The Common Cold (and why you should stop wasting your money on phenylephrine and a variety of other over the counter remedies)

The “upper respiratory infection” is a common reason for a doctor’s visit this time of year. When should you come in and when should you stick it out? For use these are simple visits, so we never mind seeing you, but most of us don’t want to run to the doctor for every sniffle.

When should I seek care:

Shortness of breath, tachycardia, prolonged fever (3-5 days duration generally warrants a check), a severe sore throat without cough (strep necessitates an antibiotic), sinus pain radiating to teeth refractory to over the counter remedies.

For kiddos I generally recommend any kiddo who worries you in terms of their breathing comfort, their hydration, their energy or unexplained fever lasting 3 days or more. Bookmark this resource if you’re a new parent.

Most colds run their course and we move on. That does not mean we should not treat the symptoms so we can better function while our body fights off the virus.

Here is what works (my favorites listed first):

For congestion:

Pseudoephedrine orally - marketed as Sudafed. Don’t make the mistake of buying Sudafed PE. That stuff don’t work. It has to be pseudoephedrine - the stuff they keep behind the pharmacist’s desk because they monitor sales as it has been used as a raw ingredient in methamphetamine. Avoid if you have hypertension.

Oxymetazoline intranasally - This is a great choice if you don’t tolerate oral pseudoephedrine for some reason or your symptoms are limited to your sinuses. The catch - you can only use if 3-5d max or you risk rebound congestion.

Ipratropium intranasally - This works wonders for drippy/runny nose which decongestants often don’t hit.

If you’ve got a common cold pick up the three products above and you’ll be comfortable and functional.

Oh, and don’t forget the analgesia (pain reliever). Appropriately dosed acetaminophen or motrin go a very long way in providing comfort for a variety of viral illnesses.

Second tier alternatives:

Phenylephrine intranasally - This also works for congestion. Phenylephrine is the same stuff they unscrupulously market as a decongestant in Sudafed PE. See above about how and why it doesn’t work when taken orally.

Diphenhydramine or chlorpheniramine - Each of these old fashioned or 1st generation antihistamines work well for congestion and won’t raise your blood pressure but they might knock you out.

How about cough? What works for that?

Truth be told not much! The number one most helpful thing is often to get your nose cleared up. Cough lozenges can help with comfort. I often prescribe oral benzonatate as it has evidence of efficacy. Treating underlying asthma can also play a role so get checked if you have a history. Accepting the cough as a normal part of the clearing of illness is often appropriate. As for over the counter options (aside from decongestants) dextromethorphan is reasonable to try. Honey is also helpful and has data for nighttime cough suppression in kids. Everything else is garbage.

That’s it. That’s all you need.

Until next time

-Dr. Jones