Question about cold remedies we can take...

[ErinENj]

Hi everyone,

I was wondering if any of you know of any over-the-counter meds that I could take for a cold/ sinus infection, which may be turning into another case of bronchitis?? My sinuses are so congested!!! I live on the top of a small mountain, have lived here all my life, and I've been struggling to pop my ears to release the pressure of changing elevations all day. I just can't believe that I managed to get sick. Like we had on the thread awhile ago, I was one of those people who rarely got sick. Guess I spoke too soon!! The only saving grace is that I know it's not the flu, since I got the flu shot (I don't get fevers, ever, so I never know the difference between a horrid cold and the flu, or food poisoning or the stomach flu), but this still stinks! My sinuses are completely clogged and have been for two days, my throat is killing me because my sinuses are congested, and I'm starting a small cough.

I've always been under the impression that with our pain meds we can't take the usuals, like Nyquil (one of my college favs! You could cure anything with a few shots of nyquil, even pneumonia!) or even dayquil, sudafed, tylenol liquid stuff, etc. Supposedly it's similar to drinking on these meds: they have a depressive aspect to them, which makes your average person tired, which can increase the depressive-ness of our meds, which in turn can cause the heart and respirative system to slow down, then heart failure, and then death. And all of those are things I want to avoid, but especially those last 3. So I haven't taken anything for my colds, bronchitis, sinus infections in the past 4 years, except for anti-biotics prescribed by my doc and the inhaler they gave me for my bout of bronchitis I had last semester. But besides that, I've suffered. Is there anything I can take without having to worry about that small side effect of, oh gee, death? I'm only 1 week, and not even a whole week, into my final semester of college so I don't have the ability to stay home and rest and get better. I need this illness gone asap! Especially with all the work I have to do! HELP!! :( Even if it doesn't completley kill it off, just a little help would work for me!

[Pharmacist.steve]

Sudafed should help the ear congestions and if you are getting a wheezy cough.. if you don't want to take oral meds ... try Afrin nasal spray. if you still have that inhaler - alubuterol I presume - you could use it for the wheeze cough/chest congestion along with the Afrin .. but should avoid with the sudafed..

to avoid potentiating of side effects of opiates avoid antihistamines and cough suspressants like anything that as DM in the name or dextromethorphan in it.

[mrsdoubtfyre]

is Mucinex (without DM) 600mg/tablet delayed release
http://www.medicinenet.com/guaifenesin/article.htm
Robitussin plain is the same thing without the long acting function.
Robitussin is 100mg/teaspoonful

Drink plenty of water, as well.

Dextromethorphan interacts with SSRI type drugs to give potential
serotonin syndrome. So it should be avoided in people using anti-depressants
along with pain meds.

Nyquil no longer has a decongestant in it. It is still high in alcohol, and
has a sedating antihistamine in it (the same as in Unisom sleep aid). It also has DM-- which should be avoided
by people taking SSRIs. (and MAOIs which are much less common).

[roz1950]

I take Zicam at the beginning of feeling sick . Works great for me .

[DiMarie]

I have been using the Musinex for the family it has a combo of I think Sudephed and something else, can't remember. But as it dried up the mess, the couogh did linger, non productive now as this was scontroled form it.
But I did not read the Robatussin, to see if the products didn't duplicate to use that. So far it is halls and vitimin C.
Garle with salt water to dry up mucus in the back of the throat and get rid of the post nasal drip and sooth the throat.

Also, an ultrasonic humidifier running every dau all winter. Walmart has great buys, and Sears too for whole house size. I have a whole house one that runs constantly all winter to moisten the air.
Dianne

[illusion129]

Erin-
I would love to give you more tips about what you could take for a cold/sinus infection but you've already received some great information.

I always use Mucinex for any chest/head congestion I have along with Sudafed to help dry out my nasal passages (I usually -only- use Sudafed if my head is super-congested). Roz mentioned Zicam, which is a GREAT alternative to other medications as long as you start it quick enough when you first notice cold symptoms; you can also use Zicam after your cold has intensified to help get over the illness quicker but I feel the medicine doesn't work as well as if you'd caught the cold before it became worse.

However, all 3 of the medicines mentioned have helped me out plenty of times when dealing with a cold! I hope you find relief soon and I wish you the best of luck with the new semester!! :)

Steve & Mrs. Doubtfyre-
Thank you for the useful information. I often times -only- get congested in my head and/or chest with a slight cough...(perhaps a light cold)...but I have always taken Mucinex (DM if I'm coughing up mucus) and Sudafed for it or some other medicine containing both an expectorant as well as a decongestant. I had no idea that taking Dextromethorphan with SSRIs could cause any serious problems, especially that involving Serotonin Syndrome.

I rarely fear problems involving sedation because medicine that sedates most people keeps me wide awake; even plain old Tylenol has that effect on me.

Questions!

Steve - Why do you advise not to use Albuterol (inhaler) with Sudafed? Also, do you warn against taking DM with opiates because it is sedating or because it would add to the cough suppresant effects of the narcotic?

Mrs. Doubtfyre - What is it about Dextromethorphan that makes it an "enemy" when combined in patients taking SSRIs (or MAOIs)? Does the rule apply also to patients who take tricyclic antidepressents? Are people at a higher risk when taking both a SSRI and a narcotic opposed to only taking a SSRI?

I ask these questions not out of concern, really, because I'm usually pretty good about NOT over-medicating with prescription and/or OTC products. I'm asking, more or less, just for the general knowledge of the contraindications (I was attending college for a PharmD degree before my chronic pain just made it too difficult to resume).


Here's wishing everyone an illness-free winter and the best of health! Oh yeah, hopefully there are some low pain-number days ahead for everyone too! (Wishful thinking never hurt anyone. Ha ha.) ;)

[Jo6]

I can't answer all your questions but will share some info I got il the mail yesterday.

I use Albuterol and just had it filled last week. I got some info in the mail yesterday saying they were phasing out Albuterol but the end of 2007.

They gave me ProAir-HFA. Today will be the first time to use it so have no idea if it is helpful or not. On the box it says :((albuterol sulfate Inhalation Arerosol)).

Then it has in red, contains no chlorofluorocarbons. ((CFCS's)) "CFCS's free"

I will look over what they sent me and see how it goes. Julia

[mrsdoubtfyre]

I think your choice of name is very "interesting"...;)

Here is a sample page from a pharmacology text:
http://www.preskorn.com/books/ssri_s7.html#p158

If you move around in that site you will see why this subject is so poorly
understood!

and this:
t seems unlikely that a patient would develop serotonin syndrome from SSRI treatment alone. However, there is a report of this syndrome following the parenteral administration of citralopam (an SSRI not available in the United States).92 Serotonin syndrome can result from high levels of dextromethorphan (which blocks the neuronal uptake of serotonin).93 Since dextromethorphan is a P-4502D6 substrate, its metabolism is inhibited by the concurrent use of SSRIs. Therefore, this combination of dextromethorphan and an SSRI may predispose to serotonin syndrome.82 The syndrome has been reported in association with a combination of an SSRI with pentazocine,94 MAOIs,95-96 and L-tryptophan.97

from http://archfami.ama-assn.org/cgi/content/full/7/1/78

People vary in their own serotonin levels...some are high to begin with..these folks have side effects early in treatment with SSRIs. Some people may have tumors secreting biogenic amines that are hidden as well. Since it is now known that TCAs work by a serotonin mechanism, they are included. But now TCAs are used in much lower doses than in the past, so they are unlikely to be a huge risk. When you get into 50mg or more a day of Elavil, that is when you need to be vigilant. Esp using Elavil with Prozac which is pretty common, and not understood. So alot has to do with genetic variability and dosing.

Modest use of TCA and DM should not be a problem. But high dose of either then increases risk. A person using TCA + Prozac + DM== not a good combo.
And with our polypharmacy type medical establishment, it happens.

Then there are the "methadone" users...who have to consider QT issues.
Antidepressants and Methadone are additive for QT. (but that is another story).

Here is a methadone/DM paper:
Am J Geriatr Pharmacother. 2005 Mar;3(1):17-20. Links
Dextromethorphan-induced delirium and possible methadone interaction.

* Lotrich FE,
* Rosen J,
* Pollock BG.

Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. lotrichfe@upmc.edu

INTRODUCTION: Dextromethorphan is a commonly used antitussive agent that can be purchased over the counter. It is metabolized primarily by the cytochrome P450 (CYP) 2D6 isozyme. Methadone has been found to inhibit CYP2D6, indicating a potential for interaction with dextromethorphan. CASE SUMMARY: An 83-year-old woman was evaluated for delirium, hypersomnia, confusion, lethargy, impaired concentration, and poor food intake. Symptoms resolved soon after discontinuing dextromethorphan. DISCUSSION: Vulnerability to delirium was potentially caused by coadministration of methadone, which can inhibit the CYP2D6 isozyme. CONCLUSION: Evaluation of delirium should include close investigation of the patient's medications for potential interactions with dextromethorphan.

PMID: 16089243 [PubMed - indexed for MEDLINE]


And this study showed no harmful effects:
http://www.ionchannels.org/showabstract.php?pmid=12095667

Alot depends on patient variables, and other drugs that may be in the picture.

And here is an interesting article about serotonin actions and certain opioids:
http://www.psychotropical.com/8_st_maois_opiate_analgesics.shtml
I think this paper is a crucial one for this board.

Certain opioids have actions that others do not...so please read this last
weblink!

[Pharmacist.steve]

Steve - Why do you advise not to use Albuterol (inhaler) with Sudafed? Also, do you warn against taking DM with opiates because it is sedating or because it would add to the cough suppresant effects of the narcotic?

Russell...

You are basically duplicating therapy.. increased risk of elevated heart rate and blood pressure.

[ErinENj]

Thank you all so much!! I'm absolutely positive that I'm getting sick now. My throat has gotten a lot worse, as has the cough and sinus congestion. I'm going to go out tommorow and pick up some cold meds now that I know I can take some of them. Luckily, I already have an inhaler, so I'll try to get the right kind of med so that I can use that also. And I have some Mucinex around this house somewhere that my mom bought for me the last time I was sick, but I was too scared to use. Hopefully, with some cold stuff, the inhaler, and the Mucinex, I'll be able to breath, swallow, and hear without any problems!! But I think if this lasts more than another 4 or 5 days, I'll go off to my doctor to see if there's anything they can do for it, just to get it gone as quickly as possible so I can get back to concentrating on school. I've managed to get all but one assignment done, and that one's not due until Tuesday, but I didn't get any of the Latin reviewing I needed to get done finished, but hopefully my professor will understand. There's just something so difficult about trying to study when you feel like your head is going to explode, you're going to stop breathing because you can't get the air in your nose and your throat is so sore you don't want to breath through your mouth.

Thanks again everyone!! I feel much better now that I know I can take something and it won't kill me!! :D

[ErinENj]

Just wanted to post a quikie update...Unfortunately, cold remedies aren't quite going to do it this time, again. I just got back from my doctor's office. Turns out I have a little bit more than a cold. I've somehow managed to get ashmatic (I can't seem to figure out how to spell that...guess my head is just too stuffed up to think) bronchitis. This is the same disease I had at the middle of last semester. She said that it seems like I do have a cold on top of it, which would explain the sinus congestion and overall crappy feeling. So I have to stay home from school tommorow, which just starts everything out fantastically as far as my absences go. :rolleyes: I have a precious few of them as is, and I have to use one of my latin ones already. Isn't that loverly?

So, I get to stay in bed for the next day, and take these horse pill antibiotics and use my inhaler to try and get all of this out of my system as quickly as I can. Unfortunately, cold remedies won't do it for this one. But I'm glad to know that I can, in fact, take them if I manage to get a cold, and just a cold. Thanks again for all your help!!

[GJZH]

I take Allegra D for sinus infections and an antibiotic...usally Levaquin...I have had two sinus surgeries though...I live on Allegra...You could maybe try Clariten D...