There is no cure for cold and flu because they are caused by viruses, which is why antibiotics are not effective. However, colds and flu are self-limiting, which means that the body’s own immune system will usually fight them off over time. While patients wait for this to happen, many will want treatments to help ease their symptoms, so that they can feel more comfortable. The main cold and flu treatments will include one or more of the following:

Analgesics or painkillers
These help to relieve muscular aches, pains, headaches and sore throats and can also reduce fever, especially in children. There are three types of analgesic available in the pharmacy:

• Ibuprofen (e.g. Hedex Ibuprofen Tablets and Nurofen Tablets) - Best taken after food to minimise irritation on the stomach; not suitable for people with asthma who are sensitive to aspirin
• Paracetamol (e.g. Panadol, Panadol Soluble and Hedex Tablets) - Gentler on the stomach than other painkillers, but adults need to be careful not to exceed eight 500mg tablets in any 24-hour period. As a number of cold and flu combination products contain paracetamol along with other ingredients, patients need to check labels carefully to avoid double dosing
• Aspirin (e.g. Anadin Original and Disprin) - Should not be recommended to children under the age of 16.

Decongestants
These products bring relief from stuffy or blocked noses. There are two main types:

• Nasal decongestant sprays e.g. xylometazoline (e.g. Otrivine), and oxymetazoline (e.g. Vicks Sinex), or shorter acting ingredients such as ephedrine and phenylephrine - Work by rapidly diffusing the nasal veins so they contract, opening up the nasal airway. These products should not be used for more than five days or they can cause rebound congestion - when the patient stops using them, their blocked nose returns
• Oral decongestants e.g. pseudoephedrine (e.g. Contac Non Drowsy) and phenylephrine (e.g. Beechams All-in-One) - Tend to be less likely to cause rebound congestion. However, they are not suitable for patients with high blood pressure, an over-active thyroid, heart disease or diabetes.

Cough medicines
There are a number of types of cough medicine available to treat different types of cough. The main ones are:

• Demulcants e.g. glycerin (e.g. Beechams Veno’s Cough Mixture), honey and lemon (e.g. Beechams Veno’s Honey and Lemon). These have a soothing action and help to provide relief from dry, tickly coughs
• Suppressants - Ingredients include dextromethorphan, pholcodine and antihistamines (e.g. Cough Nurse Night Time Liquid, Adult Meltus Dry Coughs with Congestion). These help to stop coughing and are good for dry, tickly coughs. However, they should not be recommended for coughs that are clearing excessive mucus from an infected chest
• Expectorants - e.g. guaifenesin (e.g. Beechams Veno’s Expectorant) and ipecacuanha (e.g. Galloway’s Cough Syrup). These increase bronchial secretions and reduce the stickiness of mucus making it easier to cough up. They should be recommended for productive, chesty coughs. Patients should also drink plenty of water.

Antihistamines
Some antihistamines e.g. diphenhydramine help to dry up nasal secretions. Most commonly this will be included as an ingredient in combination cold products.

Combination products
Some customers may want to use one product which addresses a number of different symptoms. For example, some combine an analgesic with a decongestant (e.g. Beechams Cold and Flu Hot Lemon, Beechams Powders Capsules). Others add an antihistamine (e.g. Benylin 4 Flu), while others offer something for coughs (e.g. Beechams All-in One Tablets, Day Nurse). Some of these products come in sachets which can be made into soothing drinks, others use a tablet or capsule formulation, or come as a liquid.

<PRACTICE POINT>
Go and look at the following products:
Beechams Cold and Flu Hot Lemon
Beechams All-in-One tablets
Beechams Powders
Day and Night Nurse Capsules
Night Nurse

For each one make note of:
1. The different formulations available (e.g. tablets, liquid, etc.)
2. The active ingredients (e.g. pain relief, decongestant, cough suppressant, etc.)
3. Recommended dosage
4. Who you would recommend it to.

Sore throat products
These can be in the form of pastilles, lozenges, gargles and throat sprays and contain a combination of the following ingredients:
• Demulcents e.g. glycerin - Act to soothe and coat the sore throat
• Antibacterials and antiseptics e.g. benzalkonium chloride (e.g. Beechams Max Strength Sore Throat Relief Blackberry Lozenges) - Work by attacking the bacteria that are causing the inflammation and pain
• Anti-inflammatories e.g. flurbiprofen (e.g. Strefen Honey & Lemon) - Act to reduce the inflammation of a sore throat
• Local anaesthetics e.g. benzocaine (e.g. Tyrozets) and lidocaine (e.g. Covonia Throat Spray) - Numb the throat and ease the symptoms of the sore throat.

Inhalants
Substances such as menthol, eucalyptus, peppermint, pine oil and camphor work to relieve congestion by being inhaled either directly or after being dissolved in hot water (steam inhalation). Product examples include Covonia Vapour Drops, Happinose and the Olbas range.

For more information about the treatment of colds and flu, take a look at the e-learning cold and flu module.