Choosing a combination cough, cold medicine

Last month, my husband came home, complaining, “I can’t find Nyquil® at the store. They’ve got everything except plain Nyquil® on the shelf. There’s Nyquil® this and Nyquil® that. I just want the stuff I’ve always used!”

My hairdresser grumbled, “I went to the grocery to get some Theraflu®, but did they have that? No! Instead, there were all these other types of Theraflu®. When you feel crummy and go to the store to find something to help, you have to figure out which Theraflu® to get. Why can’t it be simple?”
Years ago, cough, cold and flu remedies like NyQuil®, Thera-flu®, and Robitussin® had just one or two options available, like the green and red flavors of NyQuil®. These days, with 5 or more different formulas of each brand, choosing the best one for you can be frustrating. The most common product lines with multiple entries vying for your attention include NyQuil®, TheraFlu®, Robitussin®, and Mucinex®. NyQuil® liquid is the oldest product, followed by powdered packets of TheraFlu® and liquid Robitussin®.
My husband wants to keep taking the old formula of NyQuil®. It helped him sleep through the night whenever he had a stuffy head, fever, or body aches. He liked NyQuil® because it was simple to take and really helped him get a good night’s rest, helping him recover much more quickly. 
The original NyQuil® had 5 active ingredients. It had Tylenol® (acetaminophen) for fever and aches, dextromethorphan for cough, the antihistamine doxylamine for runny nose and sneezing, pseudoephedrine as a decongestant for stuffy nose and sinus pressure, and 25% alcohol. Today, NyQuil® liquid still contains alcohol, but only 10%. 
The simple formulas of NyQuil and Theraflu disappeared in 2005 when all non-prescription (OTC) products containing pseudoephedrine were required to change. The Food and Drug Administration (FDA) restricted access to pseudoephedrine because it was diverted into making methamphetamine. Pseudoephedrine became available only with appropriate identification, sold at pharmacies "behind the counter." 
Phenylephrine was substituted for pseudoephedrine in OTC cough and cold remedies. Unfortunately, it’s not a very effective decongestant. The FDA limited phenylephrine’s dose to one-third of its proper adult dose because full doses of phenylephrine have caused strokes.
The products used in combination cough and cold products include Tylenol® (acetaminophen) for fever and aches, dextromethorphan for cough, phenylephrine for stuffy nose, and an antihistamine to relieve sneezing and runny nose. 
The antihistamines used in nighttime cough and cold formulas usually cause drowsiness, which will usually help you sleep. Nyquil® contains doxylamine, which is available as the non-prescription sleep aid Unisom®. Theraflu’s® nighttime formula contains Benadryl® (diphenhydramine), which is effective as a cough suppressant and for sneezing and runny nose. Dextromethorphan for cough is also found in multi-symptom cough and cold remedies.
Triprolidine is an older antihistamine that is newly available in Mucinex® NightshiftTM products. Triprolidine is part of my personal favorite cold medicine, the original formula of Actifed® that contains the decongestant pseudoephedrine, available from the pharmacy "behind the counter."
To help you navigate this dizzying array of choices, first decide which symptoms are causing you misery and choose a product that covers those. 
Here Are 5 Suggestions for Selecting a Combination Cough and Cold Nighttime Product:
1. Avoid phenylephrine if you take blood pressure medicine. 
Phenylephrine is not as effective as the older decongestant pseudoephedrine, but they both can elevate your blood pressure. I recommend you avoid phenylephrine entirely.
2. Avoid products with Sinus or Severe in their name.
These products often contain the decongestant phenylephrine, which doesn't work, and the older product, pseudoephedrine. For best relief of stuffy nose, I recommend taking a different product that contains pseudoephedrine in addition to your cough and cold medicine. 
3. Keep track of your acetaminophen (Tylenol®) dose. 
Tylenol® (acetaminophen) is in most cough and cold combination products. If you take additional medicines containing acetaminophen, it's easy to get too much. The maximum dose of acetaminophen for healthy adults is 4000mg daily, 3100mg daily for older adults. Those with liver problems or who drink alcohol regularly should check with their doctor before taking acetaminophen products.
4. Avoid Nyquil® if you take medicines that should not be combined with alcohol.
Nyquil® contains 10% alcohol. You should select a different liquid cough and cold product if you take narcotic pain medications or certain prescription medications for anxiety or sleep. 
5. Choose between adult and children’s formulas.
Many liquid combination products have both adult and children’s strengths. When selecting a product, check the label closely.
Dr. Louise Achey, Doctor of Pharmacy, is a 42-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog  ®2021 Louise Achey

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