A middle-aged woman walked in my pharmacy and requested Vitamin C supplements for relief of her common cold symptoms. She had no current medication and no allergies.
Recalling “Complementary medicines evidence” lecture by Tran H, only high dose of Vitamin C daily would reduce incidence of common colds and newer clinical studies found its use for common cold remains controversial. Therefore, I felt uncertain about the therapeutic use of Vitamin C. After inquiring for severity and duration of her current conditions, I found that she had had productive cough and runny nose for 4 days. Vitamin C supplements, in this scenario, may not be a judicious treatment option due to her significantly severe symptoms. Instead, I recommended her Benadryl Mucus Relief Plus Decongestant, which contains guaifenesin and phenylephrine hydrochloride that can provide short term relief.
Cochrane systematic review shows that under regular Vitamin C administration, duration of colds were reduced by 8% and 14% in adult and children respectively. Natural medicines also claim that duration of cold symptoms might be reduced by 1-1.5 days in some patients taking high doses of Vitamin C orally. However, S Sasazuki et al. and Natural medicines argue that its effectiveness for treating common cold remains controversial substantially. Therefore, Vitamin C is not recommended as a therapeutic use, but may be worthwhile to test its benefits on individuals due to low cost and safety reasons as suggested by the Cochrane review. On the contrary, Benadryl Mucus Relief Plus Decongestant would be a decent medication for common cold symptoms in the scenario. According to AMH and APF22, guaiphenesin is an expectorant that aims at facilitating the removal of secretions in productive cough, while phenylephrine helps with nasal congestion by causing vasoconstriction of dilated nasal vessels. Studies also point out that guaiphenesin has shown to have antitussive properties and to inhibit cough-reflex sensitivity as stated in APF22. This can be concluded that patient’s productive cough and runny nose can be addressed with Benadryl Mucus Relief Plus Decongestant.
The National Competency Standards Framework for Pharmacists Standard 7.1, Element 2 and NPS Medicinewise have stipulated that pharmacists have to apply Quality Use of Medicines to wisely select management option for patients. After consulting with the above two standards, I realized that I have slightly developed my understanding of the judicious use of medicines. In the scenario, I recommended a pharmaceutical treatment rather than a non-medicinal alternative due to the unknown effectiveness of Vitamin C supplement. However, I still lacked confidence in explaining pharmacological actions and therapeutic basis. It will be crucial in future practices either when supplying over the counter or prescription medications to provide profound understanding for patients. Therefore, sharing my experiences and practicing with colleagues could assist me developing such confidence while benefiting them.
References:
Cochrane
Vitamin C for preventing and treating the common cold
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000980.pub4/full
Natural medicines
https://naturalmedicines-therapeuticresearch-com.ezp01.library.qut.edu.au/databases/food,-herbs-supplements/professional.aspx?productid=1001
S Sasazuki et al.
http://go.galegroup.com.ezp01.library.qut.edu.au/ps/i.do?p=HRCA&u=qut&id=GALE|A194940653&v=2.1&it=r&sid=summon&userGroup=qut&authCount=1
Hung’s lecture CSB420
AMH
APF22
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