The latest in over-the-counter relief for families
Ah yes, the season of cruds. We’ve become regular connoisseurs, curating light sneezy colds that trick you into thinking it’s allergies, to the coughing kind that lasts three weeks — and keeps the whole family hacking all winter long.
What’s a mom to do? We asked three local pharmacists for advice: Anne Harthman, RPh, PharmD, of Broadway Apothecary in Eugene; Ryan Ferris, PharmD, of Salem Health in Salem; and Caelon Vecchio-Miller, PharmD, of Samaritan Pharmacy Services in Corvallis.
Finally, the good stuff is back
In 2006, Oregon made pseudoephedrine — a truly effective decongestant — prescription only, in an effort to halt its use in illegal methamphetamine production. In 2022, this restriction was repealed: no more prescriptions needed.
Today, you can get pseudoephedrine over-the-counter, but with a hitch: you have to ask for it. At the pharmacy counter, be prepared to show a government-issued ID (you must be 18 or older) and sign a logbook. There are limits to how much you can buy, so your purchase will be tracked; good to keep in mind if you’re the one who buys meds for your family. “If you need more than what is allowed by the federal limits, you can get a prescription from your doctor or pediatrician,” said Ferris.
So we’ve been buying...a placebo?
About that cold medicine we’ve been taking the past 15 years, phenylephrine. In 2023, the FDA declared what many of us suspected: oral phenylephrine is ineffective. So why is it still fully stocked on shelves?
“The FDA reviewed the scientific evidence for phenylephrine and have said that it appears to not be effective, but they have no concerns on its safety at recommended dosages,” said Vecchio-Miller. “For it to be taken off the shelf it must go through a multistep process. Until that is done you are likely
to continue to see them on the shelves.”
Ferrris added, “It is important to note that the FDA’s actions only apply to oral phenylephrine and not to the nasal spray form, which are still effective for congestion.”
Now that pseudoephedrine is easier to access, can I give it to my stuffed-up kids?
It’s a no for kids under age 4, and yes for over age 12. For children in between, it’s complicated. “Over-the-counter labeling is going to say ages 6 and under should consult with a provider for the 30 mg immediate release,” said Vecchio-Miller. “Children 12 and under should consult a provider for 60 mg immediate release.”
If you’re looking for a liquid version containing pseudoephedrine, you’ll have to ask for it behind the counter, too. “While it is available to purchase, you may have to shop around as tablets are far more common,” noted Vecchio-Miller. Harthman gave a reminder that congestion can produce headaches and pain for children, which children’s acetaminophen or ibuprofen can ease. Nasal suctioning with appropriate bulb devices, as well as nasal irrigation aren’t fun, but they can be helpful.
A common over-the-counter (OTC) nasal spray may be of use: “Children’s fluticasone spray can help with almost all nasal symptom management. It is a better option to help them get through their day with a better safety profile,” said Harthman. Children’s Flonase Sensimist is approved for use in children ages 2 and up.
What can we give a coughing child who is keeping themselves (and the whole house) awake all night?
Once again, for children under age 4 there are limited options beyond supportive care of keeping them hydrated, taking warm baths, using humidifiers and so on.
All three pharmacists recommend honey, with some precautions. “You can try honey if the child is over one year old. Never give honey to babies under the age of 12 months due to the risk of botulism,” said Ferris. Vecchio-Miller said to avoid rhododendron honey as it can contain a dangerous toxin. Harthman noted that Manuka honey is a favorite of many in health care fields for its antibacterial effects.
“For kids ages 4 to 11, dextromethorphan (a cough suppressant) may be considered for a children’s cough. Stick to age-appropriate formulations and always check with your pharmacist or pediatrician for dosing instructions, especially if the cough is severe or accompanied by other symptoms,” said Ferris. She added that for kids over age 12, you can use dextromethorphan or guaifenesin (an expectorant) for cough relief.
“Many families swear by a night time salve to help children sleep,” noted Harthman. “The salve is rubbed on the chest and neck at night. These have a long standing history of use in children ages 2 and up.”
We’re begging for medicine for kids under age 4.
Any parent who has held a snarfling, miserable toddler all night would give just about anything for a remedy. “Unfortunately, there are no FDA-approved OTC cold or cough medications available for children under age 4 because many can be potentially life-threatening. Young children’s bodies are more sensitive to medications and cold medicines can cause serious side effects such as rapid heart rate, seizures, or even death,” said Ferris.
Having some perspective can help. “Not all coughing is bad. Coughing helps to clear secretions,” said Vecchio-Miller. “Have realistic expectations of the course of a cold: in young children colds will usually begin to improve in 10 to 14 days. However, some coughs might stick around for three to four weeks. Older children and adolescents usually have their symptoms resolve a little quicker, in about a week.”
Vecchio-Miller cautioned, “Also recognize when to be seen. If symptoms are going longer than expected or worsening in anyway, they should be checked by a provider. Be sure to monitor for things such as high fever, or any difficulty in breathing or swallowing.” Harthman added, “If a cough or cold is persistent, reach out to your pediatrician or local health care provider. The greatest expert on your child is you — the parent.”
Published in the Dec/Jan 2024-2025 print edition of MOM Magazine
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