Cold Remedies Research Articles

The Safety of Dextromethorphan in Pregnancy: Results of a Controlled Study

Dextromethorphan (DM), the d-isomer of the codeine analog levorphanol, is an active ingredient present in a variety of cough and cold remedies. Recently, data generated from a study in chick embryos were extrapolated to suggest that pregnant women should not use this drug because of the risk of birth defects. We conducted a controlled study of pregnant women who used DM, to examine the possible teratogenic risk in humans. We followed up women who used DM and had been counseled by the Motherisk Program during their pregnancy. A control group of women was matched for age, smoking, alcohol use, and disease state (upper respiratory tract infection, not treated with DM). We were able to ascertain pregnancy outcome in 184 women. There were 172 live births, 10 spontaneous abortions, 1 therapeutic abortion, and 1 stillbirth. One hundred twenty-eight of the women used the drug during the first trimester of pregnancy. There were three major malformations (2.3%) among the babies of women who used DM in the first trimester, seven minor malformations, and the mean (+/- SD) birth weight was 3,381 +/- 670 g. In the control group, there were 174 live births, 8 spontaneous abortions, and 2 therapeutic abortions. There were five major malformations, one of which was a chromosomal abnormality (2.8%), eight minor malformations, and the mean birth weight was 3,446 +/- 571 g. This study fails to show that DM use during pregnancy increases the rates of major malformations above the expected baseline rate of 1% to 3%.

New game, old competencies: The outlook for OTC

Ten years ago, at the beginning of the ‘prescription-only (Rx) to over-the counter (OTC) switch revolution'. Nurofen (ibuprofen) had switched in the UK and Advil/Nuprinregd had moved OTC in America, along with 0.5 per cent hydrocortisone (Cortaidregd) and several cold remedies. The outlook for additional switches and the OTC market generally was bullish. Most experts predicted that the OTC market would explode, led by switches and the coming harmonisation of EU regulatory mechanisms beginning in 1992.If you had to pick an icon that would be symbolic of the growth curves most OTC business managers had in mind, you might choose the hockey stick. So what happened? There has been an enormous increase in consumer interest in alternative, prevention-oriented self-treatment but the growth in non-prescription pharmaceutical sales has been much more modest. So where do we go from here?This paper explores:current business trends in the global market for over-the-counter brandsa comparison of Rx to OTC brand switche...

Prescribing trend of fixed-dose drug combinations in a tertiary hospital in Nepal

The objective of this study was to analyze the prescribing trend of the different fixed-dose drug combinations (FDCs) in a tertiary hospital in Nepal. A retrospective study was conducted after collecting prescriptions from patients attending Manipal Teaching Hospital, Pokhara. The rationality of FDC formulations were studied on the basis of FDCs recommended by Department of Drug Administration (DDA), Ministry of Health (MoH), Nepal and the World Health Organization (WHO). An audit of the prescriptions revealed that 40% of the prescriptions contained FDC formulations. However, FDCs in accordance with recommended DDA, MoH Nepal and WHO lists of FDCs were only 0.8% and 2.1%, respectively. The most commonly prescribed FDCs were multivitamins, cough and cold remedies and antimicrobials which constitute nearly 63% of the total FDCs prescribed. In 48.4% of the prescriptions, the prescribed FDCs contained ingredients which were not essential for the desired therapeutic effect. Nearly 98% and 95% of the FDCs prescribed did not conform to the recommended Nepal and WHO lists of FDCs, respectively. The prescription of certain FDCs, however, were justifiable and in accordance with rational drug usage.

Phenylpropanolamine and the risk of hemorrhagic stroke.

Phenylpropanolamine is commonly found in appetite suppressants and cough or cold remedies. Case reports have linked the use of products containing phenylpropanolamine to hemorrhagic stroke, often after the first use of these products. To study the association, we designed a case-control study. Men and women 18 to 49 years of age were recruited from 43 U.S. hospitals. Eligibility criteria included the occurrence of a subarachnoid or intracerebral hemorrhage within 30 days before enrollment and the absence of a previously diagnosed brain lesion. Random-digit dialing identified two matched control subjects per patient. There were 702 patients and 1376 control subjects. For women, the adjusted odds ratio was 16.58 (95 percent confidence interval, 1.51 to 182.21; P=0.02) for the association between the use of appetite suppressants containing phenylpropanolamine and the risk of a hemorrhagic stroke and 3.13 (95 percent confidence interval, 0.86 to 11.46; P=0.08) for the association with the first use of a product containing phenylpropanolamine. All first uses of phenylpropanolamine involved cough or cold remedies. For men and women combined, the adjusted odds ratio was 1.49 (95 percent confidence interval, 0.84 to 2.64; P=0.17) for the association between the use of a product containing phenylpropanolamine and the risk of a hemorrhagic stroke, 1.23 (95 percent confidence interval, 0.68 to 2.24; P=0.49) for the association with the use of cough or cold remedies that contained phenylpropanolamine, and 15.92 (95 percent confidence interval, 1.38 to 184.13; P=0.03) for the association with the use of appetite suppressants that contained phenylpropanolamine. An analysis in men showed no increased risk of a hemorrhagic stroke in association with the use of cough or cold remedies containing phenylpropanolamine. No men reported the use of appetite suppressants. The results suggest that phenylpropanolamine in appetite suppressants, and possibly in cough and cold remedies, is an independent risk factor for hemorrhagic stroke in women.

From the Feds

From the Feds

Camphor Hepatotoxicity

We report a case of hepatotoxicity in a 2-month-old baby after a camphor-containing cold remedy was applied dermally. Liver function tests returned to normal after the application of the cold remedy was discontinued. Ingestion of camphor can cause severe liver and central nervous system injury, and neurotoxicity has been observed after exposure to camphor through the skin. Hepatotoxicity after dermal application of camphor has never been reported. This report emphasizes the common use of cold remedies that are usually not beneficial and may be potentially dangerous.

Camphor Hepatotoxicity

We report a case of hepatotoxicity in a 2-month-old baby after a camphor-containing cold remedy was applied dermally. Liver function tests returned to normal after the application of the cold remedy was discontinued. Ingestion of camphor can cause severe liver and central nervous system injury, and neurotoxicity has been observed after exposure to camphor through the skin. Hepatotoxicity after dermal application of camphor has never been reported. This report emphasizes the common use of cold remedies that are usually not beneficial and may be potentially dangerous.

Effect of Eucalyptus Oil Added Surfactants on the Rheology of Mucus Gel Simulants

Abstract Eucalyptus oil is a commonly used remedy for common colds. For a substance to be effective therapy in obstructive airway diseases, it must reduce the viscosity of respiratory mucus. The present study evaluates the effectiveness of eucalytpus oil added phospholipid mixtures as possible substitute therapies in diseases of altered mucus viscosity by studying their effect on the viscosity of mucus gel simulants in vitro. Test formulations of surfactants consisting of phospholipid-eucalyptus oil mixtures in the ratio of 1 part of oil to 9 parts of phospholipid were prepared. The phospholipids used were dipalmitoyl phosphatidylcholine (PC), phosphatidylethanolamine (PE) and phosphatidylglycerol (PG). The effects of these phospholipid-eucalyptus oil mixtures on the viscosity of Mucus Gel Simulant (MGS – a polymeric gel consisting mainly of gum tragacanth and simulating respiratory mucus) was studied by application of steady shear rates ranging from 0.512 to 51.2 s−1 in a concentric cylinder viscometer at 37°C. The change in MGS viscosity, after incubation with surfactants, with application of shear rates was found to have a Non-Newtonian flow and to follow the power law model with R2 values > 0.8. The addition of eucalyptus oil-phospholipid mixtures caused a decrease in the MGS viscosity when compared with the effect of the phospholipid alone at both low and high shear rates. The combination of PG with eucalyptus oil and of PG with eucalyptus oil and calcium caused ratios of change in MGS viscosity < 1, i.e. they caused a decrease in the MGS viscosity. Thus, the addition of eucalyptus oil improved the ability of the phospholipids to alter MGS viscosity. The combinations of PG with eucalyptus oil and PG with eucalyptus oil in the presence of calcium were even capable of lowering mucus gel viscosity and should be further researched as possible substitute therapies for diseases of altered mucus viscosity.

Overlooked sources of ethanol

The case of a 55-year-old female who presented to the emergency department with acute ethanol intoxication and suicidal ideation is reported. After initiating routine management, we discovered that her serum ethanol levels remained persistently elevated as a result of the patient’s secretly ingesting mouthwash. This occurred after she was searched and allowed to retain personal hygiene products. Alcohol-dependent patients may consume ethanol products that are not manufactured for ingestion. These products include cosmetics, cough and cold remedies, and personal hygiene products. The ethanol content of these nonbeverage ethanol (NBE) products exceeds that of many conventional alcoholic beverages. Financial constraints and ease of availability are factors leading to their consumption. This report serves as a reminder to be aware of the existence and popularity of NBE in order to avoid potential morbidity and even mortality associated with its use.

OTC cold, cough and allergy products: more choice or more confusion?

Cold and allergy remedies are one of the most confusing markets to consumers. There are several reasons why there is confusion among consumers when forced to select a cough/cold/allergy product. This paper examines the over-the-counter cold/cough/allergy products market specifically with respect to: (1) What are the common pharmaceutical active ingredients in cold/cough/allergy products? (2) What percentage of products are single ingredient, two ingredient, three ingredient or more? (3) What are the common combinations of pharmaceutical ingredients present in cold/cough/allergy products? The answers to the above questions could help health professionals such as pharmacists in rendering services such as counseling consumers when approached with questions about cold/cough/allergy products. The results could also help retailers in developing better shelf placement and positioning of cold/cough/allergy products.

Abuse of guaifenesin-containing medications generates an excess of a carboxylate salt of beta-(2-methoxyphenoxy)-lactic acid, a guaifenesin metabolite, and results in urolithiasis

Objectives. Several urinary calculi were submitted to our institution for compositional analysis. The typical techniques of analysis, polarized light microscopy, electron microprobe analysis, and infrared spectroscopy proved inadequate for a definitive identification. As a result, a more detailed organic analysis was conducted to determine the exact chemical structure of the material. Methods. Infrared spectroscopy and mass spectrometric analysis were carried out on the solid material, providing information concerning the functional groups and the molecular mass of the organic constituent and its components. The stone was solubilized in deuterated solvents and analyzed by nuclear magnetic resonance spectroscopy, which resulted in a definitive chemical structure. Results. The spectroscopic analysis indicated that the stones were composed of a calcium salt of beta-(2-methoxyphenoxy)-lactic acid, a metabolite of the pharmaceutical guaifenesin, which is used as an expectorant. Conclusions. Guaifenesin, an expectorant common in over-the-counter cold and allergy remedies, can cause urolithiasis if taken in excess. Discussions with physicians and their patients confirmed that most patients admitted to taking large doses of guaifenesin-containing medications.

スイッチＯＴＣ製剤を含んだラニチジン薬剤情報用紙に対する外来患者の意識調査

Switch OTC preparations of H2-receptor antagonists have been marketed since September 1997, which causes concern about the possible concomitant use with H2-receptor antagonists while the patient does not know that they are from the same drug class.We conducted a telephone-interview survey of patients awareness of drug information leaflets on switch OTC preparations of H2-receptor antagonists including precautions for use and adverse drug reactions in 203 patients who were taking ranitidine.Of the 203 patients, 16 (7.9%) purchased OTC preparations including cold remedy and gastric drugs. Of the 203 patients, 164 (80.8%) replied that they did not know about the selling of switch OTC preparations, because, for example, they were aware of their commercial message but did not know that they were from the same class of drug as ranitidine.Twenty-three (11.3%) of the 203 patients also received medication from other hospital (s), although type of drugs were not known.

Home-based therapies for the common cold among European American and ethnic minority families: the interface between alternative/complementary and folk medicine.

Most studies of alternative/complementary medicine use in children have focused on children with chronic illness and have not addressed the more common form of complementary medicine: popular home-based interventions and therapies for common low-morbidity sickness episodes. Also, there has often been a distinction between alternative/ complementary medical practices used by the general population and those used by members of ethnic minority groups and commonly referred to as folk medicine or ethnomedicine. To describe the home-based therapies and practices that parents from diverse ethnocultural backgrounds use to treat the common cold in their children. Interviews with mothers of children coming for care at a number of clinics and physicians' offices. Included were mothers from European American, African American, Puerto Rican, and West Indian-Caribbean heritages. Mean number of home-based remedies for the common cold did not differ among ethnic groups (controlling for maternal age, maternal education, number of children, and health insurance status). There were differences among groups regarding the frequency of use of specific remedies. Home-based remedies for colds in childhood are commonly used. Many of the treatments are complementary to biomedical treatment (ie, antipyretics, over-the-counter cold remedies, fluids). Very few are potentially hazardous if taken in moderation. Mothers from ethnic minorities use similar amounts of homebased interventions when compared with mothers from the majority culture.

Ginkgo: The Beautiful Powerhouse Tree

Ginkgo: The Beautiful Powerhouse Tree Ruth Trimble It has been said that beauty is its own reward, and the ginkgo's unique loveliness is reason enough for being, let alone the fact that it is an esoteric powerhouse which seems to hold vast promise for mankind. Ginkgo-thc hottest name going in medicinal research into natural herbs. Why the accelerated interest in this ancient tree? Can it really be the long-sought panacea for so many related ailments? Before the Ice Age the ginkgo tree covered many parts ofthe globe. Fossil records tell us that it has been around for over 200 million years. Extremely long-lived, some trees have survived as long as 4,000 years. It is highly resistant to parasites and seemingly impervious to industrial pollution. Because ofits beauty you will find it most often along streets and in parks, where it grows from thirty to fifty feet tall. New spring leaves are light and delicate, giving it the common name of maidenhair tree. During the summer the fan-shaped, bilobed leaves turn dark leathery green, then to butter-yellow in the fall. China and other Asian countries have used the kernels and roots of the ginkgo for centuries. The name "ginkgo" means silver fruit or white nuts in Chinese. The fruits are highly sought after in the Far East, and the roasted pits are considered a rare delicacy. The fruits are rarely seen in our country because both the flowers and fruits have a somewhat disagreeable odor, so usually only male trees are planted. It is the ginkgo leafupon which modern research is focusing. To be therapeutically effective, the leaves are converted into a concentrated extract since a simple decoction of the leaves is not potent enough to achieve the maximum results. However, an old Chinese remedy for the common cold is to infuse a handful of the leaves in boiling water and inhale the vapors from the steam. Ifthis is done at the very first "tickle" of a cold, it can often be warded offentirely. Ifthe symptoms persist, a frequent inhalation ofthe steam will help alleviate the discomfort and has been known to cut the duration by several days. This also works well for sinus infections, bronchial difficulties, stubborn coughs, and asthma, with-out the weird side effects sometimes experienced from the use ofthe-counter preparations. Loosening the phlegm soothes the air passages and linings, which makes breathing easier. Ruth Trimble is a native and life-long resident of Kingsport, Tennessee. Since her retirementfrom the U.S. Postal Service, she has been active in Tennessee and Virginia archaeological research, the study ofwildplantfoods and herbs at her Scott County, Virginia, hillsidefarm, and compiling and publishing herfamilygenealogy and other writings. 36 To be ready when the cold season arrives, gather a supply ofthe green leaves and dry in a warm place out of direct sunlight. When they thoroughly dry, crumple, place in a clean container, and store in a dark cupboard . Ifyou have difficulty locating a ginkgo tree from which to gather the leaves, consider raising your own. Find a fruit-bearing tree and collect the fruit when it falls from the tree after the first frost, probably in October. Wash the pulp away from the hard 1/2-inch seed kernels to prevent fungal rot during germination. Pack the seeds in moist sand in a plastic bag for eight or nine weeks at sixty-five to seventy degrees Fahrenheit. Check them often to make sure the sand stays moist. Then sow the seeds in a starting soil, covering them about 1-1/2 inches deep. Wet thoroughly, then put the pot outside for about two months. They need to be where the temperature is below forty degrees Fahrenheit, so you may want to put them in the refrigerator. Ifso, cover the pot with a plastic bag. In the spring take offthe bag and put the pot outside. Feed the newly germinated seeds lightly during the summer. Then in autumn transplant them to a well-drained section of your garden . As I lay abed early one spring morning, enjoying the cool breeze from the open window, I became aware ofa low, humming sound, which I thought was...

The Integration of Medical Management with Recovery

Patients recovering from alcohol and other drug addiction have unique medical and pharmacological needs. Careful selection of medications can decrease the risk of relapse. Angiotensin-converting enzyme inhibitors and calcium channel-blocking medications are excellent choices to treat hypertension. Most gastrointestinal problems resolve with abstinence and can be treated nonpharmacologically. In managing pain, physicians should avoid narcotics and use nonpharmacological treatment whenever possible. Treating recovering patients with HIV can be challenging because of the side effects of many of the antiviral medications. The newer antiviral agents have fewer side effects and contraindications. Commonly used remedies for colds and cough can cause a relapse to drug use. Patients with diabetes mellitus need to be monitored very closely in early recovery to prevent hypoglycemia. Frequently a team approach is helpful in managing the medication needs of patients in recovery.

Lymphangiolipomatosis: A New Pathological Entity

To our knowledge lymphangiolipomatosis is a pathological entity that has not been previously described in any tissue. We report the initial case of this lesion noted at routine transurethral prostatectomy. CASE REPORT A 66-year-old white man with a history of a coronary artery bypass graft and mild cerebrovascular accident presented in acute urinary retention after ingesting a nonprescription cold remedy. An indwelling catheter was placed and he returned for urological evaluation 4 days later. Retrospectively the International Prostate Symptom Score was 20 before catheterization. The catheter was removed but the patient was unable to urinate and the catheter was reinserted. An escalating dose of doxazosin was instituted in anticipation of a repeat voiding trial. Several days later the patient elected transurethral resection of the prostate. Digital rectal examination revealed a moderately enlarged, clinically benign prostate. Prostate specific antigen (PSA) was normal at 3.4 ng./ml. Preoperative evaluation, including urinalysis, serological testing, electrocardiography, chest radiography and physical examination, was normal. Transurethral prostatectomy was performed primarily with an electrovaporization technique supplemented with standard cutting loop electrosurgical resection. The prostatic fossa evidenced typical trilobate prostatic enlargement and the bladder was mildly trabeculated. At resection the prostate had an unusual pale appearance but the operation proceeded routinely. Convalescence was uneventful. Followup demonstrated negligible post-void residual urine and a marked decrease in International Prostate Symptom Score of 5. Gross inspection of the prostatic specimen revealed gray pink tissue fragments floating at the surface of a 10% formalin solution. Microscopy showed diffuse infiltration of the prostatic stroma by clusters of mature adipocytes associated with dilated endothelial lined vessels, comprising approximately 50% of specimen volume (parts A and B of figure). The vessels lacked muscular walls and intraluminal erythrocytes. These lining cells failed to stain for PSA (part C of figure). Immunoperoxidase staining for factor VIII related antigen confirmed endothelial cells lining the vessels (part D of figure). Glandular and stromal hyperplasia represented 10% of specimen volume and there were scattered foci of periglandular chronic inflammation. No malignant elements were present.

総合感冒薬の精神運動機能に及ぼす影響 ワープロ数字入力作業を用いた検討

総合感冒薬の精神運動機能に及ぼす影響 ワープロ数字入力作業を用いた検討

PSEUDOEPHEDRINE TOXICITY IN RENAL FAILURE

SUMMARY A case of pseudoephedrine toxicity is reported in a man with chronic renal failure. The effects of renal impairment on the metabolism of pseudoephedrine are discussed and the implications of the widespread availability of the drug in proprietary cold remedies are highlighted.

Finding the Most Reliable Dope on Doping

EVEN ATHLETES who have no interest in taking performance-enhancing substances need to learn about the substances that they may be tested for. The innocent use of the wrong over-the-counter cold remedy or an herbal tea from a health food store could land them in a lot of trouble with their sport's governing body. At the very least, the athlete's physician should be able to advise him or her where to get the most up-to-date information on substances that are prohibited by the athlete's sport governing body, says Lyn R. Frumkin, MD, PhD, associate director for clinical research at Amgen, Thousand Oaks, Calif. Frumkin is one of the US Olympic Committee's (USOC's) physician crew chiefs who supervise the collection and processing of urine samples from US Olympic athletes. The USOC, which operates a complete drug-testing program equivalent to the International Olympic Committee's (IOC's) program, distributes an official list of banned substances.

Cold, Cough, and Allergy Medications: Uses and Abuses

Separately or in combination, antihistamines, decongestants, antitussives, and expectorants are used to treat the cough and rhinitis symptoms of the common cold and of allergies. Each year, Americans spend 1 to 2 billion dollars on cough and cold remedies and lose more than 26 million school days and 23 million work days because of rhinitis and associated symptoms. Studies have shown that antihistamines and decongestants are efficacious in the treatment of allergy symptoms, but the results of studies are mixed regarding their efficacy in the treatment of symptoms of the common cold, and studies show no effect in prevention or treatment of otitis media.Some review articles and consensus opinions do not recommend the use of these drugs in the common cold (especially in preschool children), although some studies have demonstrated symptomatic relief, and physicians continue to prescribe or recommend these drugs for respiratory illness more than 36 million times annually.The Common ColdMore than 200 million cases of acute upper respiratory infection (URI) occur each year in the United States, and more than 75 million are seen by physicians. URIs account for 23 million missed work days and 26 million missed school days. This is the second most common diagnosis made by office-based pediatricians, second only to otitis media.