It has been a tough week for ibuprofen and paracetamol. An Australian court has ordered the manufacturers of Nurofen to withdraw a number of products because of misleading claims about efficacy. And, as reported in yesterday’s Times, researchers in New Zealand have just published a study suggesting that paracetamol doesn’t alleviate many of the symptoms of flu.
Both these stories may have originated on the other side of the world but the repercussions will be felt closer to home. Ibuprofen and paracetamol are the two key ingredients in a wide range of cold and flu remedies sold in the UK and concerns about how they are marketed, and whether they live up to the hype are all too relevant at this time of year.
We spend hundreds of millions of pounds on over-the-counter products for coughs, colds and flu and every family has a favoured brand, often selected on the basis of TV advertising campaigns and clever packaging. But is their choice backed by science? And how do doctors treat their own seasonal maladies?
Let’s start with the easiest one. Cough remedies. The general consensus among medics, scientists, and even the pharmacists selling them, is that they are generally a waste of time and money – a triumph of marketing over science. Like most doctors, whenever I get a cough – an occupational hazard during the winter – I simply ride it out. Cough medicines haven’t crossed my lips for 40 years and my daughters have never taken them.
The role of ibuprofen and paracetamol in colds and flu is more complex. My experience – both personal and professional – is that both drugs can make you feel more comfortable when you are ill. This may fly in the face of the New Zealand researchers’ conclusions but their study only involved 80 people and all the volunteers were also taking the anti-viral drug Tamiflu so that may have masked some of the benefit of paracetamol (although not by much as Tamiflu doesn’t work very well either – see below).
So I still advocate taking paracetamol (or ibuprofen) in colds and flu if it makes you feel more comfortable. But I have an issue with some of the other ingredients of OTC remedies designed to help symptoms like a blocked or runny nose. These vary from product to product with two of the most common including old-fashioned sedating anti-histamines (like promethazine) and adrenaline-like decongestants (such as pseudoephedrine). Both these ingredients are “dirty” from a pharmaceutical perspective, having myriad other effects on the body other than the intended target (the nose). And side effects can range from drowsiness and blurred vision, to palpitations and difficulty passing urine (most GPs will have first hand experience of the deleterious effect they can have on men with a bit of prostate trouble).
If you want to take something to clear your nose or sinuses then I suggest you avoid pills and liquids and use drugs that work locally – either a decongestant spray (see below) or an anti-inflammatory steroid like beclometasone (trial results are disappointing but it is still occasionally recommended for those prone to sinusitis and/or troublesome sneezing and a runny nose).
By all means give ibuprofen or paracetamol a go if you are feeling rough, but stick to the recommended doses and stop them if they don’t make an obvious difference. Buy the cheapest generic or own-brand versions you can find and don’t be tempted by glossy packaging and marketing terms like “Max Strength” – the only thing they are likely to hit harder is your wallet. If in doubt ask your pharmacist to point you in the right direction.
No OTC remedy will shorten a cough, cold or bout of flu. Even the latest prescription anti-virals only have a minimal impact on the infectious agents they are targeted at, and no effect on the vast majority of the hundreds of viruses responsible for the upper respiratory infections doing the rounds at the moment. But OTC products may just make your cold or flu more bearable. Sometimes.
If you do get a cold or flu:
- It is still worth trying paracetamol or ibuprofen for headache and other “fluey” symptoms
- Use a decongestant nasal spray like Otrivine or Vick’s Sinex if you have a blocked nose. But try to limit use as, paradoxically, if they are taken for more than a few days they can perpetuate the problem
- There is no need to see your GP for a cold or most cases of flu. We can’t cure colds. Antibiotics don’t help. And you will just pass it on to everyone else, including your doctor.
- Flu can be more serious, not least because there are more sinister problems that share the same symptoms, so if you are concerned seek medical advice.