Monday, March 2, 2015

Navigating through the Cold Medication Jungle

A trip to the pharmacy or grocery store to pick up an over-the-counter medicine to help with cold symptoms can be a confusing affair.  A host of manufacturers, each vying for your business, claim to be better than the others.  The use of different letters behind the name of the  same medication---AC, DM, LR, XP, NX, PD, and so on---just confuse things even further.

In reality, most cold medicines are made from just a few types of drugs.  These drugs fall into just a few categories, designated by the symptoms that they treat.  By learning these categories and a few names of the drugs in these categories can help direct you toward the most appropriate medications for your cold symptoms.
 
Oral Decongestants are some of the most commonly used medications for cold symptoms. They help to open congested nasal passages and improve air flow through the nose. Decongestants work by shrinking blood vessels in the nasal region which reduces the leakage of fluid into the tissues. Two of the most common decongestants are pseudoephedrine (e.g. Sudafed) and phenylephrine (e.g. Sudafed PE).  Cold medications containing phenylephrine are available over-the-counter. Pseudoephedrine-containing cold medicines can be obtained without a prescription but have to be signed for at the Pharmacist’s counter.

Intranasal decongestants work in a similar manner as oral decongestants but are delivered to the nasal tissue via drops or sprays.  Examples include oxymetazolin (Afrin, Nasin, and others) and phenylephrine (Neo-Synephrine). In general, one or the other type of decongestant (oral or intranasal) should be used at a time.  A major concern with the nasal decongestants is using them for too long a period of time which can result in “rebound” congestion.

Antihistamines help primarily with allergy-related symptoms. In general, they are not as helpful as decongestants for stuffy nose associated with a cold. Histamine is a chemical released by the immune system when the body is challenged by infection or allergens.  Histamine causes small blood vessels to expand resulting in typical allergy symptoms such as runny nose, watery eyes, and itching.   Antihistamines work by blocking histamine receptors on the cells to prevent histamine from being released.  There are a number of antihistamines on the market, including diphenhydramine (e.g. Benadryl), brompheniramine (e.g. Dimetapp), and loratadine (e.g. Claritin).

Expectorants, also known as mucolytics, are medications that thin mucus in the bronchial passages making it easier to cough up phlegm from the lungs.  The most common  active ingredient in expectorants is guaifenesin which is contained in the brand name medications, Mucinex and Robitussin Chest Congestion.

Cough Suppressants (antitussives) work in an entirely different manner than expectorants. Instead of helping to remove phlegm from the lungs, suppressants, such as dextromethorphan or codeine, actually block the cough reflex.  The most appropriate use of cough suppressants is for a severe cough that is keeping someone up at night or interfering with activities. Otherwise, the removal of phlegm from the lungs should be encouraged.  If a cold medication’s name if followed by the letters, DM, CF, or AC, it most likely contains a cough suppressant. In some cases, cough suppressants and expectorants will appear in the same medication. This combination seems to be more of a marketing gimmick than a useful treatment.
 
Pain medications including NSAIDs and acetaminophen appear in many combination cold medications.  NSAIDs (non-steroidal anti-inflammatory medications) include ibuprofen (e.g. Advil) and naproxyn (e.g. Aleve). Acetaminophen is the active ingredients in Tylenol. While both can be effective for pain and fever associated with colds, it is important to note whether the cold medications that you are taking contains one of these medications so that you avoid taking the same medication from multiple sources.

Multisystem Cold Medications typically contain some combination of pain medication, decongestant, antihistamine, and/or cough suppressant. Examples of these include Delsym Multi-Symptom, Tylenol Cold Multi-Symptom, Theraflu Multi-Symptom, and others.  The active ingredients in these products vary depending on the symptoms they are designed to treat; however, most of them contain a decongestant. As mentioned previously, with so many different medicines containing acetaminophen, care must be taken to avoid overdosing.  Multisystem cold medications can simplify treatment of a cold, but in many cases it is better to direct treatment toward specific symptoms, for example gargling with salt water for sore throat or using a nasal decongestant for stuffy nose.

Friday, February 20, 2015

The end of the Vitamin Debate? Don't bet on it! Part:2

According to an analysis of data that the National Health and Nutrition Examination Survey (NHANES) collected in 2003–2006, multivitamins were taken by 33% of Americans over the age of one year.  The National Institutes of Health reports that during the year 2012, U.S. consumers spent 5.4 billion dollars on multivitamins.  The reasons that people take multivitamins include “insurance” against nutritional deficiencies and to prevent certain chronic diseases. This widespread consumption of multivitamins, however, has occurred since their introduction in the 1940’s with very little scientific data to support their benefits.
 
Last week, we looked at two recent studies that supported the use of multivitamins. The first found that vitamin deficiency occurs at a surprisingly high rate in our industrialized society.  The second presented evidence indicating that thousands of cases of cancer could be prevented each year by taking multivitamins.

Countering the idea that taking multivitamins is beneficial or life-saving, several studies published in the Annals of Internal Medicine about a year ago drew opposing conclusions. A brief synopsis of the findings from those studies follows:
  1. Compiling the results of 3 major trials of multivitamin supplements and 24 trials of single or paired vitamins involving more than 400,000 participants showed no clear evidence of a beneficial effect of supplements on all-cause mortality, cardiovascular disease, or cancer.
     
  2. A second study looked at the effect that taking multi-vitamins had on mental functioning in an aging population.  After following almost 6,000 male physicians over the age of 65 for 12 years, no differences in regard to mental performance or verbal memory in those who took or did not take multi-vitamins was found.
     
  3. A third study evaluated the possibility that taking a multi-vitamin would prevent a second heart attack in 1,700 men and women who had sustained an initial heart attack. This study, admittedly limited by a high rate of dropouts, found no difference in recurrent heart attack rates whether subject took a multi-vitamin or a placebo.
Findings from a number of other studies have determined that, in a generally healthy population who are consuming a well-balanced diet, there are no additional health benefits to be derived from taking multi-vitamin supplements.  Ironically, this is the very population of Americans (healthy, well-fed, etc.) that appear to be taking the lion’s share of these supplements.

Obviously, not everyone in this country falls into the “generally healthy and well-fed” category.  In fact, as last week’s Health Tip pointed out, up to one-third of Americans may be deficient in one or more vitamins. In these people, there is a definite role for improved nutrition and/or vitamin supplementation. There are other instances in which specific vitamin supplementation plays an important role in the maintaining health:
  • Calcium and vitamin D supplements in post-menopausal women to reduce the risk of fracture.
     
  • Folic acid in women who are considering becoming pregnant in order to reduce the risk of neural tube defects in their newborn.
     
  • Vitamin B12 supplements in vegans who may not receive adequate intake since natural food sources of vitamin B12 are limited to animal foods. Vitamin B12 supplementation may also be necessary due to impaired absorption in the elderly.
      
  • Iron supplementation for pregnant women since the amount of iron needed for making hemoglobin (the protein in red blood cells that carries oxygen to other cells) may not be provided by diet alone.
       
  • The American Academy of Pediatrics advises that individuals who have anorexia, follow fad diets, have chronic disease, consume a vegetarian diet, or participate in dietary programs for managing obesity might benefit from multivitamin supplementation. 
While the debate regarding the benefits of vitamin supplementation will no doubt continue, few would argue that there is a better way to get enough vitamins than by eating a balanced diet with a variety of fruits, vegetables, fortified dairy foods, legumes (dried beans), lentils, and whole grains. The most appropriate role for vitamin supplements appears to be in circumstances in which the diet fails to provide adequate amounts of vitamins or a medical condition causes the need for additional supplementation.

The end of the Vitamin Debate? Don't bet on it! Part:1

According to an analysis of data that the National Health and Nutrition Examination Survey (NHANES) collected in 2003–2006, multivitamins were taken by 33% of Americans over the age of one year.  The National Institutes of Health reports that during the year 2012, U.S. consumers spent 5.4 billion dollars on multivitamins.  The reasons that people take multivitamins include “insurance” against nutritional deficiencies and to prevent certain chronic diseases. This widespread consumption of multivitamins, however, has occurred since their introduction in the 1940’s with very little scientific data to support their benefits.

Clearly, an adequate supply of vitamins is necessary for maintaining optimal health. A few of their important functions include boosting the immune system, strengthening bones, facilitating wound healing, and obtaining energy from food.  Without adequate vitamin intake, vitamin deficiency disorders can develop. Examples of these are anemia (low blood count) due to a lack of adequate vitamin B12 intake and osteoporosis (bone thinning) from inadequate vitamin D intake.  Recently, publications touting the importance of taking multivitamins as well as those indicating that taking vitamins is unnecessary have appeared. Let’s look at some of this information as we consider both sides of the vitamin debate.

A study published last month in the Journal of the American College of Nutrition, looked at nutrient intake from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2008. Of the U.S. adults surveyed, over 40% were found to have inadequate intakes of vitamin A, vitamin C, vitamin D, vitamin E, calcium, and magnesium.  From this study, no conclusions were drawn regarding the effect of vitamin deficiency on health, nor was it determined that standard multi-vitamin supplementation would have corrected these deficiencies.  Nevertheless, this study suggests that there may be a role for vitamin supplementation in American adults with sub-standard diets to bring vitamin levels up to healthy levels.

Results from the Physicians’ Health Study II (PHS II), published last month in the journal Postgraduate Medicine, suggest that multivitamin and mineral (MVM) supplementation may play an important role in cancer prevention. In this study, healthy middle-aged and older men (mean age 64 years) were randomized to taking daily multivitamin and mineral (MVM) supplementation or a placebo and followed for an average of 11 years.  Men taking MVMs experienced a statistically significant 8% reduction in incidence of in all types of cancer.  This translates to a reduction of 68,000 cancers per year that could potentially be prevented with multivitamin use.

These studies point out that not only is vitamin deficiency a significant problem in this country, but that taking multivitamins may provide a protective effect against the development of cancer. Next week, we’ll look at the flip side of the coin regarding the vitamin debate.