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Are you a high-risk patient?

There are some patients that should be seen by a doctor or other healthcare professionals before taking over-the-counter cold and cough medication as these medications may cause serious complications, drug interactions or adverse effects in these patients.

Infants and young children

Many of the over-the-counter medications contain ingredients that should not be used in children, especially children under 2-6 years of age. 1,2 Check with your doctor or pharmacist before giving your child any medication.

Women who are pregnant or breastfeeding

When you are pregnant or breastfeeding, whatever medication you are taking may reach your baby so it is important to check with your healthcare professional before taking over-the-counter medication. Long-term or high doses of cough and cold medication may be harmful to your baby. 3,4

The elderly

Elderly people often have other conditions and are on many medications that can interact with cold and cough medication. 5,6 Ask your doctor or pharmacist before taking any over-the-counter medication.

People with heart conditions

  • Heart failure
  • Heart attack or stroke
  • Warfarin treatment

Cold and flu remedies may contain anti-inflammatories that can cause you to retain fluid and make your heart failure worse. Many cold medicines also contain decongestants, which can raise blood pressure. 7 Over-the-counter medication may also interfere with your heart medication, especially if you are on warfarin. 8

People with kidney conditions

  • Kidney failure

If you have kidney disease it is important to check with your doctor before taking any over-the-counter medication as some of them may interfere with your kidney medication or damage your kidney function. 9

People with liver conditions

  • Liver failure
  • Cirrhosis

If you have liver disease you may not be able to tolerate normal medication doses so it is important to check with your doctor what medications you can take and at what doses. 10 Never double up on over-the-counter cold medications as these often contain paracetamol, which can be toxic to the liver in large doses. 10

People with mental conditions

  • Epilepsy
  • Depression
  • Psychosis

If you have a mental condition you will most likely be on long-term medication. Check with your healthcare professional before taking any over-the-counter medications as these may interfere with your treatment and result in unwanted severe side effects such as seizures or psychosis. 11-13

People with diabetes

Over-the-counter cough and cold remedies may contain agents such as sugar, alcohol, oral decongestants or NSAIDs that may negatively affect your blood vessels and blood sugar levels. Speak to your healthcare professional before using any over-the-counter medication if you have diabetes. 14,15

People with cancer

Over-the-counter medications, even herbal or vitamin products, can interfere with anticancer agents and affect their efficacy and/or safety. 16,17 If you have cancer and are receiving any treatment, it is important to speak to your oncologist or healthcare professional before taking any over-the-counter medications. 16

People infected with HIV

Over-the-counter medications can interfere with HIV medications and affect their efficacy and/or safety. 18 If you have HIV and are receiving any treatment, it is important to speak to your healthcare professional before taking any over-the-counter medications.

NSAIDs = nonsteroidal anti-inflammatory drugs; HIV = human immunodeficiency virus

References:

1. Centers for Disease Control and Prevention. Infant Deaths Associated with Cough and Cold Medications – Two States, 2005. MMWR Weekly 2007;56(01):1-4. 2. Gov.UK. Over-the-counter cough and cold medicines for children. [online] 2009 Apr [cited 2018 Mar 28]. Available from: URL: https://www.gov.uk/drug-saftey-update/over-the-counter-cough-and-cold-medicines-for-children. 3. Erebara A, Bozzo P, Einarson A, Koren G. Treating the common cold during pregnancy. Can Fam Phys 2008;54:687-689. 4. Mayo Clinic. Cough And Cold Combinations (Oral Route). [online] 2017 Mar 1 [cited 2018 Mar 28]. Available from: URL: https://www.mayoclinic.org/drugs-supplements/cough-and-cold-combinations-oral-route/before-using/drg-20061164. 5. Maher RL, Hanlon JT, Hajjar ER. Clinical Consequences of Polypharmacy in Elderly. Expert Opin Drug Saf 2014;13(1):doi10.1517/14740338.2013.827660. 6. Glaser J, Rolita L. Educating the Older Adult in Over-the-Counter Medication Use. Geriatrics Aging 2009;12(2):103-109. 7. University of Rochester Medical Center. Heart Disease: Considering Cold Relief. Available from: URL: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=56&contentid=DM20. 8. Mayo Clinic. Warfarin side effects: Watch for interactions. [online] 2018 Feb 3 [cited 2018 Mar 28]. Available from: URL: https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/in-depth/warfarin-side-effects/art-20047592?pg=2&p=1. 9. Kidney Research UK. Over the counter medicine. [online] [cited 2018 Mar 28]. Available from: URL: https:www.kidneyresearchuk.org/health-information/over-the-counter-medicine. 10. Saab S, Konyn PG, Viramontes MR, Jimenez MA, Grotts JF, Hamidzadah W, et al. Limited Knowledge of Acetaminophen in Patients with Liver Disease. J Clin Transl Hepatol 2016;4:281-287. 11. Khan AY, Preskorn SH. Multiple Medication Use in General Practice and Psychiatry: So What? Psychiatr Times 2005;XXII(12). Available from: URL: http://www.psychiatrictimes.com/adhd/multiple-medication-use-general-practice-and-psychiatry-so-what. 12. Bouwer A. Combination cold and flu medicines: an overview of autonomic nervous system receptors. S Afr Pharm J 2011;78(6):17-22. 13. Farrer F. EPILEPSY and Over-the-Counter medications. SA Pharmaceut J 2009:26-30,52. 14. Rhoades KR. Prescribed Medications and OTCs: Interactions and Timing Issues. Diabetes Spectrum 2002;15(4):256-261. 15. Taylor J. Over-the-Counter Medicines and Diabetes Care. Can J Diabetes 2017;41:551-557. 16. Mouzon A, Kerger J, D’Hondt L, Spinewine A. Potential Interactions with Anticancer Agents: A Cross-Sectional Study. Chemother 2013;59:85-92. 17. Hanigan MH, dela Cruz BL, Thompson DM, Farmer KC, Medina PJ. Use of Prescription and Non-Prescription Medications and Supplements by Cancer Patients during Chemotherapy; Questionnaire Validation. J Oncol Pharm Pract 2008;14(3):123-130. 18. Brooks KM, George JM, Kumar P. Drug interactions in HIV treatment: complementary & alternative medicines and over-the-counter products. Exp Rev Clin Pharmacol 2017;10(1):59-79.


 

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