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College of pharmacy/University of Baghdad

Clinical pharmacy Dept.

Fourth year. Community Pharmacy workshop. 2009-2010

COMMON COLD

 Common cold : is  a self-limiting viral infection of the upper respiratory tract (1(.

The probable routes of transmission are (2(:

 1-Manual transmission (e.g. hand- to-hand contact.(

 2-Inhalation of droplets spread by sneezing and coughing.

 Note: contrary to common belief, cold environment or sudden chilling do not increase

susceptibility to viral upper respiratory infection (1 ( . 

Patient assessment with common cold (questions and answers(A-Age:

Very young patients and very old patients required referral. Also the age affect the choice of treatment(3(.

B-Duration(3): Generally (see flu later:(

 Abrupt onset of symptoms-------------------May indicates flu.

 Gradual onset of symptoms-----------------May indicates common cold.

C-Symptoms.Symptoms typically are worst on day 2 or 3 of illness and last about 1 week( but in about 1/4 of patients

it may lasts for about 2 weeks or longer) (2). Symptoms of common cold are:

 1-Sore throat: The throat is often feels dry and sore during a colds and it is usually 1st sign of 

common cold (3(. 

2-Runny / congested (or blocked) nose:)Initially clear watery fluid-------after 1-2 days (2) become thicker mucus (3(.(

 3-Sneezing/ coughing (3(

 

4-Aches and pains: Headache may occurs but a persistent or worsening frontal headache (pain above or

bellow the eyes) may be due to sinusitis ------------referral for further investigations(3(.

)Note: headache of sinusitis increase by lying down or bending forwards) (3(. 

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 5-Low grade fever (feeling hot but in general a high temperature (>37.5) is rare

in common cold (3) (<1% of patients (2(.(( 

The presence of fever may indicate FLU rather than common cold (see flu later.(

 6-Earache: A blocked uncomfortable ear is often present and does not need referral if it does

not persist. A very painful ear needs referral (3(.

D-Previous history: Patient with a history of asthma (asthmatic attack can be triggered by respiratory viral infection)

or lung disease e.g. chronic bronchitis (which can be complicated by secondary chest infection)-----------required referral for further investigations(3(.

F-Flu(3 ( :Differentiating between colds and flu is needed. Flu is generally considered to be likely if :

 1-Temp. Is 38c or higher (37.5 in elderly.(

 2-At least one of the respiratory symptoms (cough, sore throat, nasal congestion, or rhinorrhoea) is

present.

 3-At least one of constitutional symptoms (headache, malaise, myalgia, sweat, chills, and

prostration) is present.

NOTE:

 In common cold the upper respiratory symptoms are the most prominent while in flu the

constitutional symptoms are predominant and fever is present in more than 95% of patient (2(.

 Flu often starts abruptly with sweat and chills, muscular aches and pain in the limbs, a dry sore

throat, cough and high temperature. Someone with flu may be bedbound and unable to go to their

usual activities. There is often a period of generalized weakness and malaise following the onset of 

symptoms. A dry cough may persist for some time.

 Flu generally settle with no need for referral, however , flu can be complicated by secondary lung

infection (pneumonia)---------------therefore any patient with Flu and warning sign and symptoms of 

complication (severe or productive cough, persisting high fever, delirium ,pleuretic chest

pain)  -------required referral for further investigations (3(.

)However reference 3 recommends referring any patient with symptoms indicative of Flu(

G-Present medication(3 ( :If one or more appropriate remedies have been tried without success (failed medication) -------------

referral for further investigations (3(.

Also patients taking chronic immunosuppressive drug therapy (e.g. corticosteroid or ciclosporin)

--------------referral (1(.

Treatment timescale:

Once the pharmacist has recommended treatment, patient should be advised to see the Dr. in 10-14days if cold has not improved(3(.

Management:

A- To reduce the likelihood of catching or passing on infection (8(:– If possible, stay away from people with colds or influenza.

– Avoid crowded places where the risk of infection is greater.

– Do not touch nose or eyes after being in physical contact with somebody who has a cold or influenza.

– Wash hands thoroughly, especially after blowing the nose.

– Throw away paper tissues after use to prevent the spread of infection.

– Keep rooms well aired.

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B-Non pharmacological measures: Non -drug therapy include:

1-increased fluid intake which may loosen the mucus and promote drainage (1(.

2-getting adequate rest may help to recover quickly (1(.

3-adequate nutrition (1( 

4-saline solution (discussed later) can soothe the irritated nasal tissue and moisturized nasal mucosa 

(2). And it can be given to all age group and during pregnancy (1(.

There are already formulated saline drops or spray products in the market:Dose : use as often as needed (8(

C- Pharmacological therapy:

1-Decongestants (sympathomimetics:(A-Systemic (oral) decongestants: like Pseudoephedrine and phenylphrine. They reduce nasal

congestion by constricting dilated blood vessels in the nasal mucosa (3(.

C/I: Systemic (oral) decongestants cause stimulation of the heart, increase the BP and may cause

hyperglycemia. Therefore they should avoid in (3(:

)D.M, Ischemic heart disease (angina, M.I), hypertension, and hyperthyroidism.(

غير شئعة اسعم ف العراق حلي إم توجد ضمن الـ: (ر)هدحول  أ ةا إ:ةظح Cough or common cold) preparation for compound(

B-Topical(drop/spray) Nasal Decongestants( sympathomimetics:(

1-Classification and Doses (1(:

doseExample(s(type2drops/sprays q 4-6

hours p.r.n)but Naphazoline q 6 hours(

phenylphrine, Naphazoline,

tetrahydrozoline

Short acting (4-6 hours.(

2drops/sprays q 8-10

hours p.r.n

Xylometazoline(Otrivine:(®

 0.1%:<12years

 0.05%:2-12years 

Intermediate acting (8-10

hours.(

2drops/sprays q 12hours

p.r.n

Oxymetazoline(Nazordine:(®

 0.05%:<12years

 0.025%:2-12years 

Long acting ( 12 hours.(

2-Nasal Spray or Drop (1,3(???

-Nasal sprays are preferable for adults and children aged over 6 years because spray has a

faster onset of action and cover a large surface area.

-Nasal drops are preferable for children aged below 6 years because their nostrils are notsufficiently wide to allow effective use of sprays.

)But the drops cover a limited surface area and easily swallowed which increase the possibility of systemic effects.(

3-Topical Nasal decongestants (sympathomimetics) can be recommended for those patients in whom

Systemic (oral) decongestants are to be avoided (3(.)i.e. D.M, Ischemic heart disease (angina, M.I), hypertension, and hyperthyroidism.(

4-Duration of treatment with Topical Nasal Decongestants (sympathomimetics:(

If topical; (drops or sprays) decongestants are to be recommend, the pharmacist should advice the

patients not to use the product for longer than 7 days (3) (3-5 days in some references (1))

because: Rebound congestion (Rhinitis medicamentosa) (with congestion returning often worse than

before)(4) can occur with topically applied (3) (especially short acting (1)) but not with oral

sympathomimetics (3(.

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5-Topical nasal decongestants:

*can be given to pregnant women after the 1st trimester (i.e. the 1st three months) of pregnancy (5(.

*Not OTC for children < 2 years (1(.

*Not recommended for children <6 months (or 3 months in BNF) because they are obligate nose

breathers and rebound congestion can cause obstructive apnea (6). Saline nose drop can be used from

birth to help with congestion. This would be more suitable and safer alternative than topical

sympathomimetics (5(.

6-Administration of nasal spray and nasal drop:(ا خب  رط معس ةيصلا ةرطلا ىرل رملا  ملا رظا) 

2-Antihistamines:Antihistamine can reduce some of symptoms of a cold: runny nose (rhinorrhoea) and sneezing but are

not so effective in reducing nasal congestion (3). There is no evidence that any antihistamine is preferable

to another in the treatment of rhinorrhea (4(.

Antihistamine can be classified into:

 A- Sedating Antihistamine:Examples of OTC sedating antihistamine are:

Chlorpheniramine (Histadin® tablet and syrup), Dexchlorpheniramine (polaramine® tablet), and

Diphenhydramine (Allermine® tablet and syrup(

 

S/Es: include sedation and drowsiness (patients should be informed) and anticholinergic S/Es (i.e. dry

mouth, urinary retention, constipation…) and the elderly patients are more susceptible to these (7(.

Accordingly they are not recommended (3) (or used with caution (6)) for patients with: Glaucoma, or

prostate hypertrophy and in elderly patients.

Drug Interactions: the sedative effects of antidepressants, anxiolytics, and hypnotics are likely to be

enhanced by sedating antihistamine (7(.

 B- Non-Sedating Antihistamine:Examples of OTC non-sedating antihistamine are:

Loratadine (clarityn® tablet and syrup), and cetirizine (Zirtek® tablet and syrup.(They are generally preferable over the older antihistamines because of much lower incidence of S/Es (7(.

Adult dose of Loratadine: 10 mg once daily.Note: although the drowsiness is rare, but the warning that these drugs may affect driving and skilled tasks is still present (6,

7.(

3-Combination products: sympathomimetics (for congestion) + Antihistamine (for rhinorrhoea and

sneezing:(

 The antihistamine is usually combined with Sympathomimetics because:

A-The suppression of rhinorrhea can provokes congestion so the Sympathomimetics will offset this

effect.

B- Sympathomimetics may also help to counteract sedation caused by the antihistamines (because theSympathomimetics cause CNS stimulation), but not counteract other side effects such as dry mouth ,

urinary retention,…….(4(.

Example of OTC products is:

Actifed® tablet and syrup: which composed of Triprolidine (sedating antihistamine) and Pseudoephedrine(sympathomimetics.(

4-Analgesics, antipyretics, and cough preparations (2(:Systemic analgesics and antipyretics (e.g. Paracetamol, Ibuprofen) are effective for aches or fever

which may be associated with common cold.

In addition, cough, when present, may be treated by suitable cough products (see cough.(

5-Vitamin C in common cold:A review of trial data conducted in 2000 concluded that Vitamin C:

*Does not prevent colds.

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*Appears to reduce the duration of symptoms when ingested in large dose (up to 1gm daily)

although the response is variable(5(.

)Reduce the duration by less than 1 day and severity by about 22%) (1(.

 Taking mega doses of vitamin C can have an adverse consequences particularly for group of 

patients who are already at risk :

1-Vitamin C is a reducing agent and may interfere with diabetic urine glucose tests.

2-It has also been reported to counteract the action of anticoagulants.

3-It may increase the production of urinary oxalate , leading to renal stone.

4-In case of vitamin C effervescent tablets, large quantities of sodium bicarbonate are required in thisformulation, which could disturb the electrolyte balance of patients with cardiovascular diseases ,

especially those whose sodium intake is restricted (4(.

حظة: – بلة لوزا  ا بع المص تو بحلة جمي ال لطي ا بع ع بك ج بلصيدلية  ل تك1

:  مب وت صملا  ذه .بس هر لا ارب ةبوص ددشTreatment – influenza(8(:

-Rest, preferably by staying in bed.

-Try to get plenty of sleep.

-Drink as much as possible, as large amounts of fluid are lost during a fever

-Avoid smoking.– Treat with over-the counter antipyretics and other medications as symptoms require.

– Consult a doctor if the symptoms have not gone after a week, or sooner if symptoms worsen.

ف الد حيث تص احلة إل الطي2حظة  (  رلا ويطلا) -هذا الك  ط د شيو و طير ن اوزاضرة.

لـا ن ع نمل لديصلا ل لا ةسب  ص  ميفCommon Cold 

References

1-Handbook of Non-prescription drugs. 2002

2-Applied therapeutics :the clinical use of drugs.2004

3-Symptoms in the pharmacy . A guide to the managements of common illness.

 4th edition By Alison Blenkinsopp and Paul Paxton .2002.

-Nathan A. Non-prescription medicines. 3rd edition. London: Pharmaceutical Press; 2006.4

5-Community Pharmacy. Symptoms, Diagnosis and Treatment.

By Paul Rutter.2004.

6-BNF. 52

  لـا   Common Coldا  ن-ن هو المر  مر ؟(ا  ارأ ف سن ا  إ  ح أ رضع؟)1

2 عت لا ارا ه-

تدي أ بصو سرعة)3 ) ارا أدب ي-4 ملا ن عت ه-5ا ةلح ف ادصلا از ه ؟نييعلا وح ادصلب رعت ف وج ةلح ف ؟ ادصلا ن عت ه-

إل ا؟-ه وجد ال ف ا ؟ه هو شدد أ ي؟67ارا ذه عل معت لا ةا ه  ؟ه ؟ ىرأ ارأ ن عت ه -

8لح عل  ؟  ه اليةذ  بدأ اسعمل ؟ ه ؟هذ--ه اسعم أة

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7-A. Nathan .How to treat hay fever and associated allergic conditions in the pharmacy . the

pharmaceutical journal (vol 268). 27 April 2002 pages 575-578.

8-Nathan A. fasttrack. Managing Symptoms in the Pharmacy. Pharmaceutical Press; 2008.

Homework: complete the following table:

Caution or contraindicationsCompositionsTrade name

Coldin® tablet

Coldin® syrup

Actifed®tab and syrup

Flu out® tablet

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