Throat sprays and cough drops and nasal sprays, oh my

Midwestern winters are famous for bringing low temperatures, icy winds and dry air, as well as coughs and congestion. Luckily, over-the-counter (OTC) products can provide relief, and are available in a variety of brands and dosage forms. It’s important to differentiate between their active ingredients to safely and effectively treat cough and congestion. Brandon Euen, PharmD at Parkview Health, shares what consumers need to know.

Cough drops

Cough drops (also called lozenges or troches) dissolve in the mouth to relieve irritated tissues of the throat that stimulate coughing. Not all cough drops are created equal. These active ingredients are used to target specific cough/cold symptoms:

Menthol - Naturally found in plants such as peppermint, menthol has mild local anesthetic properties and can be found in brands like HALLS™.

Eucalyptus oil - Has an anti-irritant effect and may provide minor antibacterial activity. Often seen in combination with menthol in brands such as Ricola™.

Dextromethorphan - Works in the brain to suppress coughing, and is used in many OTC cough products. Can be found in some Delsym™ and Cepacol™ lozenges.

Pectin - Naturally found in fruits, pectin serves as a demulcent (or a compound that forms a protective film to prevent irritation). Found in brands such as Luden’s™.

Benzocaine - a local anesthetic sometimes used to numb areas for surgical procedures. It can be found in low concentrations in brands such as Cepacol™ or Chloraseptic.

Throat sprays

Throat sprays, as the name implies, are sprayed directly into the mouth to exert local action on inflamed throat tissues. After the spray stays in the throat for the duration on the package labeling, the user spits out excess medication. If a little is swallowed, don’t worry, accidental consumption of a small amount of these medications is completely safe. Like with cough drops, there are several different active ingredients that give throat sprays their soothing effects:

Phenol - Used for its local numbing effects, phenol is often combined with other ingredients,  such as menthol. It is the primary ingredient in Chloraseptic throat sprays.

Glycerin - Like pectin, glycerin is a demulcent that coats the throat to prevent irritation. It is found in various brands of throat sprays and also serves as a sweetening agent.

Benzocaine – Described above, it is often found in higher concentrations in sprays than in cough drops. Although uncommon, overuse of benzocaine sprays has been tied to a blood disorder called methemoglobinemia, prompting the FDA to issue a warning about inappropriate benzocaine throat spray use.

Nasal sprays

Nasal sprays come in multiple varieties, including non-medicated, steroidal, antihistamine, decongestant and homeopathic. It is especially important to read the active ingredients in these products, as certain types of nasal sprays are designed to treat certain conditions. Additionally, some active ingredients can only be used safely for a specified duration of time.

Non-medicated

Saline – Moistens and irrigates nostrils, relieving congestion and dryness. Saline spray is cheap and safe for all ages, and is available under a variety of different brands.

Steroidal

Fluticasone or Triamcinolone – Used to treat congestion, sneezing, and itchy nose, these medications are intended for the relief of allergy-induced symptoms and will likely be ineffective for winter congestion.  Common brands include Nasacort and Flonase

Antihistamine

Cromolyn – Works by stopping histamine release, which has little impact on winter congestion.  Like fluticasone and triamcinolone, cromolyn is best used to relieve allergy-induced symptoms.  NasalCrom™ is one commonly seen brand.

Decongestant

Oxymetazoline - Narrows the blood vessels in the nasal passages to reduce congestion and swelling. Use of oxymetazoline is not recommended for greater than 3 days, as nasal symptoms may worsen due to a phenomenon known as “rebound congestion”. Several brands of spray such as Afrin and Sudafed contain oxymetazoline.

Homeopathic

Ingredients vary by product. Zicam™ nasal spray is one example; however, there is limited evidence to support the efficacy of many homeopathic medications.

 

Always follow these rules when considering the medications described above.

Do: Follow age restrictions on products, which vary based on active ingredient type and strength. Follow dosing instructions on the medication labeling, as these medications can be harmful when used incorrectly. Consult your pharmacist before using any new medications, especially if you take other prescription products or have diagnosed medical conditions.

Don’t: Use these products for extended durations without seeing a physician.  If troublesome symptoms persist for over 3 days, see your primary care provider to address any underlying causes. Make assumptions based on brand name. Products with the same brand name can have different active ingredients, or the same active ingredients in different strengths.

Remember, your local pharmacist is a great source of information to answer any additional questions you may have involving cough drops, throat sprays and nasal sprays.

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