When it comes to treating the common cold, supermarket pharmacists have much more to recommend these days than chicken soup.
Remedies for colds, allergies and sinus conditions have grown faster than any other over-the-counter category, and account for more than 60% of all cough/cold sales, or about $2 billion in the over $3 billion category, according to research by Miles Consumer Healthcare Products, Elkhart, Ind.
The proliferation of new products and formulations has caused confusion in the marketplace and given pharmacists more opportunities to recommend treatments for individual symptoms and needs. Said Tom Combes, staff pharmacist at a Marietta, Ga., Winn-Dixie Marketplace, "You see patients standing in the aisles, looking at the labels, wondering what the products are and what they actually do."
Clarence Lea, pharmacy manager at a Medistat pharmacy in a Jitney Jungle store, Jackson, Miss., said, "I've always found that this category drives people to ask more questions of the pharmacists."
William Marth, director of pharmacy at Schenectady, N.Y.-based Price Chopper Supermarkets offers similar sentiments about product proliferation. "I absolutely believe that the proliferation of products [in cough and cold] has led patients to ask the pharmacists for more recommendations," he stated.
"There's been a lot of specialization of products, and specialization is something patients have difficulty understanding," he added.
Part of the consumer confusion as to what is an appropriate cough and cold product lies in the marketing, said pharmacists interviewed by SN.
Combes of Winn-Dixie said "the way the product is marketed leads to a lot of confusion out there."
For example, he pointed to the patient that picks up a non-drowsy Chlore-Trimeton (Schering-Plough) thinking it is an antihistamine when if fact it is really a decongestant. "It used to be an antihistamine," stated Combes. But as a non-drowsy ingredient, it is simply a decongestant, he explained. Martha Duncan, pharmacy manager at Minyard Food Stores, Coppell, Texas, said, "There are a lot of similar products on the market, and the consumer doesn't know which to take or which is better."
Glenn Glaser, pharmacy manager at Hackley Pharmacy Glenside, located inside Plumb's Valu-Rite, Muskegon, Mich., said there are several different types of cough and cold consumers.
"There are those that don't know what the products in the category do; those who buy a product based on a friend's recommendation -- even if it doesn't work for them; and those who make purchases based on coupons," he said.
"I sometimes see a person looking for Dimetapp [A.H. Robins'] because they have a coupon and that's all they want," Glaser added. Combes said many of his customers are heavily influenced by national brand advertising. "Some people prefer the national brand because of all the marketing a company puts behind the product. They've seen the advertising, and they seem to think this product is going to work better whether it does or not," he added.
Even with the confusion over a multitude of products, a majority of pharmacists said they recommend Drixoral tablets or capsules (Schering-Plough) as the No. 1 cold remedy brand, according to a survey on OTC medications conducted for SN Pharmacy in June.
The No. 1 brand for cold remedy multisymptoms was Comtrex (Bristol-Myers), which was recommended by 30% of the pharmacists surveyed, and just over 50% of the respondents recommended Thera-Flu (Sandoz) as a flu remedy for their customers.
"We recommend Comtrex, a multisymptom product, instead of just the antihistamine or decongestant," said Duncan. She also prefers Tavist-D (Sandoz) for colds as well as allergies.
Glaser at Plumb's said he typically recommends Sudafed (Warner Wellcome) and Robitussin DM (A. H. Robins). "If I can find a multisymptom product that deals with all the symptoms a patient has, then I'll recommend it," he added.
However, some pharmacists differ on their recommendations of dual and multisymptom remedies. Lea of Jitney Jungle said he recommends more dual-symptom products over the single-symptom ones because people with colds usually present a multitude of symptoms.
"While we'll recommend the dual-symptom products, we don't usually recommend some of the 'catch-all' products," said Lea.
On the other hand, Leah Barker, assistant pharmacy manager at Homeland Stores Pharmacy, Oklahoma City, said she doesn't like to recommend a multisymptom product because "there's no reason for the patient to take an extra ingredient if they don't need it." Pharmacists said they need to spend more time questioning patients about their symptoms because many patients confuse allergies with summer cold symptoms.
Combes said that the pharmacist has to find out what the patient's real needs are. Questions he asks are: Do they have a runny nose or is it a sinus congestion? Do they have a sore throat and watery eyes? He also cautioned about patients taking other medication -- OTC or prescription -- that might interact with the pharmacists recommendations.
"Before I make my recommendation, I need to know if the patient really needs an expectorant, or a decongestant," said Bob Oliveras, staff pharmacist at Randall's Food Markets Pharmacy, Austin, Texas. "There's a new Robitussin that contains an expectorant, but not all my patients will get this recommendation based on their symptoms, or if they have any pre-existing health conditions such as diabetes or high blood pressure."
Price Chopper's Marth agrees that not only should the pharmacist check for drug interactions, but they also should ask about pre-existing physical conditions, such as diabetes.
"Pharmacists need to know if the patient is a diabetic, so they can recommend a sugar-free remedy or something which isn't contraindicated," Marth said.
"For diabetics, we have set aside a selection of sugar-free products, as well as alcohol-free products for people in recovery," said Jitney Jungle's Lea. "It's important to know about these pre-existing conditions before the pharmacist makes their recommendations."
"If I'm going to recommend a product which has a decongestant in it, I make sure to ask if the patient has any kind of heart condition or high blood pressure," said Homeland's Barker.
Oliveras at Randall's added: "If a patient has high blood pressure, I tell them to stay away from nasal decongestants." Those patients may be able to use a localized nasal spray such as Afrin (Schering-Plough), he said.