for treatment of the common cold, though they can be helpful in combination products.

Conclusion: Based on our review, we recommend that Nurse Practitioners make recommendations for OTC products based on the patient’s symptoms. We recommend a Dextromethorphan product for cough, Pseudoephedrine for nasal symptoms, Acetaminophen or Ibuprofen for fever and body aches, and a first-generation antihistamine if the patient is struggling to sleep at night. Nurse Practitioners should consider patient history and comorbidities when making recommendations for OTC common cold products.