Cold and Flu Season

[Bub]

Anyone have a list of over the counter stuff we can safely take?

[RightSide]

OTC meds my neph doesn't object to, include the following:

Guaifenesin (plain Mucinex, plain Robitussin)
Acetaminophen (Tylenol)
N-acetylcysteine (NAC, a good mucolytic)
Saline nasal spray

Meds to use in SMALL doses include dextromethorphan (the usual cough suppressant in OTC cold medications).  Dextromethorphan is excreted through the kidneys, so with us renal patients, it's excreted very slowly.  So if you take the adult dose every 4 hours, you're going to build the dose in your bloodstream up to high levels.  And you'll get plastered; it's a CNS depressant.

Meds to avoid include Sudafed (especially if you have high blood pressure), aspirin, NSAIDs (Advil, Aleve).

And no one, whether they have ESRD or not, should use decongestant nasal sprays. Those are highly addictive.

Finally, note that if yoiu're taking prescription meds, there's always the chance of a drug interaction between the prescription meds and the OTC med.  Ask your doctor or pharmacist.

[Restorer]

When I had lung problems earlier this year, I took normal adult doses of dextromethorphan syrup, and it had me strung out.

A couple years ago, before I was on dialysis, I took some pseudoephedrine (Sudafed - decongestant), and felt extra-powerful, and lasted a long time. Pseudoephedrine lasts up to ten times as long in someone with severe kidney disease, and can have more side effects, one of which for me included difficulty urinating.

And it was ibuprofen that sent me to the hospital to be diagnosed with kidney failure. NSAIDs like ibuprofen and naproxen (Aleve) can sometimes cause a shift of potassium out of the cells and into the blood, which is dangerous for people with serious kidney problems.

Some more information:

Robitussin labels their syrups by symptoms now, it seems. Robitussin Cough (orange label) is just dextromethophan. Robitussin Chest Congestion (blue label) is just guaifenesin. Robitussin Cough & Chest Congestion (black label) is both guaifenesin and dextromethorphan. Avoid the Cough & Cold (pink label) and the Cough, Cold & Flu (purple label) - they both contain phenylephrine, another decongestant that can mess with your blood pressure.

Avoid anything with the "D" suffix, like Claritin D, Robitussin D, etc. They contain either pseudoephedrine or phenylephrine.

N-acetylcysteine is what they use to combat acetaminophen poisoning. If you're taking more than 4000 mg of Tylenol per day, it might be a good idea to take some NAC to protect your liver (but it takes a lot).

Long-acting antihistamines like Claritin and Zyrtec last longer with kidney disease, so either split a pill in half, or take it half as often (24 hours instead of 12).

Anyone know about the safety/effectiveness of different antihistamines, especially Benedryl/diphenhydramine?

[kitkatz]

Tylenol- for aches, pains, fever
Benadryl- for allergies and cold symptoms
Claritin- for allergies
promethazine w/ codeine- who wee, strung out on that stuff for hours! Make dosage smaller than usual if needed for cough.

[Bub]

Thanks for the information.  I was looking for something other than Benadryl as it makes me very hype for some reason --- opposite of most people who become drowsy.  I have the list I compiled from your suggestions and will take to my nurse practioner for his recomendations.  Thanks guys!

[Lillupie]

My nurse says you can use Claritin every other day on dialysis

Lisa

[RightSide]

When I had lung problems earlier this year, I took normal adult doses of dextromethorphan syrup, and it had me strung out.

N-acetylcysteine is what they use to combat acetaminophen poisoning. If you're taking more than 4000 mg of Tylenol per day, it might be a good idea to take some NAC to protect your liver (but it takes a lot).

Anyone know about the safety/effectiveness of different antihistamines, especially Benedryl/diphenhydramine?

These days, some young people actually drink dextromethorphan cough syrup to get plastered.

Benadryl is safe for us ESRD patients; my own neph prescribes it.
The problem is that it's not very effective for colds.

Whatever effect it has is due to its drying action on mucus.  That may appear to dry up a runny nose.  But what it's doing is thickening up the mucus in your sinuses, making it harder to drain--which can lead to a bacterial sinus infection.  Been there, done that.

Benadryl also acts like a sedative on most people.  If you're having difficulty falling asleep at night due to a bad cold, you can take one Benadryl and it will help you fall asleep.  But don't take it all through the day or you're risking sinus problems.

My Ear-Nose-Throat doctor swears by nasal saline irrigation.  You can do it as much as you like.  And the more infected secretions you flush out, the quicker your nose will heal.  And there will be less infected secretions to drain down into your lungs and possibly cause bronchitis.

Finally, I know that NAC can help protect the kidneys sometimes.  But it also has the ability to dissolve the molecules of mucus, which I find helps when I'm congested with a cold.  (A nebulized form of NAC, called Mucomyst, is often prescribed for patients suffering from chronic bronchitis or cystic fibrosis, to dissolve the thick mucus in the lungs.)  As long as I've got the cold, I take 1200 mg NAC first thing in the morning.  And all that mucus in my windpipe becomes much easier to cough up.

[Rerun]

Some great information here!  Thanks

                   

[RightSide]

One more warning:

Topical nasal zinc preparations (e.g., Zicam nasal spray) should be avoided by everyone, regardless of whether they have kidney disease.

Putting zinc in the nose has been linked to loss of the sense of smell (anosmia), which can be permanent.  I had tried Zicam nasal spray for a cold once, and my sense of smell disappeared and didn't return for seven more months.

In June, the FDA ordered Zicam nasal zinc taken off the market, but other brands of topical nasal zinc may still be available in some stores.  DO NOT USE THEM.