Walk down the medication aisle in your local pharmacy and you'll be inundated with choices—too many choices. The first thing that you should know is that when a doctor tells you to use Sudafed or Tylenol, what they are telling you are the brand names of the companies that make medications.  In the old days, Tylenol only made pain relievers with one ingredient, and Sudafed meant the standard decongestant. These days, there's Sudafed, Sudafed PE, Sudafed 12 hour, Sudafed Sinus, Sudafed Non-drying sinus, and ten other variations. Every other brand has a similar dizzying variety of choices. What's a patient to do?

 

First, ask yourself what's bothering you. Is your nose stuffy? Then you need a decongestant. Ignore the brand name and go straight for the active ingredients. There are two kinds of decongestants—one in pill form and another in spray form. The pill form comes as either phenylephrine (usually red round 30 mg tablets which lasts 4-6 hours), or pseudoephedrine (usually 120 mg tablets that last about 12 hours). Some people are sensitive to these class of medications—it can cause restlessness, heart palpitations or even raise your blood pressure. If you have any concerns, talk to Dr. Park. In most cases, you can take the minimum amount possible, and definitely not before bedtime.

 

The spray forms (neosynephrine or oxymetazoline) are useful in the short term, but cannot be used for more than 2-3 days. Oxymetazoline is a 12 hour form that is more convenient to take. This is the spray that people can get addicted to if used for more than a few weeks. In contrast, the prescription topical steroid medications (such as Flonase or Nasonex), are designed to be used on a long-term basis. "Non-medicated" nasal sprays are typically salt water (or saline) with or without other soothing additives. Things can get confusing—this is why you have to look for the active ingredient.

 

If you have sneezing, itching,runny nose or scratchy throat, you need an antihistamine. Again, forget about the brand name and look at the active ingredient. There are many types available, including Brompheniramine, Chlorpheniramine, Diphenhydramine, or Loratadine. These are the class of medications that can make you drowsy, with the exception of Loratadine (Claritin or Alavert). Note however, that some people are sensitive to Loratadine and may get drowsy (my wife, for example). So in theory, there is no such thing as a truly nonsedating antihistamine. If you took two Loratadine tablets, for example, your chances of getting drowsy increases. Many of the "PM" combination medications use the sedating property of antihistamines to help you sleep at night.

 

For cough, the main ingredient out there is Dextromethorphan. It's been clinically proven to be just as effective as codeine in cough suppression. The only reason that people may favor prescription codeine is that it makes you sleepy and so you may get a better night's rest. Remember that sometimes cough is caused by a runny nose and post-nasal drip, so taking an antihistamine is important if you have nasal symptoms as well. There are many reasons for cough, including post-nasal drip (from any nasal reason such as a cold or allergy), or even acid reflux, so it is important to treat what is aggravating the cough, in addition to suppressing the cough.

 

To loosen thick mucous and phlegm in your sinuses or chest, Guaifenesin is the typical ingredient. This is also called an expectorant. Frequently, this is mixed with a cough suppressant such as Dextromethorphan.

 

Finally, Acetominophen or Ibuprofen are two common pain and fever reducers that can be taken alone or packaged in combination with any or all of the above.

 

Regardless of which brand you choose, the active ingredients are all the same. Generics or store brands are usually much less expensive. Choose ingredients that match the symptoms that you have. On thing you'll see is that although the type of medications is generally the same, there are different amounts of each ingredient between each brand. In general, the combination medications contain the minimum amount for each ingredient, so it works, sometimes, but not all the time. This is why I prefer to the maximum dosage for each ingredient based on the corresponding symptom, taken individually, not in combination.  For example, if you have a cough, stuffy nose and postnasal drip, you'll want an antihistamine, decongestant and cough suppressant. Adding an expectorant may also help. In addition, "drowsy" medications will have any of the sedating antihistamines (except Loratadine). "Non-drowsy" means that there is no sedating antihistamine.

 

There it is in a nutshell. Obviously this is just a brief summary of the enormous number of options for OTC medications, but it's a start. If you have any questions whatsoever, please do not hesitate to contact Dr. Park.