When colds, flus, and allergies strike, many people automatically turn to over-the-counter medications to push through and treat their symptoms. These include decongestants, pain relievers, cough or allergy medicines, and combinations thereof. Nearly 70% of adults in the US take over-the-counter medications as a first-line response to high blood pressure treatment of cold and flu symptoms.
While these drugs are readily available and widely used, it may come as a surprise to many people to learn that they are not risk-free.
We are a pharmacoepidemiologist and pharmacist team and we investigate drug adherence and potential harm associated with drug interactions. Pharmacoepidemiology is the study of medication use and treatment outcomes in large populations in real-world settings.
A 2021 study showed that from 2017 to 2019 in the US, about 6.1 out of every 1,000 people visited emergency room due to drug damage. Of these emergency room visits, 38.6% resulted in hospitalization. More of these cases occurred in patients 65 years and older than in younger populations.
Another study estimated that each year 26,735 people went to the emergency room for rheumatoid arthritis side effects associated with over-the-counter cold and cough medications. And more than 60% used the drugs for reasons other than the intended use of the medication.
The dangers of mixing drugs
When two or more drugs are used together, their interactions can sometimes occur cause unexpected harmful effects. Pharmacists and physicians are typically aware of potential drug interactions, so it is very important for patients to ask their healthcare providers which over-the-counter medications are safe for them to use.
It is important to carefully read the packaging ingredients of over-the-counter medications to avoid duplication of doses. Cold medicines are usually composed of multiple ingredients, including pain relievers, nasal decongestants, and cough suppressants or expectorants. A person also taking a single-ingredient drug in combination with one of these multi-ingredient formulations could receive an unsafe dose of that ingredient.
For example, acetaminophen, also known by the brand name Tylenol, is often used as a single active ingredient in an acetaminophen pill. But acetominophen is also often added to multi-ingredient over-the-counter medicines. For example, certain formulations of DayQuil, an over-the-counter medication for cold and flu symptom relief, contain acetaminophen along with a cough suppressant and a nasal decongestant. Doctors typically do not recommend using both Tylenol and single-ingredient DayQuil at the same time, as this increases the risk of side effects such as liver damage from accidental overdoses. Signs and symptoms of acetaminophen overdose include nausea, vomiting, abdominal pain, and confusion.
It is also dangerous for patients taking drugs called monoamine oxidase inhibitors – an early class of antidepressants that include Marplan (isocarboxazid) and Nardil (phenelzine), among others – or tricyclic antidepressants in combination with pseudoephedrine, phenylephrine or ephedrine, which are used to treat congestion. Combining these decongestants taking monoamine oxidase inhibitors or tricyclic antidepressants can lead to very high blood pressure and heart rhythm problems.
Taking the opioid oxycodone at the same time as certain antidepressants can also be dangerous.
Each person reacts differently to drugs
In addition to the potential for drug interactions or other side effects, these medications may affect certain people differently and may increase the risk of harm depending on a person’s characteristics and age group. As we age, our bodies begin to lose the ability to efficiently remove drugs, increasing the risk of side effects and accidental overdoses.
Some medications can be dangerous for people with certain health conditions. For example, pseudoephedrine, phenylephrine and ephedrine may increase blood sugar, so it is important for diabetic patients to be careful when using it. In addition, since these drugs are associated with increased blood pressure, patients with hypertension, hyperthyroidism, or heart disease should use them with caution, or avoid them altogether.
While anyone can potentially experience adverse effects from cold and flu medications, some groups — including older adults, children, and pregnant women — may be at greater risk.
Older people who take prescription medications to treat multiple health conditions may be at higher risk for drug interactions due to the greater number of medications used at the same time to treat different conditions. The aging body is not as adept at absorbing, distributing and eliminating drugs as younger bodies. Because of this, older adults may be at greater risk for overdose and drug interactions with some medications.
Alternatives for children
The Food and Drug Administration and the Centers for Disease Control and Prevention not recommend giving cold medicine to children under 4 years old. Due to several factors, young children have high blood pressure higher risk of accidental overdose and side effects that can lead to death.
First, small bodies respond differently to dosages – the same dose in a child can lead to a higher blood concentration of a drug than in an adult. In addition, as the child develops, organs mature at their own pace and changes in body composition are observed. In addition to the size of a child, prescribers must therefore take into account the developmental stage of the child. And some medications are not even recommended for childrenbecause they have not developed the necessary mechanisms to process the drug.
However, there are some safer alternatives. Research has shown that honey can be helpful for reduce cold and flu symptoms in children older than 1 year.
Nasal saline, a saline solution used to clear the nasal passages to improve nasal airflow, can help relieve congestion and nasal drip. And certain creams and ointments containing the emollients camphor, menthol, or eucalyptus oil can sometimes be effective for reducing cough, congestion and sleep problems.
Best Practices for Pregnancy
Some of the components commonly used in cold medicines are not recommended during pregnancy, as they can endanger not only the mother, but also the fetus. Acetaminophen is the over-the-counter medication recommended by the doctor for the treatment of pain and fever at any stage of pregnancy. But paracetamol should only be used when needed and taken minimally, from a single use to a few days at the most.
Any other pain relievers or anti-inflammatory drugs such as ibuprofen, ketoprofen, naproxen, and aspirin should not be taken during pregnancy without a doctor’s approval. These medications, with the exception of aspirin, are known as nonsteroidal anti-inflammatory drugs or NSAIDs. They are associated with various adverse effects in the unborn babysuch as kidney failure and decreased amount of amniotic fluid.
For symptoms such as nasal congestion during pregnancy, a decongestant called oxymetazoline is used in its intranasal form. the drug of choice. But it is also critical to use this medication as recommended by a physician, as it is suspected that it may have adverse effects on placental and uterine blood flow in certain circumstances.
For your safety, always ask your pharmacist or healthcare provider about the risks and dangers of taking multiple medications at the same time.