A Q&A with Katreena Merrill on how to navigate the cold and flu aisle
The New Year ushered in freezing temperatures and snow, making the cold and flu uptick unavoidable. Fortunately, there are plenty of accessible options for dealing with irritating cold symptoms such as congestion, sore throat, headache, runny nose, sneezing and coughing. But sometimes, says BYU nursing professor Katreena Merrill, there are too many options.
“The choices are overwhelming when you walk into the cold and flu aisle, even for me,” Merrill said. “Colds and flus are viruses, so they can’t be treated with antibiotics, but people are miserable. They need symptom management relief but often leave the doctor’s office frustrated. They go to the cold and flu aisle, and they don’t know which one to take. I mean there’s just so many it’s ridiculous.”
In this Q&A, Merrill shares her decades of expertise and recent findings from her perfectly timed research (carried out with fellow BYU professor Beth Luthy) to help make navigating the cold and flu aisle at the store more manageable this winter.
Q: Is there a difference between name brand and generic medicine?
A: Generics should be equivalent as long as they contain the active ingredient you need. The research studies we looked at were specific to the active ingredients found in medication. So, generic brands are actually pretty good if you can look on the active ingredients listed on the box or bottle and confirm whether the medication has the active ingredient you need to help you with your symptoms.
Q: Is there one medicine that is better than others when dealing with a cough?
A: When a cough is the thing that is bothering you the most, you should look for a product that has an anti-cough active ingredient, specifically Dextromethorphan. Dextromethorphan is a cough suppressant, and it is found in things like NyQuil, Delsym, and Robitussin. Those will help you decrease your cough, especially at night.
Q: What is best for stuffy or runny noses?
A: It depends, because there’s decongestants and then there’s antihistamines (medicines often used to relieve allergy symptoms). You know how it is: when you have a cold, your nose can be running like crazy, or you can’t even breathe because you’re so stuffed up.
Let’s start with decongestants. Decongestants have gotten a bad rap because previous misuse cases of Pseudoephed — a medicine using the active ingredient pseudoephedrine — have made some people believe it shouldn’t be taken. But if you’re congested, pseudoephedrine is one of the better drugs to take. Pharmacies and grocery stores keep it behind the counter so it can’t be abused, but it is worth asking the pharmacist for. (You don’t need a prescription.) Pseudoephedrine can be found in Pseudoephed, Advil Cold and Sinus, and Claritin-D. You have to be careful because Claritin by itself doesn’t have pseudoephedrine in it.
If you have a runny nose, especially at night, antihistamines are the way to go. Unfortunately, there’s quite a few to pick from, but some of the more common ones are Benadryl and Tylenol Complete. At nighttime you should look for something that has a first-generation antihistamine, (diphenhydramine, chlorpheniramine maleate, or doxylamine succinate) because it will also make you sleepy. The daytime ones have different ingredients to stop your nose from running or stop congestion, but they don’t make you drowsy.
Q: At what point should someone see a doctor?
A: Colds typically last from a week to 10 days. We tend to get frustrated after a while. The rule of thumb is to wait it out, but if you have any underlying conditions then you need to be a little more careful. If you start to run a high fever (103 or 104+ degrees Fahrenheit) you need to be seen. When you have a cold or other viral infection and gunk starts coming up when you cough, it should be clear. Same thing with your runny nose — it should be clear. If you start to see green goo, you probably need to be seen by a doctor. Anytime you become short of breath, then you definitely want to be seen.
In general, colds without underlying conditions are just annoying and don’t cause major problems. There are other viruses that are more serious, like influenza and COVID, that could possibly hospitalize a normal healthy person, so you do need to be careful. In a nutshell, a high fever (103+), shortness of breath or underlying disease are reasons to see a doctor. The other thing is intuition: always rely on personal revelation and feelings. I know that isn’t a medical term, but it is definitely a factor, because you know when something isn’t right.
Q: Are there other important factors to be aware of when taking cold and flu medicine?
A: One of the things I often see in college students is that they load up on Tylenol and Ibuprofen, in addition to cold combination drugs, when they don’t feel good. The problem with that is that most cold combination drugs often contain acetaminophen and a rare few include ibuprofen. It is really important when you are taking a cold and flu medicine to not take additional acetaminophen if it is already included because you can overdose if you’re not careful. Tylenol is the brand name; acetaminophen is the generic ingredient.
The reason that they have dosages and frequencies is for safety. More medicine is not necessarily better. You must be careful to follow the directions on the box and don’t expect to take nighttime stuff and still be able to drive or study.
Q: What are the common mistakes parents make when scanning the cold and flu aisle while searching for medicine for kids?
A: This is a topic that has recently been in the news and in the research! Over-the-counter decongestants and cold medicine are often not recommended for small children, so you have to be extra careful. Young children are not small adults so you can’t just give them a low dose of adult cough medicine. I strongly suggest that parents call their provider and explain that their child is sick. Say, “I have something here, but I hesitate to give it to them because they are a kid.” The provider will make a recommendation.
You can use these medications for school-aged children, junior high and high school, but you have to be really careful not to let your kids self-medicate. When they are miserable and just want to feel better, they take extra amounts of something or take two medications like cough syrup and something else that both have Tylenol in them. You need to be careful because they don’t always understand.
Q: Are there medicines that people should have on hand, and others that you should only buy on an as-needed basis?
I like to have an antihistamine on hand even though I don’t always take it as a first line drug. The reason is that an antihistamine stops inflammation. For example, if someone gets a bee sting you can use it for that. I think as a college student that is strapped for cash I would just buy on an as-needed basis and go with generics.