Clinical question
Are oral antihistamine‐decongestant‐analgesic combinations effective in reducing the duration of symptoms and alleviating symptoms (general feeling of illness, nasal congestion, rhinorrhoea, sneezing and cough) in children and adults with the common cold?
Bottom line
This review evaluated 4 combinations: antihistamine‐decongestant, antihistamine‐analgesic, analgesic‐decongestant, and antihistamine‐decongestant-analgesic combinations. All 4 combinations showed some beneficial effect on overall symptoms of the common cold in adults and children aged over 6 years. There was no evidence of effectiveness in younger children. The effect on individual symptoms is probably too small to be clinically relevant.
Where pooling of results was possible, the number needed to treat for an additional beneficial outcome was 4 for the antihistamine‐decongestant combination. The antihistamine‐analgesic combination was beneficial in the 2 trials that reported on global effectiveness, and the analgesic‐decongestant combination was beneficial in the 1 trial providing data on this outcome. The antihistamine‐analgesic‐decongestant combination was more effective than control in 2 of the 5 trials, 1 of which was large and of high methodological quality.
Caveat
Adverse effects were not always clearly reported, but based on the available data, this review found that adverse effects were usually more frequent with the active treatment than with control. Dry mouth and insomnia were more frequent with antihistamine‐decongestant combinations, and dizziness was more frequent with analgesic‐decongestant combinations.
The antihistamine‐analgesic and antihistamine‐analgesic‐decongestant combinations were well tolerated, which is rather remarkable as they contain similar products to the other 2 combinations.
Context
Although combination formulas containing antihistamines, decongestants, and/or analgesics are sold over the counter in large quantities for the common cold, the evidence for their effectiveness is limited.
Cochrane Systematic Review
De Sutter AIM, et al. Oral antihistamine‐decongestant‐analgesic combinations for the common cold. Cochrane Database Syst Rev 2022;1:CD004976. This review contains 30 trials with a total of 6304 participants.
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