Keep Those Sneezing and Wheezing Away!!!

Asking medications for your "cold and flu" symptoms from a pharmacy is an easy way to relieve those irritating symptoms, such as blocked nose, running nose and sneezing, without paying for the consultation fees. But, have you ever asked yourself that what are those medications that you are taking to "eradicate" or relieve those annoying symptoms? Do you know that certain oral nasal decongestants can lead to insomnia problems or fluctuating blood pressure?

Here I am today to spill some little secrets of those medications in which some pharmacists may not share with you. 

1. Not all "cold and flu" medications can lead to drowsiness (make you feel sleepy).

There are other options available for you if you do not wish to have medication to make you feel drowsy. The sedative antihistamine inside the medication is the one that is responsible for making you feel drowsy.

Oh, wait! What is antihistamine?

Antihistamine is a class of medication which is usually used to relieve skin allergic responses (such as skin rashes and itchy skin) and symptoms of cold or allergic rhinitis ("sensitive nose" or "allergic nose problems", also known as hay fever), such as running nose and sneezing. Antihistamine can be classified into sedative or non-sedative.

Examples of Sedative Antihistamine: Chlorpheniramine, Dexchlorpheniramine, Tripolidine, Promethazine and Hydroxyzine.

Examples of Non-sedative Antihistamine: Cetirizine, Levocetirizine, Loratadine, Desloratadine, Fexofenadine and Bilastine.

The formulations shown below, which consist of non-sedative antihistamine in its combination, is unlikely to make patients feel drowsy (sleepy).     

Non-sedative antihistamines

The formulations shown below, which consist of sedative antihistamine in its combination, is very likely to make patients feel drowsy (sleepy).    

Sedative antihistamines

2. Oral "cold and flu" (CF) medications should be used with care in patients having heart problems, thyroid problems, high blood pressure and diabetes.

CF medications contain nasal decongestant, such as pseudoephedrine or phenylephrine.

Hmmm...What is nasal decongestant?

Nasal decongestant is a medication that is used to relieve nose block. Nasal decongestant can be classified into oral or topical (nasal).

Oral nasal decongestant, such as pseudoephedrine or phenylephrine, is also known as sympathomimetic. In other words, sympathomimetic is a stimulant which is able to increase the heart rate and blood pressure to make the person feel awake and energetic. Increasing heart rate and blood pressure in patients having heart diseases will definitely post a risk in worsening their conditions! 

Patient with active thyroid will have fast heart beat due to the active secretion of thyroid hormone. Taking oral nasal decongestant might unknowingly increase the heart rate, leading to irregular heart beat conditions.

Oral nasal decongestant will also affect the diabetic control in patients having diabetes, leading to temporarily increment in blood glucose level. The physicians might step-up the diabetic therapy unnecessarily because they are unaware that the patient is taking oral nasal decongestant.

So, please consult the physician or pharmacist before taking any medications for your "cold and flu" symptoms.

Compared to oral nasal decongestant, topical nasal decongestant can be used safely in patients with those medical conditions shown above. Besides that, topical nasal decongestant, such as oxymetazoline and xylometazoline, has a faster effect than oral nasal decongestant. Topical nasal decongestant works by constricting the veins in the nose which swell up during inflammation of any infection or allergic response.

The following diagrams shown below are the examples of topical nasal decongestant.

Topical nasal decongestant

However, topical nasal decongestant is not entirely safe to be used continuously due to the risk of rebound congestion. Hence, it is recommended to be used as necessary basics for continuous 3-5 days. The topical nasal decongestant should be withheld for 1-2 weeks before restarting.

3. Should all the oral nasal decongestants should be taken after meal?

Ans: This is not necessary. Most of the oral nasal decongestants can be either taken before or after meal. However, the formulation containing fexofenadine should be taken 1 hour before meal for better and complete absorption. 

Telfast D (Fexofenadine HCl + Pseudoephedrine HCl)

4. If the patient is allergic to sulphur, is the patient alright to take all types of oral nasal decongestants?

Ans: NO! Many formulations of CF medications use pseudoephedrine sulphate as nasal decongestant. You can opt for the formulations which use pseudoephedrine hydrochloride or phenylephrine hydrochloride.

5. Why does the pharmacist inform me to take the second dose of non-sedative oral nasal decongestant as early as possible, for example before 7 p.m. in the evening?

Ans: Due to the absence of sedative antihistamine in non-sedative oral nasal decongestant, the stimulant will slightly increase your heart rate and blood pressure to make you feel awake and energetic. This might lead to insomnia (unable to sleep) during the night.

6. Should I take my CF medications with paracetamol?

Ans: It depends on whether the oral nasal decongestant contains any paracetamol. The following products shown below contain paracetamol and should not be taken with paracetamol as it might lead to overdose of paracetamol.

7. If I am either pregnant or breastfeeding, should I take the oral nasal decongestant?

Ans: Most manufacturers advise to avoid using oral nasal decongestant during pregnancy and breastfeeding. However, there are no evidences of fetal abnormality or harmful effect to the baby, except Hydroxyzine (it is shown to be harmful). The use of sedative antihistamine is shown to cause irritability in the newborns.

The safest nasal decongestant which can be used by pregnant or breastfeeding mother will be the topical nasal decongestant or saline nasal spray.

Thank you so much for reading and I will be touching more on the allergic responses on antihistamines and nasal sprays in my future post! Stay tune!

Meanwhile, if you are anticipating for the next post and wondered what the next topic will be, just a little sneak peek that it will be related to travel medications! If you are always worried on what medication to prepare for travelling, this is the post that you should take note. Just follow our blog and keep yourself updated every Sunday! :)

Have a pleasant day!

Author:

Jordy Wong Der Yuan

BPharm (Hons) (IMU)

Editors:

1. Chang Jen Nee

BPharm (Hons) (IMU)

2. Grace Ho Mee Yan

BPharm (Hons) (IMU)