Marketing and Medicine: Part Two

Last entry, I mentioned that there are at least 14 different formulations produced with the Tylenol brand name to help treat cough, cold, and flu symptoms. Here's a piece of valuable information. There aren't anywhere near 14 different drug ingredients on the market for cough, cold, and flu.

Any pharmacist can tell you that all these products are just rehashings and reformulations of the same five or six different drugs in different combinations with fancy new labels. And Tylenol isn't the only corporation using this strategy; they all are. Pfizer has half a dozen different Sudafed products to capitalize on the popularity of the brand. Wyeth's Robitussin is the same deal.

There are five big drug classes used to treat cold and flu symptoms: Pain relievers/fever reducers, antihistamines, decongestants, cough suppressants, and expectorants. Most of the multi-symptom cold products contain Tylenol, otherwise known as acetaminophen, as a pain-reliever and fever reducer. You'll see a lot more combination products with acetaminophen than you will other pain relievers like ibuprofen because acetaminophen has fewer gastrointestinal side-effects and isn't as likely to interact with other medications. And no matter how many different "cough" products you see marketed, there are only two FDA-approved "cough" ingredients commonly available OTC, those being dextromethorphan and guaifenesin. Dextromethorphan is a cough suppressant available in a wide variety of products, commonly those tagged with "DM," like Mucinex-DM, but you'll rarely find it by itself. Guaifenesin is an expectorant, which thins secretions in the lungs and chest to make them easier to cough up.

The attentive reader (or those living outside the U.S.) will note that I didn't mention codeine, because getting codeine cough syrup without a prescription in the States is practically impossible because of how much paperwork and hassle is involved in selling it. It's more abusable, honestly doesn't work any better than dextromethorphan, and a huge pain in the ass for both pharmacists and the chains they work for.

So no matter how many cough medicines are on the shelves, they all contain more or less the same thing in different boxes. And it doesn't matter what the box looks like; all that matters are the active ingredients listed on the back.

My personal favorite "misleading" branding/packaging in the Tylenol line is either Tylenol Sore Throat liquid or Tylenol Severe Allergy. The sore throat liquid is a great source of amusement for me because Tylenol itself is an excellent treatment for a sore throat; there's no need to add anything else to it. But many people think that medication for a sore throat or to stop a cough needs to be a liquid so that it can coat the throat. This is totally false. Liquids might have a soothing effect on the throat, such as hot tea, but as long as the acetaminophen dosage is the same, it doesn't matter whether you drink it or swallow a tablet. It's all going into your bloodstream before it does any real work, although the liquid might theoretically work slightly faster because liquids are absorbed more quickly. That has more to do with what goes on in your intestinal tract than anything involving your throat.

The "severe allergy" product amuses me because the only ingredient in the product that will do anything to reverse an allergic reaction is diphenhydramine, otherwise known as Benadryl. If you're having a truly "severe" allergic reaction, you need an EpiPen or steroids like prednisone. Benadryl is just not going to cut it.

Combination products with three or four different ingredients are a "shotgun" approach to symptoms. True, you're probably covering all the potential problems, but you're also probably taking at least one medication that you don't need. Tylenol PM is my least favorite product on the pharmacy shelf; it's a combination of acetaminophen and diphenhydramine. Acetaminophen, flat-out, does not cause drowsiness. It plays absolutely no role in helping you sleep. It's the diphenhydramine that knocks many people out. Again with the Benadryl. I always tell people looking for the Tylenol PM to get a box of generic diphenhydramine instead. It's going to have the exact same effect, it's cheaper, and you're not taking unnecessary acetaminophen, which can be toxic to the liver. True, most people aren't going to even approach a toxic dose of acetaminophen by taking Tylenol PM, but if you start combining cold products without reading the labels it's pretty easy to approach the 4 grams/day limit. The manufacturers know this, too, which is why a lot of packaging carries text that says "acetaminophen warning" now.

So be pharmsavvy and ignore the front of the box. Flip it around, check the ingredients, and ask your pharmacist for help selecting individual products for specific symptoms instead of assuming that just because something says "cold and flu" that it's the magic remedy you're looking for.