Modern Cold Medicines: Same Stuff, New Packages

Mar. 25–At first glance, the cough and cold section at the Milpitas Walgreens looks like pharmaceutical pay dirt. Ten shelves high and about 35 feet wide, it is stacked with myriad syrups, sprays, salves and swabs aimed at easing symptoms of the common cold.

Eureka! you think, as you navigate the aisle in a cold-induced haze. Modern medicine in all its might has yielded hundreds of different remedies to beat your virus into submission.

But the boxes of the grape-, orange- and cherry-flavored elixirs tell a little-known truth: Manufacturers are selling us the same drugs in alternate flavors, formats and formulations.

The cold-fighters come as chest patches, vapor sticks, soft chews, tongue strips and even freezer pops. But they all still contain combinations of fewer than a dozen active ingredients.

“Many of these products aren’t any better. They’re just a different package with the same ingredients,” said Candy Tsourounis, director of the Drug Information Analysis Service at the University of California-San Francisco. “The medicines haven’t really changed at all.”

Indeed, the biggest recent change to the cold medicine market was not the addition of any medical breakthrough, but the elimination of a common ingredient, phenylpropanolamine, in 2000. The substance, which appeared in nasal decongestants, was linked to strokes and withdrawn by drug makers.

Since that time, decongestants have been reformulated, predominantly relying on another old standby, pseudoephedrine, to clear up stuffy noses.

But with no major new addition to the over-the-counter market since the antihistamine Claritin was first sold without a prescription in 2002, drug makers have turned to marketing magic to sell consumers on their cough and cold products.

Enter Triaminic Thin Strips. And Triaminic Softchews. And Triaminic spray. And Triaminic Vapor Patch. Plus, Triaminic Night Time Cough & Cold, Triaminic Chest & Nasal Congestion, Triaminic Cold & Cough, Triaminic Cold & Allergy and Triaminic Cough & Sore Throat.

Forgive us if we’ve forgotten any.

“It’s very confusing,” agreed Dr. Carrie Loutit, the lead physician at the acute care clinic at Lucile Salter Packard Children’s Hospital at Stanford. “Most parents invest a lot of time in going to the drugstore looking at all the products, trying to buy the right medicine.”

That can take awhile. There are more than 600 cough and cold preparations to choose from, according to Information Resources, a Chicago-based market research firm. When you include generic-label cold medicines hawked by grocery stores, pharmacies and big-box centers, the true number is probably in the thousands, analysts said.

With so many options do come some good choices. For one, there are those generic store brands with the exact same active ingredients as the more expensive brand-name drugs.

And there are now sugar-free cold syrups for diabetics and alcohol-free versions for children or teetotalers.

Consumers can pick from capsules, nasal sprays, nasal swabs, chest patches, hot liquid formulas, nose creams, effervescent formulas, liquid medicines and even a “vapor plug” that emits a medicinal mist after being plugged into an electrical outlet.

Cold sufferers can purchase decongestants, cough suppressants, expectorants, antihistamines or analgesics alone. Or they can buy combination drugs that contain several ingredients.

“It gives individuals a choice to decide what is best for them from a cost perspective or a taste perspective or an ingredient perspective,” said Fred Eckel, a North Carolina pharmacist and editor of Pharmacy Times.

From a medical perspective, however, a cough suppressant is a cough suppressant. Read the package labeling and you’ll see that each of the cough quieters relies on dextromethorphan to work its wonders. The expectorants are all made with guaifenesin. And decongestants are largely made with pseudoephedrine.

Do the decongestants make you jittery or leave your hands feeling cold? Sorry, there really aren’t any alternatives.

Some experts wonder if there need to be.

“What we already have is pretty effective,” said Evelyn Hermes-DeSantis, a clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers University.

But consumers should have realistic expectations.

Over-the-counter medicines are only meant to ease symptoms, and do not shorten the duration of colds. Research is also mixed on whether expectorants do a good job at loosening phlegm. And the Food and Drug Administration has stated that cough suppressants are “most soothing” when taken in the form of throat lozenges. “As liquids,” the agency said, “they are probably swallowed too quickly to be effective.”

Packard pediatrician Loutit does not recommend giving cold medicine to children under age 6, except for Children’s Tylenol or Children’s Motrin.

In young children, “they don’t work,” Loutit said. “And they can have side effects.”

Still, Americans certainly haven’t replaced cold medicines with grandma’s chicken soup, spending $2.9 billion on cold and cough formulas in 2004 alone, according to Information Resources.

Which is why you’ll probably continue to see manufacturers churning out product after product not unlike the ones already in consumers’ medicine cabinets.

And it stands as a classic example of economics, supply and demand. People get sick. They feel horrible. They want relief. And drug makers reward them with plenty of medicinal options.

“Because,” Loutit said, “people buy them.”

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