Active ingredient | Mechanism[1,2] | Potential benefits | Potential risks*[1-3] |
Antipyretics/analgesics:
| Reduction in temperature; little evidence regarding effects on discomfort[4] | Acetaminophen may suppress the neutralizing antibody response, resulting in increased nasal secretions and prolonged viral shedding | |
First generation antihistamines:¶
| Anticholinergic effects decrease mucus secretionΔ | No clinically significant benefits[5] |
|
Narcotic antitussives:¶◊
| Act on cough center in brainstem | No more effective than placebo[5,6] |
|
Nonnarcotic antitussives:¶
| Act on cough center in brainstem | No evidence of effectiveness[5-8] |
|
Oral decongestants:¶
| Vasoconstriction | No evidence of effectiveness in children <12 years[9,10] |
|
Topical decongestants:¶
| Vasoconstriction | No evidence of effectiveness in children <12 years[10] |
|
Antihistamine-decongestant combination¶ | Anticholinergic effects (antihistamine) Vasoconstriction (decongestant) | No more effective than placebo[5,9,11] | Refer to potential risks for antihistamines and decongestants above |
Expectorant:¶
| Increase mucus production to make secretions easier to remove with cough or mucociliary transport | No studies of effectiveness in children[1,2,5] |
|
Mucolytics:¶
| Thin secretions to make them easier to clear through coughing | Some evidence of improvement compared with placebo[5] |
|
Topical aromatics:
| May act on TRPM8 cation channel to produce a cooling sensation | Subjective improvement of nasal patency without objective increase in air flow[12] Parental report of symptomatic improvement in nocturnal cough and sleep in poorly blinded study§[13] | GI and CNS effects may result from accidental ingestion |
Ipratropium bromide״ (nasal) | Decreases nasal discharge via anticholinergic activity | May decrease nasal discharge but not nasal congestion[14] |
|
CNS: central nervous system; GI: gastrointestinal.
* Overdose is a potential risk with all of these agents, particularly when combination products are used.
¶ Because the risks outweigh the proven benefits, these medications generally are not recommended for children younger than six years of age. We suggest not using these medications in children 6 to 12 years of age.
Δ Histamine is not an inflammatory mediator in the common cold.
◊ Requires a prescription.
§ Significant placebo effect cannot be excluded.
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