Antihistamines for Colds

The next issue of The Medical Letter (November 25, 2013) will include an article on a new combination of the opioid hydrocodone and the first-generation H1– antihistamine chlorpheniramine that will be marketed as Vituz for treatment of cough and cold and allergy symptoms. Hydrocodone (in combination with acetaminophen for treatment of pain—Vicodin, Lortab, and others), as we wrote 2 blogs ago, will likely soon be reclassified as a Schedule II controlled substance because of concerns about its abuse.

One thing has to be said for hydrocodone: it will suppress a cough, which is more than can be said for chlorpheniramine or diphenhydramine (Benadryl), both of which are ubiquitous in over-the-counter cough and cold concoctions. So what are they doing there? They are there for sedation, which has plusses and minuses. And maybe to dry up secretions, which may not be such a good idea. Sometimes they are combined with guaifenesin, which increases secretions, which is a good idea.

So now we have a cold remedy that combines a (soon-to-be) Schedule II opioid with a first-generation antihistamine. (Actually, there are 2 other combos containing hydrocodone and chlorpheniramine on the market already – Tussionex Pennkinetic, Zutripro, and generics). How irrational is that? Well, for starters, they both can cause sedation and constipation, so that could add up, especially the constipation. But first-generation antihistamines can cause some other problems as well. The way we described it in our Treatment Guidelines from The Medical Letter article on Drugs for Allergic Disorders (May 13, 2013) was this:

First-generation H1-antihistamines such as diphenhydramine or chlorpheniramine can cause impairment of CNS function with or without sedation. They can interfere with learning and memory, impair performance on school examinations, decrease work productivity, and increase the risk of on-the-job injuries. Impairment is particularly evident during performance of multiple concurrent tasks or of complex sensorimotor tasks such as driving, and can occur before drowsiness or sedation. When these medications are taken at night, adverse effects on wakefulness and psychomotor performance can persist the next day. With regular use, tolerance to both sedation and performance impairment can develop. First-generation H1-antihistamines can also cause anticholinergic effects such as dry mouth and urinary retention.

Maybe an OTC cough syrup with only dextromethorphan and guaifenesin would be less problematic. And for patients who really can’t sleep, there are some less worrisome alternatives. But that’s another subject for another day.

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  1. Fought this battle for thirty-six years as an otolaryngologist, first in private practice and later in academia, and not sure it will ever be won. Thanks for an honest view of the situation.

  2. Tony Shallin, M.D. says:

    So, what kind of advertising will the public be hearing: “Ask your doctor for Vituz for your allergy or cold”? An addictive narcotic for your allergy? That’s crazy.

  3. Reblogged this on Tulsa Allergy News and commented:
    Should I use sudafed or allegra? Antihistamines are often not the best for colds anyway. This is from the editor of The Medical Letter…great reviews on lots of medication.

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