Cough and Cold Medications and Diabetes
Written by Donna Itzstein, Diabetes QLD Pharmacist
It’s no secret that pain, infection and feeling unwell can raise blood glucose levels in people living with diabetes. While short illnesses during the colder months may not require changes in diabetes management, long-term conditions leading to a change in medications such as steroids may require a treatment change. Pharmacy preparations that target cough and cold symptoms may be in liquid, tablet, nasal sprays or lozenge form. They may also contain a variety of ingredients which could affect glucose levels in people with diabetes. Read on to learn key considerations when talking to patients with diabetes about cough and cold medications.
Cough and cold medications and their impact on people with diabetes:
Decongestants and blood glucose levels
Decongestants such as pseudoephedrine and phenylephrine will increase blood glucose levels. While no recent, direct studies confirm this, older studies with ephedrine and mice models support what happens in humans.1,2 The Therapeutic Goods Administration website product information suggests caution for use in people living with diabetes.3 This is because these oral medications may also increase blood pressure. Blood pressure management is an important aspect of diabetes and cardiovascular management.
Sugar content in cough and cold medications
Other ingredients such as guaiphenesin, dextromethorphan, ivy leaf, pholcodine will not directly affect blood glucose levels. However cough and cold medications may contain sugar or honey, natural sugar sources which can impact blood glucose levels in people with diabetes. Consider how much sugar is in a dose in relation to the total carbohydrates in a person’s usual daily consumption. This is often minimal. Many of the currently available mixtures and lozenges are sugar free.4
Analgesics and blood pressure
Some tablets may include analgesics for pain and fever. Although it’s important to note that Ibuprofen may not be appropriate if your patient has gastrointestinal tract conditions. Ibuprofen interacts with medications that act on the kidney. Furthermore, it also retains fluid raising blood pressure and adds strain on the heart. In contrast, Paracetamol is considered a milder analgesic; mind you, patients may take paracetamol in other formulations such as for arthritis. The total daily amount exceeding 4 grams may be hepatoxic. 5
Herbal cough and cold medications
Herbal preparations in liquid or lozenge formulation will not directly improve symptoms, however they can assist in reducing the duration of illness. They may also help reduce the perception of symptoms through a placebo effect. All ingredients whether they are chemical or herbal must be considered, this is because all preparations have the ability to have serious interactions. Therefore, it is important to encourage your patients with diabetes to check with their Pharmacist before using any cough or cold mediations.4
Nasal sprays are commonly used to reduce symptoms of coughs and colds. They work directly on the nasal cells with very little systemic absorption. This is due to the small amount of medication required for a direct local effect. Consequently, nasal sprays have little or no effect on blood glucose levels.
Nasal sprays may contain decongestants such as oxymetazoline, and Ipratropium in Atrovent which can be used for 3-5 days. Regular ongoing use is not recommended due to rebound congestion. Hay fever symptoms may require use of steroid sprays for short or long periods of time.5 Saline sprays are an option for congestion with or without other sprays or oral medications. Chest rubs and inhalations or nasal rinses are useful to clear sinus congestion and have no impact on glucose levels.
Important considerations when talking to your patients with diabetes about cough and cold remedies:
- How long will they be taking the medicine? Short term use may not be an issue.
- For medications containing sugar or honey will the amount ingested make a big difference to blood glucose levels? For example you may like to ask your patient how many lozenges a day they are having and if they have noticed a difference to the glucose levels.
- Are there alternatives which have little affect on blood glucose, such as nasal sprays?
- Consider the analgesic contained in the preparation. Does it interact with the persons other conditions or medications? Ask your patient to consider consulting their local pharmacist regarding an appropriate remedy.
- If your patient is not fluid restricted request they drink extra water. High blood glucose spills over into the urine and takes water with it, dehydrating the body.
- For unmedicated options consider saline nasal sprays or rinses, heat rubs and inhalations.
- Does your patient present with other medical conditions that impact on kidney and liver function?
- The glycemic responses to selected sympathomimetics in the normal and goldthioglucose mouse . Sandage, B W. Purdue University : Proquest dissertations, 1981.
- Comparing hemodynamic and glycemic response to local anesthesia with epinephrine and without epinephrine in patients undergoing tooth extractions. Kaur, P, et al. 2, July 2016, National Journal of Maxillofacial surgery, Vol. 7, pp. 166-172.
- Therapeutic goods administration. Core pseudoephedrine product information. Therapeutic goods administration. [Online] [Cited: August 16th, 2019.]
- MIMS Australia. Mims online. North Sydney : MIMS Australia, 2019.
- Therapeutic Guidelines Limited. Therapeutic Guidelines . [eTG] West Melbourne : Therapeutic Guidelines Ltd, June 2019.