All articles are written by 4th year Doctor of Pharmacy students at Washington State University’s College of Pharmacy, Spokane, WA
What Cough and Cold Medicines Can You Take?
by Jessica Carpenter, PharmD Candidate 2010
A reasonable concern for those people with Parkinson’s disease is whether or not over-the-counter (OTC) medications can safely be taken without interacting with their Parkinson’s medications or worsening their Parkinson’s symptoms. There are numerous cough and cold ingredients sold under different brand names and in different formulations which can make selecting a product very confusing.
Dextromethorphan is a cough suppressant and common ingredient in many cough and cold medications, either by itself or in combination with other ingredients. Common brands that often contain dextromethorphan are Delsym, Vicks, Robitussin DM, Theraflu, and Triaminic, as well as other generic store brands. People taking the MAO-B inhibitors selegiline (Eldepryl) or rasagiline (Azilect) for Parkinson’s disease should not take dextromethorphan. If you are not sure if a product contains dextromethorphan or not, please ask your pharmacist and let them know what medications you take for Parkinson’s disease.
There are two common oral decongestants that are found in cough and cold medicine to reduce a stuffy, runny nose. Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) are oral decongestants used for nasal congestion associated with allergies or the common cold. Pseudoephedrine is available for purchase at the pharmacy counter only. There is a limit to how much a person can legally buy at one time and how often. Despite earlier warnings that MAO-B inhibitors cannot be used with certain OTC medications due to the risk of an increase in blood pressure, recent studies have shown that Azilect (rasagiline) is safe to use with decongestants such as pseudoephedrine or phenylephrine. The other MAO-B inhibitor, selegiline is similarly considered to be safe. If a decongestant is needed, nasal sprays such as Afrin can also safely be used with any Parkinson’s medications, but to avoid worsening congestion, limit use to a maximum of 3 to 5 days.
Guaifenesin is an expectorant cough medicine, which means it thins mucous and phlegm and assists in bringing up mucous from the throat and lungs. Guaifenesin can be found in numerous cough and cold products, more common ones being Robitussin, Mucinex, Q-Tussin, as well as many other combination products. Guaifenesin is considered safe when combined with any of the available Parkinson’s medications.
Many cold and allergy preparations contain antihistamines. They are often used for runny nose, sneezing, itchy or watery eyes, or allergic reactions like hives. Examples of these are diphenhydramine (Benadryl, Tylenol PM, Advil PM), chlorpheniramine (Chlor-Trimeton), loratadine (Claritin), cetirizine (Zyrtec), and numerous other combination products of different names. These are all considered safe to take with Parkinson’s medications, although some have more side effects than others, such as drowsiness, so it’s good to ask a pharmacist for a recommendation.
Many cough and cold products contain ingredients for pain or fever. The most common products include acetaminophen (Tylenol), ibuprofen (Motrin or Advil), and naproxen (Aleve). These are considered safe medications that won’t interact with Parkinson’s medications. Always check the ingredients or ask your pharmacist to make sure you don’t choose multiple products with the same ingredient.
With the number of OTC products available in various combinations, it makes choosing a safe and effective product overwhelming. Always ask your pharmacist what they recommend to best target your symptoms without using additional products that may be unnecessary. Most importantly, if you have Parkinson’s disease, always talk to your doctor about which products are okay and which products you shouldn’t take.
A Running Nose in Parkinson’s: How to Catch It
By Cara Turner, PharmD Candidate 2010
In a recent study it has been noted that idiopathic rhinorrhea occurs in about half of people with Parkinson’s disease. Rhinorrhea (ry-nuh-REE-uh) refers to a runny nose, and idiopathic means that we don’t know for sure what causes it. Normally, a runny nose is caused by allergies or a cold, and is the body’s natural defense to flush foreign substances from the sinus and nasal passages.
In people with Parkinson’s disease a runny nose is thought to be caused by the body’s decreased control over the secretion of mucous. This results in increased nasal secretion, and thus, a runny nose. Eating may make it worse, as well as some Parkinson’s medications, though only one drug lists increased nasal secretions as a possible side effect (Apokyn; apomorphine).
A persistent runny nose is not only embarrassing and a nuisance, but can lead to post nasal drip and coughing. Treatment options for idiopathic rhinorrhea in people with Parkinson’s disease have not been well studied, but there are several treatments for a runny nose caused by cold and allergies that may be beneficial. It is important to note that before you begin any treatment, you should talk to your doctor about its safety and appropriateness.
Perhaps the least expensive and most simple solution is to lightly blow the nose as needed. While this could be useful if the rhinorrhea only occurs at certain times of the day, it may be unrealistic if it persists all day long. Constantly blowing the nose or blowing the nose too hard can cause inflammation, which may actually make it run more.
Other possible remedies are the nasal and oral decongestants. These medications may be likely to work for people with Parkinson’s because they decrease secretions. However, they do have drawbacks. Nasal sprays, such as oxymetazoline (Afrin) can only be used for 3-5 days maximum at a time or worse congestion or runny nose will occur. Oral forms include pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE), and should be avoided if you have high blood pressure, heart disease, diabetes, insomnia, or an enlarged prostate. They also interact with the drug class MAOI’s, some of which can be used in Parkinson’s (rasagiline and selegiline). While decongestants may be great for short term use, extended daily use could lead to serious health effects.
Acupuncture has been used to treat idiopathic rhinorrhea with varied success. Because it is not a chemical, it could decrease medication and disease interactions, but may not be covered by insurance. Other common treatments for a runny nose may not be effective because they work by flushing allergens out of the nose or by decreasing the body’s reaction to allergens, which doesn’t seem to be the problem in Parkinson’s. These include sinus rinses (Neti Pot), steroid nasal sprays (Flonase), and nasal antihistamines (Astalin or Patanase).
While there is little known on idiopathic rhinorrhea in Parkinson’s disease, there are ongoing studies that are looking more in-depth into this subject. Hopefully, with time, we may better understand the link between a runny nose, Parkinson’s disease, and possible remedies.