Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 77 Drugs for Allergic Rhinitis, Cough, and Colds
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.2 Allergic Rhinitis Inflammatory disorder of the upper airway, lower airway, and eyes Symptoms Sneezing Rhinorrhea Pruritus Nasal congestion For some people: conjunctivitis, sinusitis, and asthma
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.3 Allergic Rhinitis Seasonal and perennial Triggered by airborne allergens Allergens bind to immunoglobulin (Ig)E on mast cells Inflammatory mediators released Histamine, leukotrienes, and prostaglandins
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.4 Classes of Drugs Used for Allergic Rhinitis Oral antihistamines Intranasal glucocorticoids Sympathomimetics (oral and intranasal)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.5 Oral Antihistamines For allergic rhinitis Do not reduce nasal congestion Most effective if taken prophylactically Adverse effects are mild: sedation with first generation (much less with second generation) Anticholinergic effects Azelastine nasal spray Only intranasal antihistamine available Benefits equivalent to oral antihistamines Metered-spray device, leaves bitter taste
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.6 Intranasal Glucocorticoids First choice—most effective for treatment and prevention of rhinitis Mild adverse effects Drying of nasal mucosa or sore throat Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.7 Intranasal Cromolyn Trade name: NasalCrom Extremely safe, but only moderately effective Suppresses release of histamines from mast cells Best used for prophylaxis, not for treatment Response may take 1–2 weeks to develop
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.8 Sympathomimetics (Oral/Nasal) Reduce nasal congestion (do not reduce rhinorrhea, sneezing, or itching) Activate alpha 1 -adrenergic receptors on nasal blood vessels Adverse effects Rebound congestion CNS stimulation Cardiovascular effects and stroke Abuse
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.9 Sympathomimetics (Oral/Nasal) Factors in topical administration Should not use longer than 5 consecutive days Drops vs. sprays Phenylephrine, ephedrine, pseudoephedrine Antihistamine-sympathetic combinations Ipratropium bromide (Atrovent) Montelukast (Singulair) Omalizumab (Xolair)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.10 Drugs for Cough Antitussives Drugs that suppress cough Opioid antitussives Codeine and hydrocodone Codeine and hydrocodone Nonopioid antitussives Dextromethorphan Dextromethorphan Diphenhydramine Diphenhydramine
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.11 Common Cold Acute upper respiratory viral infection Rhinorrhea, nasal congestion, cough, sneeze, sore throat, headache, hoarseness, malaise, myalgia Fever common in kids, rare in adults Self-limited and usually benign No cure; just treatment of symptoms
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.12 OTC Cold Remedies Combination cold remedies usually contain two or more of the following: Nasal decongestant Antitussive Analgesic Antihistamine (for cholinergic actions) Caffeine (to offset effect of antihistamine) OTC = over-the-counter.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.13 Pediatric OTC Cold Remedies Use with caution in young children No proof of efficacy or safety, but proof of harm Avoid OTC cold remedies in children younger than 2 years of age Use only products labeled for pediatric use Consult a healthcare professional before giving to a child Read all product safety information before dosing Use the measuring device provided with the product Discontinue the medicine and seek professional care if the child’s condition worsens