Prevent Problems With OTC Cough and Cold Meds

Winter is bringing a flurry of issues with OTC cough and cold meds to put on your radar.

Stay alert for brand-name extensions...since many products often use a well-known brand name to sell different ingredients.

For instance, Benylin Extra Strength Mucus & Phlegm contains guaifenesin and menthol...Benylin Extra Strength Mucus & Phlegm Plus Cough Control has guaifenesin, menthol, and dextromethorphan...and Benylin Extra Strength Mucus & Phlegm Plus Cold Relief contains acetaminophen, guaifenesin, dextromethorphan, and pseudoephedrine.

Help patients check package labelling...so they know which ingredients are in the product.

Look out for duplicate therapies...since patients may use a cough and cold product with other meds that have the same ingredient.

For example, a patient on oxycodone/acetaminophen (Percocet, etc) may exceed max acetaminophen doses if they take OTC Extra Strength Tylenol Cold.

And getting Nyquil Cold & Flu Nighttime Relief plus Robitussin Cough Control may provide too much dextromethorphan...since it's in both products.

Keep drug interactions in mind...since patients often don't realize they can pop up between OTCs and Rxs.

Encourage patients to ask the pharmacist about using cough and cold products if they take other meds...some combos can be risky.

For instance, taking diphenhydramine with certain meds...such as cyclobenzaprine or gabapentin...may further increase sedation.

Watch for special populations...since some cough and cold meds are dangerous for young kids, pregnant women, or elderly patients.

For example, phenylephrine may be unsafe for an unborn baby...and chlorpheniramine may increase fall risk in elderly patients.

Refer these patients to your pharmacist for guidance.

For instance, your pharmacist can advise parents that OTC cough and cold meds should usually be avoided in kids under age 6...to limit the risk of adverse effects or overdose.

If parents do get a cough and cold med for their child, make sure they have a proper dosing device (oral syringe, etc)...to avoid under- or overdosing.

Get our technician tutorial, Safety Considerations With OTC Meds, for more ways to avoid issues with cough and cold products.

Key References

  • www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2016/57622a-eng.php (2-3-20)
  • Chest 2017;152(5):1021-37
Pharmacy Technician's Letter Canada. February 2020, No. 360213



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