Archive for the ‘Cough and Cold’ Category

How to Stay Healthy During Flu Season

February 9th, 2017. Filed Under: Allergies, Cough and Cold, Influenza, Travel.
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It’s been a nasty flu season so far. Over the holidays I see family members that don’t get out too much, and one of my cousins asked me, “How do you avoid getting sick during the winter months, when your job requires you to be exposed to sick people all day long?”

There are two habits that can REALLY help you avoid infections from viruses like colds and the flu. One of the most important is also simple, yet not always easy to do: avoid touching your face with your hands, because that is how viruses can easily infect you. As much as possible, avoid using your hands to rub your nose, rub your eyes, or touch your mouth. I admit, it’s a hard habit to break, but it does cut down on your exposure to viruses.

The second key habit to avoid getting the flu is to wash your hands frequently and EFFECTIVELY. Unfortunately, most people, even medical professionals, don’t wash their hands well enough. Wiping your hands with antibacterial gel is just not good enough if you want to avoid getting sick from viruses.

Friction is more important than chemicals. Washing your hands by lathering with soap, then rubbing the surfaces thoroughly has been proved more effective than using an antibacterial gel or soap. Two of the most neglected areas are between your fingers and along your cuticles.

After years as a hospital pharmacist I’ve developed a serious allergic reaction to triclosan, a common antibacterial chemical used in Liquid Dial® and Softsoap®. To avoid having my hands itch and peel after using soaps containing it, I avoid all antibacterial soaps as much as possible. Instead, I carry a small bottle of liquid shampoo with me to wash my hands in hotels, restaurants, airports and some family member’s homes that still contain liquid antibacterial soaps.

Here are a few tips to help you stay healthier during the winter months:

  1. Wash your hands frequently and thoroughly. You DON’T have to use antibacterial soap, just good technique.
  2. The key to good hand washing technique is FRICTION. Lather up and rub every surface well, spreading your fingers apart to get in between them.
  3. When washing your hands, don’t neglect to rub the lather into your cuticles, where viruses can easily hide.
  4. To avoid contact with the chemical soaps found in most airport and restaurant restrooms, carry a hotel-sized bottle of liquid shampoo that you can use instead.


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Which is the Best Antihistamine For You?

Q: Every summer my nose runs and my eyes itch from my allergies. Claritin® has worked for me in the past but for some reason this year is different. I tried Allegra®, but it’s not helping, either. What other antihistamines could I try?

Antihistamines work by keeping histamine locked away inside your body. Histamine is a compound that triggers inflammation and is stored in special cells in your body called mast cells. When you come in contact with something you’re allergic to, your mast cells open up, spilling out histamine and triggering the symptoms we associate with an allergic reaction: stuffy or runny nose, itchy eyes and sinus pressure.

Because they work by preventing histamine from escaping from your mast cells, antihistamines work best if you take them at least 1 hour BEFORE being exposed to what sets your allergies off.
Which antihistamine you should try depends on which one will work best for you and how drowsy it makes you. There are 2 main categories of antihistamine medicines to choose from: sedating ones and non-sedating ones. The sedating antihistamines are older drugs that often cause drowsiness and dry you out. This drying action can actually help relieve your runny nose and watery eyes. Newer antihistamines don’t drowsiness but may not be as effective at drying up a runny nose.

Some antihistamines relieve allergy symptoms better with some people than with others. Many people have to try more than one before they find the one that works best for their allergy symptoms while causing the least drowsiness.

How important to you is avoiding drowsiness? Older antihistamines cause at least some drowsiness in most people. If this is a concern for you, start with the newer antihistamines because they cost little to no drowsiness.

One of the best antihistamines to try first is loratadine, also known as Claritin® and Alavert®. It’s taken only once a day, and rarely causes drowsiness. If loratadine isn’t helping you, another newer non-sedating antihistamine is Allegra®, or fexofenadine, available in either twice a day or once a day versions.

If either of those is not working for you, try cetirizine (Zyrtec®). It’s more likely to cause you some drowsiness compared to Claritin® or Allegra® but because it’s more drying than either of them it can help dry up your runny nose. You only have to take it once a day and it causes minimal drowsiness.

If Claritin®, Allegra® or Zyrtec® aren’t giving you enough relief, you can try one of the older sedating antihistamines. The most powerful is Benadryl® also known as diphenhydramine. It helps with serious allergic symptoms but will cause drowsiness in most people. In fact, you can buy diphenhydramine as a sleeping pill without a prescription as Tylenol PM® or Sominex II. Benadryl® needs to be taken 3 to 4 times a day for best results. Some people take it just at night and substitute another antihistamine during the day.

There are other older antihistamines still available, including chlorpheniramine, brompheniramine, and triprolidine. Triprolidine causes less drowsiness than the other older antihistamines and seems to have the most drying action as well. Surgeons used to avoid having their nose drip while doing surgery. Its main drawback is that it’s only available as Actifed®, a combination with the original formulation of Sudafed®. I really like how effective it is for runny nose, watery eyes and nasal congestion.

4 Tips on how to choose an antihistamine:

1. Take a dose of your antihistamine BEFORE you come in contact with what you are allergic to, if possible. That way you’ll get better results than if you wait until your nose stuffs up and your eyes start itching.

2.  If you have to drive or use machinery, choose one of the newer non-sedating antihistmines like loratidine (Claritin®), fexofenadine (Allegra®) or cetirazine (Zyrtec®) first.  Everyone is a little different in how they react to a medicine.

3. If your first antihistamine choice doesn’t help you, try another one. It’s not unusual to get good results with one yet very little relief from another.

4. An antihistamine can be purchased as a single agent or combined with other medicines, like a decongestant. I recommend you avoid the Sudafed PE® that is sold on the shelf which contains phenylephrine because it is not as effective as the original formula of Sudafed® containing pseudoephedrine. If you need a decongestant for a stuffy nose I recommend the original version of Sudafed®, available from your pharmacist.  You will need to bring photo identification to purchase it. Triprolidine/pseudoephedrine (Actifed®) is a good choice for runny and stuffy nose symptoms.

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New Options For Your Allergies

Allergies can be an occasional annoyance or a source of ongoing misery. They can even change your life. One guy I knew, Steve, after finally reaching his lifelong dream of becoming a veterinarian developed a very serious allergy to dogs and cats while in his very first year of practice.

After trying every antihistamine and desensitizing treatment available at the time, Steve’s allergies were still so severe that he faced a tough choice: to completely change his veterinary practice to taking care of other animals instead of dogs and cats, completely give up his lifelong dream of being a veterinarian, or risk dying from an anaphylactic reaction to one of his patients. He eventually left the veterinary world behind to become a pharmacist, graduating a couple of years after me.

Many years ago I had a customer called Connie, who came in frequently seeking help for her allergies. After years of sniffling and sneezing she was told she was allergic to cats. The trouble with that was she had 2 Siamese cats that she refused to part with. Sasha and Lucy were her best buddies: they slept with her every night and she dressed them up in cute outfits every Halloween and Christmas.

Back then I only had a few antihistamines and a couple of nose sprays to offer to Connie, but today I can show her many more options. Claritin®, Zyrtec® and Allegra® are newer antihistamine pills now available without a prescription. Claritin® (loratadine), Zyrtec® (cetirizine) and Allegra® (fexofenadine) each had great success as prescription antihistamines and are widely available today without a prescription.

In addition to those pills I can also suggest 2 new nose sprays that can really change Connie’s life. These nasal sprays contain anti-inflammatory medicine that works similar to prednisone and are very effective for allergy symptoms of the nose, called allergic rhinitis. Now she doesn’t need to go to a doctor to benefit from them. Nasacort AQ 24 Hr® was the first nose spray with triamcinolone, a prednisone-like ingredient. Available without a prescription, Nasacort AQ 24 Hr® has been joined by Flonase Allergy Relief® which contains a different cortisone-like ingredient, fluticasone. These nose sprays are one of the most effective ways to treat allergic symptoms, especially those that involve the nose like sneezing, sniffling and stuffiness.

Up until now, the only nose sprays we had available for allergies that didn’t need a prescription could not be used for more than a few days at a time. Afrin® (naphazoline) and Neo-Synephrine® (phenylephrine) sprays work by causing the blood vessels in your nose to shrink, relieving your stuffy nose. Trouble is, your relief only lasts a short while; if you continue using them they eventually stop working and your congestion comes back even while you are still using them. This is called rebound. Some people can use these intermittently for months and manage to avoid getting rebound stuffiness, while others find their nose spray only works for about 3 days before it quits. If you have high blood pressure or a heart condition, you should avoid this type of nose sprays completely, as they increase blood pressure.

Nasalcrom® is a nose spray for allergies that works by blocking your allergic symptoms. It only works if you start using it several weeks BEFORE you are around whatever you’re allergic to, and has to be used 3-4 times daily for best effect. Unlike Afrin® or Neo-Synephrine®, Nasalcrom® can be used safely in children 2 years and older and can be continually used for years without losing its effectiveness.

Nasacort AQ® 24 Hr® and Flonase Allergy Relief® contain a cortisone-like medicine that can effectively relieve nasal congestion, runny nose and sneezing with just one or two sprays a day. Kids as young as 2 years old can safely use Nasacort AQ 24 Hr® and Flonase Allergy Relief® can be used safely in children 4 years old and older. Another great thing is being able to add any antihistamine pill to either Nasacort AQ®24 Hr or Flonase Allergy Relief® for even more relief.

If Connie walked into my pharmacy today, she would have 3 new antihistamine tablets and 3 more nose sprays to choose from for relieving her stuffy nose, and Lucy and Sasha could continue sleeping with her every night. My 3 Scottish Terriers would be SO jealous!

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My Favorite Remedies

If you were stranded on a desert island, which remedies would you be sure to take? I’ve been thinking about my own “must haves” for that. Here are some of my favorites:

1.  Meclizine 25mg tablets.

Indispensable in controlling my motion sickness when riding in cars, planes or ships, meclizine is such a travel essential that I NEVER leave home without it. Sure, I do fine if I’m the driver, but if I’m a passenger I’ll get a headache, nausea or worse. One dose of 25mg meclizine lasts 24 hours, allowing me to travel comfortably, even in the back seat. I can even read a book or surf the Internet on my phone. Sure, I probably wouldn’t need it while ON the desert island, but what about the trip going TO and FROM it?

2. New Skin® liquid.

This stuff is absolutely wonderful to prevent ingrown toenails. Since I’ve been using it painful or ingrown toenails have not bothered me. I apply just a little bit just under the nail and to the skin immediately around the sides of my nail and it toughens the skin and helps keep my toenails from curling under and cutting into the tender skin underneath. It also protects small cuts from dirt, a nice bonus on a desert island. New Skin® now comes in a handy 15 ml bottle which takes up less space compared to its original 30 ml size bottle.

3. Docusate 250mg capsules.

I struggle with earwax buildup and often end up in my doctor’s office getting my ears flushed out. I used to use Debrox® liquid made my ears go “snap, crackle and pop” caused an unbearable tickling sensation. This year I decided to try docusate, because docusate liquid is what most doctor’s offices use to soften impacted earwax before flushing it out. However, it’s not sold as earwax remover in the United States.

Last month my left ear became completely blocked with earwax, to the point I couldn’t hear at all. I cut off the end of a 250mg docusate capsule with kitchen scissors and squeezed the contents into my left ear. The capsule had just the perfect amount of liquid for my ear canal and unlike Debrox® it didn’t crackle or tickle. I followed that up with another capsule 12 hours later and waited another couple of hours then used my little blue bulb syringe to gently flush it out. I could hear again! The bulb syringe even helped me draw out the leftover water out of my ear.

I prefer the convenience of the capsules (buy 250mg instead of 100mg capsules), but you can also buy an empty dropper bottle and fill it with docusate liquid (not the syrup), both available from your pharmacist.

4.  Butterfly bandages.

These would be very useful on a desert island. Ever since my training as an Emergency Medical Technician, I keep both large and small butterfly bandages in my medicine cabinet and in my car. They work really well to match up the edges of medium to large cuts and help avoid getting stitches. Sometimes I cut the big ones in half lengthwise and use them extra close together to help seal up the edges.

Last week I dropped a full jar of molasses onto my husband’s empty deep green glass coffee mug. CRASH! As I reached over to carefully pick up the green shards, my thumb brushed up against the newly razor-sharp edge of a clear 4-cup glass Pyrex pitcher also broken in the crash. Thank goodness for those butterfly bandages! HOWEVER, if you can see bone or have any trouble moving your fingers get medical attention immediately, as you may have nicked a tendon which can cause permanent disability if not treated.

5. Calendula cream.

For dry or irritated skin, I’ll be sure to pack my favorite Arbordoun’s Abundantly Herbal Calendula Cream® that contains calendula and lavender in an olive oil base. Although it’s a little greasy when I first put it on, it soaks in completely in just a couple of minutes.

6. My pillbox.

Since I’ve been using a pillbox I’m SO much more consistent in taking my medicine. It’s the number one strategy I recommend to everyone for taking your medicine safely.

What are some of YOUR favorite remedies?

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Sudafed, Sudafed PE and Sudafed PSE

October 16th, 2012. Filed Under: Cough and Cold.
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Q: I just bought some Sudafed® but it doesn’t seem to work for me any more. Is there anything else I can take that would work better?

If you purchased Sudafed® from the allergy and cold medicine section of your local pharmacy or grocery store, it’s not the same medicine. In fact, if you look closely, the box has Sudafed PE® on it.

Sudafed PE® is different than the Sudafed® you remember. The original formulation of Sudafed® contains pseudoephedrine. The newer version of it has phenylephrine, which is why the name on the package is Sudafed PE®. Both pseudoephedrine and phenylephrine are decongestants designed to relieve stuffy nose symptoms but their potency and effectiveness are different.

Phenylephrine is effective as the topical decongestant in Neo-Synephrine® nose spray but Sudafed PE® doesn’t work as well. For one thing, phenylephrine is not well absorbed into your body from your stomach. Some of the phenylephrine is left behind instead of getting into your bloodstream, where it needs to be to do its job.

The other reason Sudafed PE® doesn’t work as well as Sudafed® is because it is less potent. Phenylephrine and pseudoephedrine are both effective as nasal decongestants when taken as a 30mg dose. Phenylephrine has caused high blood pressure and stroke at that dose, so the Food and Drug Administration (FDA) has limited it to a 10mg dose, only 1/3 of the adult dose considered equivalent to pseudoephedrine. Sudafed PE® is unlikely to cause any serious side effects at this dose, but it’s also unlikely to give you much relief from your stuffy nose.

Why was an effective and popular non-prescription medicine replaced with a wimpy one? Pseudoephedrine became too popular for its own good by being a key ingredient in making methamphetamine. In 2005, the USA Patriot Act restricted the sale of key ingredients of methamphetamine, called precursors, in an attempt to combat meth production, trafficking and abuse.

The compounds identified as precursors are ephedrine, phenylpropanolamine, and pseudoephedrine. Beginning on September 30, 2006, products containing any of these were to be kept “behind the counter” in pharmacies or under lock and key by grocery stores or other vendors. Today, except in Oregon and Mississippi, you can still purchase the original formulation of Sudafed® if you ask for it, show your ID and sign for it. You cannot purchase more than 3.6 grams in a 24-hour period or 9 grams in a month.

My pharmacy moved our stock of cold medicines with pseudoephedrine behind our counter nearly a year before the restrictions took effect because we were getting ripped off. When we first noticed the problem we tried moving them to where they were in plain view of the pharmacist. Despite that, the shelf would be bare again within a day or two. Pretty brazen, shoplifting them right in front of the pharmacist!

Did these restrictions on pseudoephedrine work? Not according to a report published April 30, 2012 by the National Association of State Controlled Substances Authorities (NASCSA). Titled Impact of State Laws Regulating Pseudoephedrine on Methamphetamine Trafficking and Abuse, the report describes how “smurfing” – the practice of buying pseudoephedrine frequently by using various fake IDs at multiple locations, has circumvented the federally mandated restrictions and recommends a different approach.

The state of Oregon took the Patriot Act restrictions on methamphetamine precursors even farther and changed pseudoephedrine into a prescription-only controlled substance with restrictions and monitoring just like the narcotic pain reliever Vicodin®. Oregon is one of the only states to experience a consistent and dramatic decline in meth lab incidents and trafficking since 2006 and NASCSA is now petitioning the Drug Enforcement Administration (DEA) to follow Oregon’s example and reclassify pseudoephedrine as a controlled substance.

If Sudafed® becomes a prescription-only medicine it would be more expensive and require a clinic visit, driving an inexpensive and effective systemic nasal decongestant out of reach of many Americans.

For now, except in Oregon and Mississippi you can buy the old formulation of Sudafed® or generic pseudoephedrine by stopping by a pharmacy, showing your ID and signing for it.

Dr. Louise Achey, Doctor of Pharmacy is a 30-year veteran of pharmacology. Please send your questions and comments to

©2012 Louise Achey


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