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American Academy of Pediatrics

Danger in the cold and flu aisle: How to stay safe

Kim Painter
Special to USA TODAY
Over-the-counter cough, cold and pain medicines all have risks. One way to protect children: Always use the measuring device in the package.

Behold the cold and flu aisle, stocked with dozens of products that promise to ease stuffy noses, coughs, fevers and sore throats.

It's a popular place this time of year. Seven out of 10 Americans turn to such non-prescription remedies when they have colds and flus, market research shows.

For most, it's a safe enough practice. But many adults and children end up in danger after misusing such products. The consequences can range from increased blood pressure to drowsy driving, liver damage to death.

"Just because something is over the counter, doesn't mean it's not medicine. ... It has risk," as well as potential benefits, says Angela Golden, a nurse practitioner in northern Arizona and immediate past president of the American Association of Nurse Practitioners.

The association is among several groups representing health professionals, consumers, drug stores and drug makers that are conducting an awareness campaign about the safe use of one especially common ingredient: acetaminophen. The pain and fever reducer in the brand-name drug Tylenol is in more than 600 prescription and over-the-counter medications, including many cold and flu remedies.

"It's a really safe medicine when used correctly," Golden says. The problem is that too much acetaminophen damages the liver. Acetaminophen overdose is the most common cause of acute liver failure in the United States, according to the Food and Drug Administration (FDA). Overdoses, which can be fatal, often occur when people take more than one acetaminophen-containing product at a time.

But acetaminophen is not the only concern. Decongestants, antihistamines and cough medicines also can cause trouble — and should not be given to children ages 2 and under, the FDA says. Manufacturers stopped making them for infants and toddlers after deaths were reported. The American Academy of Pediatrics does not recommend them in children under age 4.

Even use in older children requires a lot of caution, says Henry Spiller, director of Central Ohio Poison Center at Nationwide Children's Hospital, Columbus.

One reason is that children often get medication from more than one person — parents and other caregivers. The frequent result, as shown in recent study by Spiller and colleagues: They get doubled-dosed.

"It happens more than you'd think," he says, and is good reason to limit use — and to make sure caregivers communicate about all medications. If you think a child has been accidentally overdosed, call a poison control center (1-800-222-1222), he says.

Other safety tips for adults and children:

Treat only the symptoms you have: If you just have a stuffy nose, you might want a decongestant, but there's no reason to take a multi-symptom product that adds a cough suppressant, antihistamine and fever reducer, Golden says.

Know your dose: Read and stick to the recommended doses on packages and pay attention to daily limits. For adults, the daily acetaminophen limit is 4,000 mg, the FDA says, and some doctors and drug makers recommend less. Doses for children vary by age and weight. Check package instructions and use only the measuring devices that come with the medication, Spiller says.

Know your health risks: Decongestants can cause blood pressure spikes, so are not recommended for people with high blood pressure and some other conditions. Heavy drinkers are at higher risk for liver damage from acetaminophen. And while some people can safely take a nighttime cold formula with a sedating antihistamine and drive the next morning, others stay groggy longer and should avoid the medications or stay home, Golden says

Don't double up: Take only one medication containing acetaminophen at a time. Be aware that the drug is in many prescription painkillers, including Vicodin and Percocet, as well as many over-the counter drugs.

Store drugs safely: Put them up and away from children.

Consider alternatives: Cough and cold remedies do not shorten or cure illnesses, and there are lower-risk ways to get symptom relief. Among them: rest and fluids, saline nasal sprays for congestion and salt-water gargles for sore throats. If you think you might have the flu — the clue is a sudden high fever accompanied by chills and aches — you should call your health provider right away to see if a prescription medicine might be in order, Golden says.

Here's what the American Academy of Pediatrics suggests for symptom relief in small children:

• For a stuffy nose: Saline nose drops or sprays. For infants, use a suction bulb to remove mucus.

• For cough: Honey — half a teaspoon for children ages 1 to 5, a full teaspoon for children 6 to 11. Honey is not safe for babies under age 1. You can try cough drops for children ages 4 and over.

• For fever: Acetaminophen only for babies up to 6 months; acetaminophen or ibuprofen for older children. Children should not take aspirin.

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