— The cynical Cardiologist has actually some seasonally-appropriate cautions

by Anthony Pearson, MD January 22, 2020


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Little has readjusted in the $8 billion people of useless and also confusing over-the-counter (OTC) cold, flu, and sinus medications because the unconvinced Cardiologist an initial tackled "What Cold medications Are safe For my Heart" in 2015.

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I still advise avoiding mix OTC cold meds and also utilizing details medications for particular symptoms.

The original post covers most of the normal suspects in this greatly useless arena. I updated it in 2016 v comments top top a couple of additional OTC components. That write-up on Alka-Seltzer, phenylephrine, and doxylamine is had below.


Alka-Seltzer Plops right into the OTC Cold Market

I had constantly viewed Alka-Seltzer together an effervescent tablet for acid reflux, however the brand (now owned by Bayer) has actually moved aggressively right into the bewildering morass of OTC cold meds. Indeed, when Alka-Seltzer began in 1931, it was a combination of aspirin and sodium bicarbonate (baking soda) marketed because that upset stomachs. Well-known commercials from the 1960s featured the catchy jingle (still stuck in my head) "Plop, plop, fizz, fizz. Five what a relief that is" frequently sung by Speedy, one odd humanlike creature through an Alka-Seltzer thorax and cap. (The solder was composed by Tom Dawes that The Cyrkle <"Red Rubber Ball">, not by the father of Julianna Margulies.)

Recently, I obtained a request from an out-of-town guest who was suffering from a cough and also upper respiratory infection to acquisition Alka-Seltzer plus in the kind of a tablet computer that dissolves in warm water.


At his request, Alka-Seltzer Plus job Multi-Symptom Cold and Flu was purchased in ~ the local Walgreens.

The ingredient are typical for many of the Alka-Seltzer products:

Acetaminophen (Tylenol, because that pain and also fever)Phenylephrine (decongestant)

Phenylephrine: Ineffective Substitute for Pseudoephedrine

I didn"t covering phenylephrine previously. It has taken the location of pseudoephedrine in on-the-shelf OTC cold medications.

Like pseudoephedrine, phenylephrine is a sympathomimetic drug, meaning it stimulates receptors of the sympathetic worried system. Uneven pseudoephedrine, phenylephrine is useless as a decongestant as soon as taken in the dosages accessible over the counter.

A study published in 2015 confirmed what previous studies had actually suggested: Phenylephrine in dosages of 10 come 40 mg daily was no an ext effective than placebo in reducing symptom of sleep congestion.


An accompanying editorial called on manufacturers to remove this useless medicine from your products.


Alas, all of the Alka-Seltzer preparations that case to treat congestion utilize phenylephrine as the decongestant.

The change to useless phenylephrine took place when pseudoephedrine to be taken turn off the shelves and also put behind the respond to to reduce its usage in do methamphetamine.

Therefore, Alka-Seltzer plus Cold and Flu includes two useless ingredients plus paracetamol (Tylenol).

You deserve to buy a huge bottle the cheap share acetaminophen and take exactly the appropriate dose you need for relieving heat or human body aches without paying for 2 useless accompanying drugs that have the potential for offering you undesirable side effects.

Sleep Aids in OTC Cold Meds

I spanned the most usual drug found in OTC cold meds advocated for nighttime use, diphenhydramine (Benadryl), in my previous post.

Nighttime Alka-Seltzer assets contain a comparable sedating antihistamine referred to as doxylamine succinate.

Doxylamine is the energetic ingredient in the brand-name sleep assist Unisom and also the "ZzzQuil" products from the NyQuil brand that are promoted for inducing sleep. It is accessible in cheap, generic form.


According to DrugBank, "It is also the most powerful over-the-counter sedative available in the U.S., and an ext sedating than countless prescription hypnotics. In a study, the was uncovered to be exceptional to even the barbiturate, phenobarbital for usage as a sedative."

Note the the efficient dosage encourage in different sleep aids is 25 mg, no the 12.5 mg found in Alka-Seltzer OTC cold meds. Thus, if you desire an effective dosage of doxylamine to aid you sleep, you must twin the recommended dosage of Alka-seltzer"s night product, i beg your pardon then gives you too lot acetaminophen and dextromethorphan.

Doubling these drugs raises the potential because that side effects. Common dextromethorphan side impacts include nausea/vomiting, dizziness, diarrhea, and also nervousness. Too much acetaminophen can damages the liver.

In addition, both dextromethorphan and acetaminophen communicate with multiple various other medications. Dextromethorphan is well-known to connect with numerous medications.

Acetaminophen have the right to interfere with warfarin and increase the danger of dangerous bleeding.


My advice for 2020 is the same from 2015. Together I summarized previously:

"I think you space much better off avoiding these brand surname mixtures the different active ingredients.

Instead, you must take what you require for a specific symptom in the suitable dosage and also time interval.

Thus, if you have pain, take the minimal dose of Tylenol the relieves it and also repeat as soon as it comes back.

If you have a cough, acknowledge that the OTC ingredients are no better than placebo and are gift abused together recreational drugs. Most coughs go away shortly; yet if one is particularly troublesome and also persistent, get a sneeze suppressing drug from her physician.

If you have actually a yes, really runny nose through a many sneezing, that is more than likely OK to take it pseudoephedrine even if you room a love patient or have high blood pressure. Take it together I described above. Start with 30 mg of the small red pseudoephedrine pills. Wait an hour to see just how you feel. Take a second if it has actually not been effective. Repeat in ~ 4 to 6 hour intervals as needed. Take your blood press at least once after starting it.


Don"t purchase the multi-symptom lot of ingredient combinations, i beg your pardon are merely a marketing device to gain you come spend more money top top something native which you won"t benefit."

Consumer Reports appears to agree through me in a 2017 post on this subject (which doesn"t credit me).

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Anthony Pearson, MD, is a private practice noninvasive cardiologist and medical director of echocardiography in ~ St. Luke"s Hospital in St. Louis. He blogs on nutrition, cardiac testing, quackery, and other points worthy of apprehension at The skeptical Cardiologist, whereby a variation of this post very first appeared.