Managing (Covid) cough and cold symptoms with Parkinson's: Do's and Don'ts
NiH website image about history of coughs
What is pressing for so many people with Parkinson’s and neurodegenerative diseases is what I can and can’t safely consume to address my cough and cold symptoms; especially during the COVID-19 pandemic. There are many useful do’s and don’ts we have learned from many years of practice.
Previously, I wrote a What’s Hot Blog for the Parkinson’s Foundation in 2017 about “what over the counter medications can and cannot be taken with Parkinson’s”— and more precisely “how to safely take over the counter cold medications with Parkinson’s.
Here are a few updates placed into context by making a list of do’s and don’t:
You don’t have to stay away from over the counter medications. Persons with PD commonly share with us that when they “get sick” with cold and flu-like symptoms— their pharmacist and healthcare professionals warn them to stay away from the medication aisle of the pharmacy. You don’t have to be that extreme.
Do (try to) pay attention if you are told that over-the-counter medications have the potential to worsen Parkinson’s symptoms. This is true. Unfortunately, many people interpret this potential worsening as a recommendation to never use over the counter medications.
Do (try to) minimize or avoid anticholinergics (like Benadryl, diphenhydramine) which may cause acute confusion and even contribute to long-term cognitive changes. It is important to keep in mind when selecting a cough or cold medication that the intent is not to treat long-term issues; so in some cases you may be able to take for short courses with your doctor’s or advanced practice providers guidance.
Do (try to) be cautious if you have any baseline impairment in thinking and memory (if you struggled in these areas even before you had a cough or cold). If you do have memory or thinking problems consider that some over the counter drugs may be sedating (such as Sudafed) and also beware drugs that some drugs contain an anticholinergic component (for example, Trihexyphenidyl, Benadryl, Cogentin, Parsitan). Anticholinergics are rarely used to address cough and cold symptoms in Parkinson’s.
Do not take cough syrups with pain medication (such as codeine) which could lead to memory issues, thinking problems or sedation. If you take one of these medications your memory and thinking will need to be carefully monitored as confusion could lead to falls and other negative consequences.
Do not take pain medication (such as meperidine) which can interact with other medications and can result in sedation.
Consider the possibility of temporarily stopping monoamine oxidase (MAO-B) inhibitor drugs (such as selegiline, rasagiline, safinamide) to avoid drug-drug interactions with cyclobenzaprine, dextromethorphan (often found in cough medicine), meperidine (also sold as Demerol), methadone, St. John's wort or the pain medicine tramadol.
Do (try to) talk to your doctor before making changes to your medications.
These are not a clear do or don’t: pseudoephedrine, phenylephrine and phenylpropanolamine can be found in any cold or flu medication and could increase blood pressure and possibly increase the risk of stroke, especially in those with high blood pressure.
Do consider aspirin, acetaminophen and other non-steroidal anti-inflammatory drugs are usually safe, but can have side effects (particularly gastrointestinal).
Do consider antihistamines, but be aware they can result in drowsiness; many people with PD can tolerate them for short courses.
Do consider asking your doc about an albuterol inhaler if your symptoms are not getting better as you may have reactive airway issues. Be aware that an albuterol inhaler can make tremor worse especially right after you take a puff.
Do consider the possibility that sometimes a viral cold can morph to include a bacterial infection or sinusitis and that you may also need antibiotics if symptoms persist. One clue is that later in the course of the illness you start coughing up colored sputum.
In 2014, Kim Painter wrote a great article in the USA Today to help individuals and families stay safe in the cold and flu aisle.
Here are some of Kim’s tips:
Treat only symptoms you have and be wary of multi-symptom products.
Know your dose and don’t overdose.
Know your health risks (for example, decongestants can cause blood pressure spikes, especially if you have hypertension; acetaminophen can lead to liver damage for heavy alcohol users).
Don't double up and accidentally take two medicines with similar ingredients.
Consider trying alternatives (rest, fluids, saline nasal sprays, salt-water gargles, honey for cough).
Picture from nih.website
The bottom-line: It is possible to take over the counter medications for your Parkinson cough or cold symptoms. We are not thrilled with the commonly used strategy of dictating to a person with Parkinson’s to suffer through cough and cold symptoms. Working through a solution that is safe and involves your healthcare team is just good old fashioned medicine.
Verywellhealth.com has a recent article on illness; also Kim Painter at USA today writes about being careful with selecting medications
To read more books and articles by Michael S. Okun MD check on Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside
He also serves as the Medical Advisor for the Parkinson’s Foundation.
To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.
The blog artist is Jonny Acheson.