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(I) Non-prescription medications

 

1. Multi-component products containing decongestants (to treat stuffy nose, runny nose, sinusitis, etc.). These drugs contain chemicals that shrink blood vessels in the nasal passages (Phenylephrine or Pseudoephedrine). These substances are contraindicated to diabetics. What does that mean? This means that an elderly person with diabetes will almost for sure get worsening of the symptoms of the chronic condition after taking such a medication for flu (the prevalence of diabetes among the elderly is estimated at about 10-15%).

Popular brands that contain oral decongestants (Source):

TheraFlu (Flu/Cold/Cough, NightTime Maximum Strength, Sinus Maximum Strength),

Tylenol (Sinus Maximum Strength, Cold Multi-Symptom Severe Congestion Non-Drowsy) – USA, Canada,

Sudafed (Cold & Sinus, Sinus Maximum Strength Without Drowsiness, Severe Cold) – Canada, N.Zealand, S.Africa,

Panadol (Antigrippine – Switzerland, Cold – Malaysia, Fever – Ireland,)

Contac (Maximum Strength Sinus, Allergy/Sinus Day, Non-Drowsy Formula Sinus – UK),

Bayer Select Head Cold, Dristan Cold, Dynafed Maximum Strength,

Ornex (Maximum Strength, No Drowsiness),

Sinutab Sinus Maximum Strength Without Drowsiness (UK, Ireland),

Advil, Tricom, Lemsip (UK, Ireland, New Zealand), Humex rhume (France), Lisoflu, Triaminic (Italy), Naldecon (Brazil), Niocitran, Sinutab (Belgium), Rhumagrip (France), Sinugesic, Sinumax (S.Africa), Sinutab Sinus (Canada)

Coldrex (GSK – EU, New Zealand)

Vicks (Dayquil Sinus Pressure & Pain Relief with Ibuprofen, NyQuil Multi-Symptom Cold/Flu Relief)

Bi Ting, Da Feng, Dai Er Ka, Jia Nuo Mei, Jin De, LanDi, Li Shu, Nai Ping, Pai Si Ke, Xin Ai De (China),

Boots (Decongestant with Pain Relief, Maximum Strength Cold & Flu – UK)

 

2. Multi-component products containing antihistamines (designed to reduce sneezing, itching, watery eyes, and runny nose).

These drugs contain chemicals that reduce the effects of natural chemical histamine in the body (Chlorphenamine / chlorpheniramine, brompheniramine, Diphenhydramine, Pheniramine).

Among side effects of these substances is easy bruising or bleeding.

Problems with small blood vessels are very common in the elderly who have diabetes, and this side effect of antihistamine may worsen the course of diabetes in the mid-term.

Popular brands that contain antihistamines  (Source):

TheraFlu (Flu/Cold/Cough, TheraFlu NightTime Maximum Strength)

Coricidin (MSD, Schering-Plough)

Gripakin (Spain), Griponal (Merck Serono), Humex (Urgo), Pirigrip (Argentina), Rhinofebryl (Belgium), Zerinetta, Zerinol (Italy), Fervex (France), Efferalgan, Teedex (Ireland)

Panadol Night

Tylenol (Extra Strength, PM)

 

3. Most elderly people have chronic cardiovascular diseases: most importantly, arterial hypertension (50-75%) or ischemic / coronary heart disease (20-30%).

Multi-component products containing antihistamines are contraindicated in these conditions. What does that mean? This means that almost for sure you’ll get worsening of the symptoms of arterial hypertension or coronary heart disease after taking such a medication for flu.

Among side effects of antihistamines are: dry mouth, feeling nervous or restless, fast/irregular heartbeat.

Popular brands that contain antihistamines  (Source):

TheraFlu (Flu/Cold/Cough, TheraFlu NightTime Maximum Strength)

Coricidin (MSD, Schering-Plough)

Gripakin (Spain), Griponal (Merck Serono), Humex (Urgo), Pirigrip (Argentina), Rhinofebryl (Belgium), Zerinetta, Zerinol (Italy), Fervex (France), Efferalgan, Teedex (Ireland)

Panadol Night

Tylenol (Extra Strength, PM)

 

References (prevalence of cardiovascular diseases and diabetes in the elderly people):

https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319574.pdf

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6040a1.htm

http://jama.jamanetwork.com/article.aspx?articleid=196535

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748605/

 

4. Antipyretics, or fever reducers are the main ingredient of non-prescription medications for flu.

The most widely used fever reducer recommended to diabetics is Acetaminophen (paracetamol).

What’s wrong with paracetamol as a routine self-treatment for flu?

Here is an incomplete list of reasons why you should think twice before using acetaminophen (APAP, paracetamol) for flu or flu-like infections:

1) there is no proof of APAP clinical benefit in flu done to today’s standards of Evidence-Based Medicine – i.e., large-scale placebo-controlled clinical trials. (reference)

2) even in common cold the benefit of APAP remains unproven: according to Cochrane database, “Acetaminophen may help relieve nasal obstruction and rhinorrhoea but does not appear to improve some other cold symptoms (including sore throat, malaise, sneezing and cough)”.

3) in animals, treatment with antipyretics (including APAP) in therapeutic doses for influenza infection increases the risk of mortality (reference), increases viral shedding and prolongs the infectious period (reference).

4) The efficacy and even clinical utility of fever reducers (such as acetaminophen/paracetamol) in influenza has been further questioned in a recent clinical trial performed in New Zealand (reference)

5) Acetaminophen (paracetamol) is one of the most important drugs responsible for predictive drug-induced liver injury in the world. In the US alone, APAP overdose is responsible for 78,000 emergency room visits and about 500 deaths per year (reference).

To sum up, paracetamol will neither reduce flu duration, nor will it secure you from flu complications. But the price for temporary relief of flu symptoms may appear too high: liver failure or even death.

 

(II) Prescription medications

5. Healthcare authorities in the USA recommend antivirals for confirmed influenza cases.

Antivirals proven effective for flu (like oseltamivir which reduces flu disease duration by about 24 hours) have certain serious drawbacks:

1) they need doctor’s prescription (hence extra costs);

2) they are useless in cases caused by viruses other than influenza (i.e. >50% of flu-like infections), and

3) post-marketing reports of oseltamivir suggest that it may aggravate diabetes, a common condition in the elderly (reference)

 

Importantly, over the recent years the professionals who focus on Evidence-based approaches in medicine has changed a lot their attitude to Tamiflu (Oseltamivir).

The history of attitude changes is described at the web site of the most renowned and reputable source - the Cochrane Collaboration, a global network of health practitioners, researchers and patient advocates.

"The latest updated Cochrane Review, published on 10 April 2014, is based on full internal reports of 20 Tamiflu and 26 Relenza trials. These trials involved more than 24,000 people and the findings challenge the historical assumption that NIs are effective in combating influenza. The review confirms small benefits on symptom relief, namely shortening duration of symptoms by half a day on average. However, there is little evidence to support any belief that use of NIs reduces hospital admission or the risk of developing confirmed pneumonia. The evidence also suggests that there are insufficient grounds to support the use of NIs in preventing the person-to-person spread of influenza.

This latest Cochrane Review has benefited from access to more complete reports of the original research, now made available by the manufacturers, Roche and GlaxoSmithKline. Along with documenting evidence of harms from use of NIs, the review raises the question of whether global stockpiling of the drugs is still justifiable given the lack of reliable evidence to support the original claims of its benefits."

The 560-page full text of the corresponding review, reads in p.53-54 (Implications for practice, highlighting added):

On the basis of the findings of this review, clinicians and healthcare
policy-makers should urgently revise current recommendations
for use of the neuraminidase inhibitors (NIs) for individuals
with influenza. Our findings confirm that both oseltamivir
and zanamivir reduce the time to symptomatic improvement in
adults (but not asthmatic children) with influenza-like illness. The
size of this effect is small, approximately half a day. It is unclear
whether this is superior to treatment with commonly used antipyretic
medications. However, we did not find any credible evidence
that either oseltamivir or zanamivir reduce the risk of complications
of influenza, particularly pneumonia, nor reduce risk of
hospitalisation or death. Moreover, even in individuals at higher
risk of complications, such as children with asthma or the elderly,
we found no evidence of a beneficial effect for reducing risks of
complications.
Based on these findings there appears to be no evidence for patients,
clinicians or policy-makers to use these drugs to prevent serious
outcomes, both in annual influenza and pandemic influenza
outbreaks. Practice recommendations and drug labelling needs to
be changed to reflect these findings.

(...) NIs themselves may be immunosuppressants. Our findings do not

support the stockpiling of NIs, nor oseltamivir’s inclusion in the

WHO’s list of essential drugs.

 

With this Cochrane Review, the world's community has actually lost the last proven and reliable tool to fight influenza infection. This is especially important for the elderly patients and other high risk groups.

And this underlines the importance of Cont®aFlu as the new and promising alternative for people at a high risk of influenza complications.

 
WHY IS INFLUENZA SO DIFFICULT TO PREVENT AND TREAT?
Read an extensive review on this topic
published on Medscape, Jan 23, 2015