Sinonasal Med
Clarissa Chan, PharmD
Sinonasal products make up one of the most popular categories in the U.S. OTC drug market. But too many product choices can confuse patients trying to select the right medication for their ailments.
A recent study by Edward D. McCoul, MD, MPH, FACS, published in JAMA Otolaryngology-Head & Neck Surgery’s July issue, looked at sinonasal products from five of the six largest chain pharmacies. It found that 14 common brand names were available in all five pharmacy chains, accounting for 211 unique products. The brand names with the most products were Mucinex (47 products), Tylenol (26 products), and Robitussin (20 products).
These products were made up of a combination of only eight common active nonanalgesic sinonasal ingredients, including phenylephrine, dextromethorphan, pseudoephedrine, guaifenesin, chlorpheniramine, brompheniramine, diphenhydramine, and doxylamine.
Of these eight ingredients, McCoul found phenylephrine (261 products), dextromethorphan (218 products), pseudoephedrine (130 products), and guaifenesin (127 products) to be the most prevalent in sinonasal products.
The study also found that two or more of these eight active ingredients made up 688 different brand-name formulations. The most frequent combinations included guaifenesin-dextromethorphan (172 products), guaifenesin-pseudoephedrine (149 products), guaifenesin-phenylephrine (113 products), and guaifenesin-dextromethorphan-phenylephrine (85 products).
Interpreting the findings
Although medication labels usually indicate that products are used for cold, sinus, allergy, or nasal treatment, patients often approach the pharmacy counter for advice because they are too overwhelmed by the choices.
What’s more, according to McCoul’s study, companies often market products with different combinations of ingredients to treat various symptoms—all under the umbrella of a single brand name.
Unlike prescription-only medications, the brand and generic names for OTC drugs do not always correspond one-to-one. Often, a unique brand name—so-called product line—has both single and multiple active ingredients, each treating different symptoms.
“Many patients choose a product just because of the symptoms presented in the package, but they don’t realize that they are taking an ingredient that could interact with current prescriptions and cause adverse events,” said Kathy B. Doane, PharmD, RPh, RD, clinical and medication therapy management pharmacist at Caring Health Center in Springfield, MA, who was not involved in the study.
Vast redundancy of sinonasal products may confuse patients, resulting in costly and potentially dangerous choices. In addition, excessive ingredients in a product may be unnecessary or even harmful. Therapy duplications can cause toxic drug levels if patients are unaware that their home medications already contain an ingredient used in an OTC product.
To mitigate these risks, providers should encourage patients to bring all their medications’ bottles, actual packaging, or photos of product labels to their medical appointments. This can help pharmacists, in particular, identify and reconcile patients’ medications more effectively.
Do they work?
In a follow-up letter published August in JAMA Otolaryngology-Head & Neck Surgery, McCoul noted that OTC sinonasal products have not been found to be much more effective than placebo treatments. These products serve more to confuse patients than help them manage their symptoms, he wrote.
On this front, health care providers need to be informed about the vast array of products available that serve little to no purpose in treating sinonasal symptoms. Hopefully, this will help redirect the market and provide OTC treatments that are safer and more effective for sinonasal symptoms, McCoul wrote.
Reasons for confusion in the selection of appropriate OTC sinonasal medications
Although the names of common sinus and allergy medications may seem familiar, each of the common brand names is applied to different products with different combinations of ingredients.
Sinus and allergy products available are ultimately [composed] of just a small number of actual drugs, which are marketed over and over again in different combinations.
The layperson is advised to discuss their use of these products with their health care practitioner to determine whether the particular product(s) that they use don’t contain any ingredients that are unnecessary or potentially harmful. To accomplish this, they should bring either the actual package or a photograph of the package to help with [medication] reconciliation and identification by the health care practitioner.
—Edward D. McCoul, MD, MPH, FACS