I'm so confused by all of the bottles on the cough/cold shelf at the
pharmacy. If I get the flu this winter, what should I take?

Hi Soccermom-ga

First of all, I should say that if you have any concerns about your
health, you should seek professional medical advice. This answer is
provided for general information purposes only, and is not intended to
substitute for professional advice.

To begin with, we should probably note the differences between colds
and the flu, to make sure you are treating the right illness.
According to the American Lung Association, the Flu is “an infection
of the respiratory system caused by the influenza virus”.

There are three types – A, B and C. 

“Types A and B are the most severe. The viruses change constantly and
different strains circulate around the world every year.”

Those who are infected with Type C influenza will experience either
mild symptoms or none at all. Unless you have a mild version, the
symptoms are more severe and appear more quickly than those of a
common cold. These may include a temperature of over 101 degrees
Fahrenheit, a cough, muscle ache, headache or chills.
http://www.lungusa.org/diseases/c&f02/influenza.html

You are specifically interested in over-the-counter remedies for colds
and flu, and which ones you should be taking. To look at each remedy
on the market and rate its effectiveness would be almost pointless, as
different people would rate different remedies in different ways.
However, research into this topic has brought up a number of resources
that recommend treating individual symptoms rather than using
‘cure-all combos’.

Advice from the Food and Drug Administration agrees with this. 

“With all the choices on the shelves, it can be hard to know what
medicine to pick. It may seem easier to grab a multi-symptom medicine
that promises to take care of everything, but it's better to take a
product specific to your symptoms, says Jeffrey Delafuente, a
professor and director of geriatric programs at Virginia Commonwealth
University's School of Pharmacy.”

The site also points out that taking medicines to cure symptoms you
don’t have simply exposes you to the accompanying side effects.

“Taking medicine for symptoms you don't have may not be harmful, he
adds, but it unnecessarily exposes you to medicine and the
accompanying side effects. ‘Multi-symptom medicines can be useful if
you truly have many symptoms.’ ”
http://www.fda.gov/fdac/features/2001/601_flu.html

In other words, if you have a cough, take a cough remedy. If you have
muscle ches and pains, take a remedy with paracetemol in it (provided
you do not have an allergy to it). However, be careful that you do not
double up on ingredients, check the labels and take heed of any
warnings about mixing medication. Ask advice from your pharmacist or
doctor if you are in doubt, as certain medical conditions should not
be mixed with paracetemol. You should not exceed the recommended dose
for any remedy or ingredient. Also, aspirin should not be given to
children or teenagers.

This Webpage, also from the FDA, has information on the type of
remedies to take to treat individual symptoms.
http://www.fda.gov/opacom/lowlit/clds&flu.html

The effectiveness of flu remedies is a subject of debate. According to
this article from USA Today, flu remedies may only shorten the
illness’s cycle by a day.

“ ‘The benefits are minimal,’ comments K.D. Hoskins, a spokesperson
for the CDC. ‘We're talking about shortening the course of the flu by
one day,’ says Dr. Steven Simons, a practicing pulmonologist in
Beverly Hills and a clinical professor of medicine at UCLA.”
http://www.usatoday.com/life/health/doctor/lhdoc076.htm

If you really want to take medication to fight the flu, there are some
anti-viral drugs available to combat the illness. The anti-viral drugs
must be taken within 48 hours to have an effect.

“Relenza (zanamivir) and Tamiflu (oseltamivir), both approved for use
in 1999, are to treat uncomplicated cases of influenza caused by types
A and B flu virus. Tamiflu also is approved for preventive use, while
Relenza is approved only for treatment. Two older drugs, amantadine
and rimantadine, which are sold under the trade names Symmetrel and
Flumadine respectively, are approved for the treatment and prevention
of Type A influenza.”

Also from the USA Today article quoted above:

“ ‘The biggest advantage of Relenza and Tamiflu is they treat both
Type A and B influenzas,’ comments Simons. The newcomers also have
fewer troubling side effects.”

They are more expensive than regular remedies and the article notes
that there are some side effects.

“The most notable side effect from Tamiflu, which is taken in pill
form, is nausea. Side effects from Relenza, which is inhaled, include
sinus infections and diarrhea. Earlier this month, the Food and Drug
Administration (FDA) warned physicians to take added care when
prescribing Relenza, especially to asthmatics.”

http://www.usatoday.com/life/health/doctor/lhdoc076.htm


Of course, prevention is always better than cure. It’s not always
possible to avoid the flu, but you can take a couple of steps to
improve your chances
Information I’ve uncovered suggests that you might be better off
getting the flu shot rather than relying on over the counter remedies.

From the FDA’s Website:
“The flu shot remains the best way to protect yourself. The drugs are
sometimes used as a backup to the vaccine in special situations, such
as to control a flu outbreak.”
http://www.fda.gov/fdac/features/2001/601_flu.html


VHIhealthe.com recommends the flu vaccine as the best way to avoid
getting the flu. However, if you have an allergy to eggs, it is best
to discuss this with your GP. The site also recommends washing your
hands as a way to help avoid the illness.
http://www2.vhihealthe.com/topic/flushot


There are also a number of herbal remedies that are believed to help
with flu symptoms. However, it is advised that you consult with your
doctor before beginning to use these herbal treatments.

Echinacea is believed to help strengthen the immune system, but its
effectiveness as a cure for colds and flu appears to be unproven.

According to the FDA’s Website:

“As for echinacea, ‘studies have been done of echinacea for preventing
or treating colds and flu, but these studies were not rigorous or
definitive and the products tested were diverse,’ according to a
written statement from Stephen Straus, M.D., director of the National
Center for Complementary and Alternative Medicine, part of the
National Institutes of Health. ‘These studies at best suggest that
echinacea may be beneficial in the early treatment of colds and flu,
but does not help prevent them.’
http://www.fda.gov/fdac/features/2001/601_flu.html

This Website, WholeHealthMD recommends supplements for helping with
flu symptoms. As I have already mentioned, it is worth mentioning this
to your GP before taking any kind of supplement, in case an existing
medical condition or medication is incompatible with any of the
ingredients.
http://www.wholehealthmd.com/hc/resourceareas_supp/1,1442,529,00.html

Also, don’t overdo it. Overdosing on natural supplements can have
adverse affects, so stick to the recommended dosage and always consult
your doctor.

These websites also contain some ‘flu facts’:

The Center for Disease Control and Prevention, National Immunization
Program:
http://www.cdc.gov/nip/Flu/Public.htm

The National Institute of Allergy and Infectious Diseases
http://www.niaid.nih.gov/newsroom/focuson/flu00/background.htm

Tips for treating the Flu (children)
http://kidshealth.org/parent/general/sick/tips_take_care.html

The Wellness Junction
http://www.wellnessjunction.com/athome/selfcare/flu2.htm

Whole HealthMD
http://www.wholehealthmd.com/hc/resourceareas_more/1,2308,529,00.html

Search strategy:

‘flu remedies+effective’
‘treating flu’
‘natural flu remedies’
‘Echinacea+flu’ 


I hope this helps. If you require clarification of this answer before
rating it, please ask and I will be happy to help.

cobrien-ga

very useful--would just have liked a list of possible products to look
for at the pharmacy to give me a head start before hitting the
shelves.

You know what they say about the flu: With medicine you'll get better
in 7 days; without medicine - in one week...

Dear SoccerMom,

Some additional information may be useful for you.  I have worked in
the pharmaceutical industry for 25 years, developing new drugs.  I did
some work for Gilead Sciences and Roche some years back on their new
antiviral flu medication, Tamiflu.  I was not (and am not) an employee
of either company and believe I am providing a nonbiased view.  Here
is my bird's eye view opinion on preparing for the flu season.  I will
not address measures that will optimize the immune system status, but
you should certainly make sure this gets done.

First, keep in mind that a number of viral illnesses have symptoms
similar to infection with the influenza virus.  So if you get flu-like
symptoms (see below), you may not have influenza.  The prescription
medications available for influenza will only work on influenza. 
These are described below and are 1) vaccination and 2) antiviral
medicines.

Neither of the above drugs will help against a non-influenza organism.
 For non-influenza illnesses with flu-like symptoms, palliative
therapy is what's available.  Since the palliative therapy for
non-influenza symptoms is the same as for influenza symptoms, here is
the skinny.  You will want to have on hand the following
over-the-counter products: 1) an analgesic for aches and pains (e.g.,
Tylenol, Ibuprofen, Aleve); 2) an antipyretic to bring fever down
(e.g., Tylenol, Ibuprofen, Aleve); 3) a decongenstant (e.g., Sudafed);
and 4) an expectorant to loosen up lung secretions and make cough more
productive, and to suppress coughing (e.g., Robitussin).  Each of
these drugs should be used only if needed.  In other words, don't
automatically take a decongentant.  Only take one if you need to clear
up your nose so you can breath easier.  Every one of these drugs is a
powerful drug in and of itself, even though they are available as
over-the-counter drugs.  Since safety and dosage recommendations are
based on normal healthy adults and children (READ THE LABEL), be
especially careful when giving these (or any drugs) to young children,
adults with medical problems or older people since their ability to
break down and excrete drugs is different that the ability of normal,
healthy adults.  You should consult your doctor for doses for those
special kinds of people.

After all these years in the pharmaceutical industry, I believe that
the fewer the drugs you can get by with, and the least amount of each
one that you can get by with, the better.  I would therefore recommend
buying separate products for each of the categories of pain/fever (any
of the Tylenol, Ibuprofen, Aleve lines will be good), decongenstant
(Sudafed or similar) and cough suppresant (like Robitussin).  Do not
get combination products because you may wind up taking more kinds of
medicine than you have to or more of one of the medicines than you
have to.  Read the directions with each product carefully.  If you
have questions, call you doctor or pharmacist.  The other medicine to
have on hand is one of the new antivirals (see below).  You will need
a prescription for this and should get it filled now so you have it
when you need it.

The first and best line of defense against influenza is the flu shot. 
Keep in mind, though, that this will only protect you from the exact
strains against which the vaccine was developed for that particular
season, and that this is only a few strains.  In advance of each flu
season, the experts get together to decide which strains are the most
likely to be active in the coming season, and the vaccine is prepared
accordingly.

For those who do not get vaccinated, or for those infected with a
strain of influenza that is not included in the vaccine, infection may
occur.  In this case, two actions may be taken: 1) provide palliative
therapy (see above) and 2) administer an anti-influenza drug.  The
latter are relatively new to market and include Tamiflu and Relenza
(prescription drugs).  Having worked directly with Tamiflu in hundreds
of patients, I am impressed enough with this medication to have a
prescription filled and in my own medicine chest all the time.  IF YOU
BEGIN TAKING IT within 2 days of symptom onset, you will feel better
faster.  The sooner after symptom onset that you start taking the
medicine, the more effective it will be.  The company has done studies
in children as young as 1 year to show safety and efficacy in these
little people.  As mentioned in the formal Google answer above, the
most common side effect of Tamilfu was nausea.  However, this occured
in very few patients, and subsided as they kept taking the medicine.

The other way to attack influenza if you do not get vaccinated is to
wait until someone in close proximity to you gets sick (like someone
in your household) and then begin taking Tamiflu within 2 days of
exposure, IN ORDER TO PREVENT YOU FROM BECOMING SICK.  Roche has done
studies in people as young as 13 years of age for prevention of
influenza.  Studies are not yet available showing the safety of this
kind of use in younger children.

The diagnosis of influenza (as opposed to some other viral infection)
is almost always made by looking at symptoms, rather than performing a
culture on a throat swab.  Symptoms include 1) the fact that they are
of SUDDEN ONSET, 2) fever of 101 degrees or more, 3) a cough (but one
that does not bring much up), and 4) muscle aches.  Other symptoms MAY
(but do not always) include headache, sore throat, nasal congestion. 
There are laboratory tests that can determine definitely whether you
have influenza, and if so, what exact strain it is.  Sometimes your
doctor will want this information, but not usually.  If so, a culture
will be done.

Here are some final do's and don't's.  DON'T take antibiotics or press
your doctor for antibiotics when you have influenza or any other viral
infection.  This will only add to the generation of
antibiotic-resistant organisms and will not help you get better.  Only
if you get a bacterial infection on top of the viral infection would
this help.  Your doctor will know when to give you antibiotics.  DO
drink a lot of fluids and rest.  This is what your immune system needs
in order to mount its best immune response.

I can tell you that it is mightly satisfying to be able to say all
this in an open fashion, without oversight of any regulatory body! 
It's what I tell my own relatives, so I figure it's good enough for a
Google Comment!  Good luck and good health.

JCG

I think that the precise question, that you're asking is "What OTC
cough medicine, should you take, should you get a cough"?

If you have a simple cough, please contact the registered pharmacist
at your neighborhood pharmacy about the avilable OTC products in the
store.  If the cough is severe, you should consult an MD about
obtaining an Rx for a presciption cough medicine.  I noticed, that you
did not mention your age or you health. Older patients, should be on
the outlook for pneumonia and if symptoms suggest that this is the
disorder, which they have, a medical doctor should be consulted
immediately for an evaluation.  Remember, penumonia can kill.

I would just like to add two things:

1)  The flu shot is a safe, inexpensive way to cover against three
major strains of the flu for the upcoming season: it takes a month to
"kick in", so getting it today would protect you by the first week of
December.

2)  Taking cough medicine for a cough will NOT help your cough
symptoms get any better.  They typically just mask them.  As stated
above, the flu will usually last a few days and then resolve on it's
own.  However, supressing a cough is not always the best therapy. 
Typically, their most useful use is suppressing cough at night so you
can get to sleep peacefully.