Cough and cold medicines and ADHD medication: What's safe (and not safe) to take

My mother-in-law swears by menthol rubs for every known ailment under the sun.   While you may laugh at her, most people have a go-to over-the-counter medication for coughs, colds, and flu.  Medicine for ADHD, though, can be a game changer when it comes to what you reach for when your nose starts to run.  This is a review of what's safe to take for cold and flu symptoms when you are taking medication for ADHD.

Cough and cold preparations change frequently, sometimes every season.  You should read the list of ingredients to be sure that nothing interacts with your ADHD medicine.  This is the only way to be certain that you won't run into a problem.

Remember that no over-the-counter medication can cure a cold or flu.  The best it can do is help you with symptoms so that you can be more comfortable.  While getting a good night's sleep might help your immune system, it isn't worth it if you run the risk of a dangerous drug-drug interaction with your ADHD medication.

Don't take these in combination with a stimulant.

• phenylephrine HCl/phenylephrine bitartrate:  These are stimulants. 
• oxymetazoline hydrochloride:  Another stimulant, usually taken by nose spray.
• propylhexedrine:  Another stimulant, usually taken by nasal inhalation.
• goldenseal:  An herbal stimulant which may have additive effects with prescription stimulants.

When you add one stimulant to another, dangerous side effects can occur, such as heart rhythm disturbances, heart attacks, strokes and seizures.  Even if that doesn't happen, you may be kept wide awake by too much of the same class of medication.  Stimulants are safe to take with Strattera, guanfacine, and clonidine.

Use these medications with caution.  
Stimulants and nonstimulants used for ADHD do not interact with these medications, however the medications may have other side effects that need to be considered.  

• Antihistamines (brompheniramine, chlorpheniramine maleate, diphenhydramine, doxylamine): These work to dry up mucus.  They often cause drowsiness or paradoxical hyperactivity in children.  
• Aspirin or ibuprofen:  Both can cause upset stomach or even ulcers, especially if taken on an empty stomach.   Aspirin should never be given to children who may have the flu due to the risk for Reye's syndrome.  Only treats fever and achiness.
• Dextromethorphan:  A mild opiate used for cough suppression.  However, may cause or worsen constipation.
• Melatonin:  Can be found in some natural cough medications to promote sleep.  If you are already using melatonin, be sure to adjust your dose accordingly.
• Zinc: The FDA encourages consumers not to use the kind that is applied in the nose due to reports of permanent loss of the sense of smell in some patients .  The oral form has not had this issue.  This may shorten the length of a cold and does not immediately control symptoms.

These do not interact with ADHD medications and are probably safe.

• Acetaminophen:   It mainly works to reduce fever and achiness.  Make sure you get dye free.
• Chest rubs:    Young children and asthmatics should not use rubs containing menthol, but they do not interact with oral medications.
• Echinacea:  An herbal remedy used to shorten the duration of a cold. 
• Guaifenisin:  No major side effects.  However, its main function is to thin mucus, so it helps more with cough and not much for a runny nose.
• Honey:  No interactions with medications.  The amount of sugar in one dose is minimal.  Some medications are honey flavored but do not actually contain honey as an active ingredient.  Also, honey should never be given to children under the age of 1.  Honey works as a cough suppressant.
• Saline nose spray/nasal rinse:  Usually needs to be dosed often,  a problem for kids who go to school or daycare.

Inactive ingredients can also be important.  While inactive ingredients rarely make a medication unsafe, they may cause some people's ADHD symptoms to flare.  The ingredients to be specifically aware of are dyes (found in nearly all popular cough and cold syrups) and gluten.  If the medication does not carry a label that certifies it is gluten free and this a concern for you, consult the pharmacist.

Tips:

Medications that treat more symptoms usually contain more ingredients and usually can cause more side effects.  Minimize problems by treating only the symptoms you have.

Natural and sugar free syrups are more likely to not contain dyes, but always check the label first to be sure.

You can make your own honey cough syrup.  Use one tbsp honey plus 1 or 2 drops of lemon juice.  Dose as needed.  

If you take guanfacine, remember to stay well hydrated while you are sick.

Reference:

WebMD. Medscape for Android.  Reuters Health Information. Electronic application. October 22, 2013.

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