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Over-The-Counter Cold Medicines 101

Andrea Meadows, M.D., Lexington Clinic Pediatrics           

When your child is sick with a cold, it seems reasonable to try and treat his symptoms at home, right? Only, when you go to the drug store, you are confronted with a myriad of choices on what types of medications to use. Which one will work best for him? How do you know what medicines are safe to give? Hopefully, this tutorial will help. It’s important to keep in mind that these over-the-counter (OTC) cold medications are generally considered safe for kids 6 years and older but should only be used in kids under 6 with the advice of your pediatrician.   

Cold medicines fall into four general categories: fever reducers, antihistamines, decongestants, and cough medicines. Listed below are the generic names for the medications along with brand names, where appropriate. It’s important for you to be able to identify generic names so you know what is in each product. You can find these listed under “active ingredients” on the box. 

Fever reducers: Your choices here are acetaminophen (Brand name Tylenol) or ibuprofen (Advil or Motrin). The Tylenol can be safely used in all children older than 2 months of age and ibuprofen can be used for children older than 6 months. The doses are based on the child’s weight, and all packages should have a dosing guideline on the box. 

Cautions: Be careful with the amount you give your child and the time between doses. 

Antihistamines:  Most commonly used for “runny nose” or “allergies”. They are used to help stop excessive mucus production and allergy symptoms. The type of medication differs by brand name, however the most commonly used antihistamines are diphenhydramine, brompheniramine, or chlorpheniramine (these are the generic names).  Brands that include these medications are Dimetapp, Robitussin and Triaminic, among many others. 

Cautions:  Antihistamines can cause drowsiness, but in some kids can actually cause hyperactivity.  

Decongestants:  Used for “stuffy nose”, “nasal congestion” or “sinus congestions”, they help to relieve swelling in the nose and sinuses. Commonly used oral medications include phenylephrine or pseudoephedrine (now only available at the pharmacy window).  Brands include Robitussin, Triaminic and Dimetapp, among others. There are also nasal decongestant sprays available that contain xylometazoline or oxymetazoline. Triaminic Decongestant spray is the only one specially formulated for kids over age 2. 

Cautions: Decongestants sometimes can make children (and adults) jittery, anxious, or hyperactive. They also have a tendency to give you that “medicine head” feeling. 

Cough medicines:  Used to help control cough or chest congestion. Dextromethorphan is used as a cough suppressant and guaifenesin is used as an expectorant, or mucus reducer.  These are used in Mucinex, Robitussin and Delsym, among other brands. 

Cautions: Do not use cough suppressants in children that have a tendency to wheeze or who have asthma. Cough suppressants can cause drowsiness, so use only at night when possible.   

Keep in mind:

     - It is best to try to buy single symptom medications—that only have one medicine in them—rather than multi-symptom medications. 

     - Always follow the dosing guidelines and never give a larger dose than recommended or give the medicine sooner than the minimum time interval.

     - If you do buy multi-symptom medications, make sure you know exactly which medicines are in it. For example, many multi-symptom medications contain Tylenol already so you would not want to give them additional Tylenol. 

     - If your child is on other medications it is always best to check with your pediatrician before giving any OTC cold medications.