Unfortunately, cough and cold season also coincides with training season. What starts with a runny nose and sore throat oftentimes becomes a week of sneezing and coughing, leading to missed or compromised training. Different viruses can cause an upper respiratory tract infection known as the common cold.1 Because colds are viral infections, antibiotics are not effective or appropriate because they work against bacteria, not viruses.2 Many have searched for the “cure for the common cold” without success, but researchers have determined that neither exercise nor medical treatment consistently affect the duration of a cold.2,3 That said, treatment of the common cold is focused on symptom management rather than curing the infection. There are a few fundamental classes of medication used to treat colds: antihistamines, decongestants, expectorants, and cough suppressants. These medications will be covered in two different articles.
Runny noses and antihistamines
Antihistamines are divided into two groups: first and second generation. First-generation antihistamines include agents such as diphenhydramine (Benadryl) and doxylamine (Unisom) and may be used in cough and cold treatment. Available without a prescription, these medications help to decrease secretions, which can dry up a runny nose.4 Additionally, diphenhydramine can decrease cough by decreasing cough reflex sensitivity5 (this is particularly true if the cough is due to “post nasal drip” because the antihistamine will dry the secretions at the back of the throat that cause coughing). Despite their effectiveness, these medications may come with unpleasant side effects like drowsiness, blurry vision, dry eyes, and dry mouth. In some cases, their sedative (sleepy) effect can be beneficial, which leads to the inclusion of either of these active ingredients in many cough and cold medications designed for nighttime relief.4
Second generation antihistamines are newer antihistamines that have very similar side effects to the first generation medications, but with less sedation and dry mouth/eyes. They include those sold without a prescription, such as Cetirizine (Zyrtec), and those that require a prescription: levocetirizine (Xyzal) and desloratidine(Clarinex). Fexofenadine (Allegra) and loratidine (Claritin) may be prescribed or simply purchased in a pharmacy (without a prescription) depending on the actual product and dosage. All of these second generation agents are more often used for allergic rhinitis (“hay fever”), dermatitis/pruritis (itchy skin) or urticaria (hives) and not so much for relief from the common cold.
Stuffy noses and decongestants
Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) are the most common oral decongestants on the market. Although widely available over-the-counter, phenylephrine is not absorbed into the body well, and it has been shown to be no more effective in relieving nasal congestion than not treating it at all.6,7 Due to regulations concerning the misuse of pseudoephedrine, it is kept behind the pharmacy counter but is available for purchase for people at least 18 years of age without a prescription in Alabama. There are limits on the amount that may be purchased, a state or federal issued photo ID must be presented and a “logbook” signed at the time of purchase (to keep up with total amounts purchased). Pseudoephedrine and phenylephrine work by constricting blood vessels in the nose, which decreases blood flow to the congested area, thereby relieving nasal congestion (the “stuffy nose”). Their side effects come from blood vessel and heart stimulation, which can lead to an increase in blood pressure or an irregular heart beat (fast or abnormal rhythm), as well as central nervous system stimulation, which can lead to insomnia, anxiety, and restlessness. While these side effects do not occur in everyone, pseudoephedrine and phenylephrine should be used cautiously, if at all, by people with high blood pressure, heart conditions, or attention deficit hyperactivity disorder (ADHD).8
Concern exists about pseudoephedrine’s stimulant effects influencing athletic performance. Multiple studies have shown that therapeutic doses of pseudoephedrine do not affect athletic performance in endurance activities like running. Still, because of the potential for abuse, the World Anti-Doping Agency prohibits high urine concentrations of pseudoephedrine (although the prohibited concentration level is higher than an athlete taking as recommended likely would achieve).9 Because exercising while taking pseudoephedrine can increase heart rate, an athlete might experience an uncomfortable feeling in his chest when he exercises while taking pseudoephedrine. (Author’s note: I notice that when I run while taking a stimulant such as pseudoephedrine, I have a harder time catching my breath and feel like my heart is pounding in my chest).
Next month, this column will address cough medications and their potential impact on running and other exercise. In the meantime, stay well!
Want to Feel Better?
- Get plenty of rest, drink plenty of water and try chicken soup when you have a stuffy nose. It also may help to sleep upright.
- Suctioning with a nasal bulb syringe (purchased from a pharmacy) can offer temporary relief for congestion, particularly in young children.
- Antihistamines such as Benadryl can help with runny noses (and maybe coughs) but may make you sleepy for your run or workout.
- Limit the amount of pseudoephedrine you take due to its affect on your heart rate and blood pressure. Be mindful of this side effect in combination with exercise.
- Avoid taking combination products for symptoms you don’t have or taking a variety of medications for one symptom.
- Don’t hesitate to ask your pharmacist or physician for advice.
Stacy Farry and Zackary McMullan, PharmD. 2016 Candidates and Kim Benner, PharmD, BCPS, FASHP, FPPAG.
Stacy Farry and Zackary McMullen are students at Samford University. Kim Benner is a distance runner and current Volunteer Coordinator for the BTC. When she’s not running the streets of Birmingham, Kim is a clinical pharmacist at Children’s of Alabama, a Professor of Pharmacy Practice at Samford University and a mother of two non-running boys.
References:
1. Available at: http://www.cdc.gov/features/rhinoviruses/. Accessed November 1, 2015.
2. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2013;6:CD000247.
3. Weidner T, Schurr T. Effect of exercise on upper respiratory tract infection in sedentary subjects. Br J Sports Med. 2003;37(4):304-6.
4. Turner RB. Epidemiology, pathogenesis, and treatment of the common cold. Ann Allergy Asthma Immunol. 1997;78(6):531-9.
5. Dicpinigaitis P, Dhar S, Johnson A, Gayle Y, Brew J, Caparros-Wanderley W. Inhibition of cough reflex sensitivity by diphenhydramine during acute viral respiratory tract infection. Int J Clin Pharm. 2015;37(3):471-474
6. Phenylepherine hydrochloride. Micromedex 2.0. Truven Health Analytics, Inc. Greenwood Village, CO. Available at: http://www.micromedexsolutions.com. Accessed November 3, 2015.
7. Meltzer EO, Ratner PH, Mcgraw T. Oral Phenylephrine HCl for Nasal Congestion in Seasonal Allergic Rhinitis: A Randomized, Open-label, Placebo-controlled Study. J Allergy Clin Immunol Pract. 2015;3(5):702-8.
8. Gillies H, Derman WE, Noakes TD, Smith P, Evans A, Gabriels G. Pseudoephedrine is without ergogenic effects during prolonged exercise. J Appl Physiol. 1996;81(6):2611-7.
9. Chester N, Reilly T, Mottram DR. Physiological, subjective and performance effects of pseudoephedrine and phenylpropanolamine during endurance running exercise. Int J Sports Med. 2003;24(1):3-8.