In a blog for people with minor illnesses and other health concerns, amid unprecedented pressure on our health services, Sarah Chapman blogs the evidence on over-the-counter medicines and other products.
Page updated 13 December 2021
So our health services are under huge pressure as the pandemic drags on, and we have experienced pharmacy shelves empty of everyday medicines and other healthcare ‘essentials’ that we had taken for granted.
I’ve just reread a blog I wrote a few years ago, with a retrospective sense of “we ain’t seen nothing yet”, about evidence on the effectivenessThe ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of over-the-counter (OTC) medicines. “With our A&E departments in crisis,” I wrote, “we’re hearing how we’ve lost sight of how to manage minor illnesses ourselves…”. This seems a good moment to revisit this, to take a look at the evidence on how we can manage ordinary illnesses at home in the extraordinary circumstances of the coronavirus pandemic, and bearing in mind that those of us who have been able to take for granted the availability of over-the-counter medicines and other products can no longer do so.
But first, could it be COVID-19?
If you’re wondering if your symptoms might be coronavirus (COVID-19), please follow the latest advice – this NHS page lists the main symptoms of coronavirus (COVID-19) and offers advice. See also government advice:
Stay at home: guidance for households with possible or confirmed coronavirus (COVID-19) infection (updated 2 December 2021) for those in England.
NHS Scotland (current as at 13 December 2021): https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/coronavirus-covid-19/test-and-protect/coronavirus-covid-19-guidance-for-households-with-possible-coronavirus-infection
Advice from the Welsh Government (current as at 3 December 2021): https://gov.wales/self-isolation
Advice from the Northern Ireland administration (date not given but it includes information on the Omicron variant): https://www.nidirect.gov.uk/articles/coronavirus-covid-19-self-isolating-and-close-contacts
A Cochrane ReviewCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. Over-the-counter (OTC) medications for acute cough in children and adults in community settings (November 2014) highlights that there is no reliable evidence either for or against them. There were few side effects, all minor ones such as headaches, vomiting and drowsiness, but more people would need to be studied to detect serious and less common side effects.
Another Cochrane Review Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults (March 2014) also found an evidence gap, the benefits and harms for people in these circumstances unclear.
The NHS page on cough has advice on treating a cough yourself, and acknowledges the lack of evidence, but also suggests when a pharmacist could help and when to see a GP.
Honey for cough in children
Honey has been shown to have properties that work against bacteria, viruses and inflammation and it’s an ingredient in many OTC cough syrups. Many of you will have honey in your cupboards, so could this be useful for soothing a cough? The Cochrane Review Honey for acute cough in children (April 2018) showed that shows that honey is probably effective in relieving cough symptoms and may be at least as effective as some OTC preparations. You can read more in our blog by Dr Lynda Ware, Honey for cough in children: can it help?
t’s important to note that the use of honey for children under a year old is not advised as they could be made ill by the bacteria C. botulinum, which may be found in honey.
Tackling the common cold
More clarity is needed from better research studies on the impact of vitamin C on the length and severity of colds. The Cochrane Review Vitamin C for preventing and treating the common cold (January 2013) found that it may reduce the likelihood of getting a cold only for people doing short periods of extreme physical activity, such as marathon runners and skiers.
There is reliable, high-certaintyThe certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty. Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of evidence. Find out more here: https://training.cochrane.org/grade-approach evidence from this 2017 systematic review Vitamin D supplementation to prevent acute respiratory tract infections that vitamin D supplements “are safe and protect against acuteA health condition (or episodes of a health condition) that comes on quickly and is short-lived. respiratory tract infections overall”, with the most benefit for people who have vitamin D deficiency.
There is also high-certainty evidence from the Cochrane Review Antihistamines for the common cold (November 2015) that antihistamines can reduce the overall severity of cold symptoms, in adults, in the first day or two only.
Other cold remedies…
How about the myriad of other things you might hear recommended, such as garlic, steam inhalations, echinacea and decongestants? Dr Lynda Ware has blogged about Remedies for the common cold and it is a story of uncertainty – we really need more and better evidence to be confident about the effects, both beneficial and harmful.
A cold will clear up by itself, but meanwhile you can find advice from the NHS on treating a cold yourself, and how to tell the difference between a cold and coronavirus.
Add a dose of caffeine for pain relief?
Many over-the-counter painkillers have caffeine added. As well as wondering if they are worth the higher price, you may well be finding that the shop shelves are now empty of them. The Cochrane Review Caffeine as an analgesic adjuvant for acute pain in adults (December 2014) has reliable evidence that adding 100mg or more of caffeine to a standard dose of commonly used painkillers (most often paracetamol or ibuprofen) increases the proportion of people who get good pain relief from common pain conditions like headache and toothache. No serious adverse events were reported and the reviewers say it’s unlikely to be harmful if the recommended dose is not exceeded.
If you can’t get your hands on painkillers combined with caffeine, might drinking a cup of coffee with your usual painkiller be as effective? Review author Sheena Derry thinks it might be, as she commented to us: “The studies in this review did not state explicitly the form in which caffeine was given to the participants, but coffee is a good source of caffeine and we believe that a mug of strong coffee is equivalent to about 100 mg caffeine. Taking your usual painkiller with a mug of coffee certainly has the potential to be easier and cheaper” – and you might find it works for you.”
Painful nipples in breastfeeding women
I’ve written more about simple help for painful nipples in breastfeeding women but it’s worth repeating that a Cochrane Review Interventions for treating painful nipples among breastfeeding women (December 2014) found that applying nothing, or expressed breast milk, may be as good or better than applying an ointment, such as lanolin, for both nipple pain and healing, although better studies are needed to be confident about that. Regardless of the treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes., for most women, nipple pain reduced to mild levels seven to ten days after giving birth.
Here is NHS advice on Sore or cracked nipples when breastfeeding.
So, if you have minor illnesses and health concerns in these strange times…
It’s reassuring to remind ourselves that there are alternatives to our usual purchases, without even leaving the house, and that minor ailments typically get better by themselves, whether or not we do anything.
Stay well, stay connected, and stay away from misinformation!
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What about zinc lozenges? I have seen two references from medical personnel recommending zinc lozenges as a means of retarding the development of viral infections. Any evidence?