What are common brand name medications (e.g. Crocin, Benadryl) used in general practice in India to treat new onset cold, cough, fever, and headache?

Common Brand Name Medications for Cold, Cough, Fever, and Headache in Indian General Practice

First-generation antihistamine-decongestant combinations along with paracetamol are the most effective medications for treating new onset cold, cough, fever, and headache symptoms in Indian general practice. 1, 2

First-Line Treatment Options

Fixed-Dose Combination (FDC) Products

• Crocin Cold & Flu: Paracetamol 500mg + Phenylephrine 10mg + Chlorpheniramine maleate 2mg
• Benadryl DR: Diphenhydramine + Ammonium chloride + Sodium citrate + Menthol
• Vicks Action 500: Paracetamol 500mg + Phenylephrine 10mg + Chlorpheniramine maleate 2mg
• Coldarin: Paracetamol + Phenylephrine + Chlorpheniramine
• D'Cold Total: Paracetamol + Phenylephrine + Chlorpheniramine

Mechanism and Efficacy

These combinations work through multiple mechanisms:

• Paracetamol: Reduces fever and relieves pain (headache) 3
• First-generation antihistamines (Chlorpheniramine/Diphenhydramine): Reduce sneezing, rhinorrhea through anticholinergic effects 1
• Decongestants (Phenylephrine): Reduce nasal congestion 1

Evidence-Based Recommendations

For Cold and Cough Symptoms

• First-generation antihistamine-decongestant combinations are superior to newer non-sedating antihistamines for treating common cold symptoms 1
• First-generation antihistamines work primarily through their anticholinergic properties to reduce cough and rhinorrhea 1
• Recent research shows FDCs containing paracetamol, phenylephrine, and chlorpheniramine maleate significantly reduce total symptom scores in Indian adults with common cold 2

For Fever and Headache

• Paracetamol is effective for reducing fever and relieving headache 3, 1
• NSAIDs like naproxen can help decrease cough, headache, malaise, and myalgia in common cold 1
• For migraine-type headaches, specific migraine medications may be needed 1

Treatment Algorithm

1. For mild symptoms (mild congestion, occasional cough, low-grade fever):

   • Paracetamol 500-650mg every 6 hours for fever and headache
   • Consider single-agent formulations to avoid unnecessary medications

2. For moderate symptoms (significant congestion, troublesome cough, fever, headache):

   • FDC containing paracetamol 500mg + phenylephrine 10mg + chlorpheniramine maleate 2mg every 6-8 hours
   • Maximum 4 doses in 24 hours

3. For severe symptoms (high fever, intense headache, severe congestion, persistent cough):

   • FDC as above
   • Consider adding naproxen if inflammation is significant
   • For severe cough: Consider dextromethorphan-containing preparations

Special Considerations

Cautions and Contraindications

• First-generation antihistamines may cause sedation; advise patients about potential drowsiness 1, 4
• Decongestants should be used with caution in patients with hypertension, cardiovascular disease, diabetes, or glaucoma 1, 5
• Paracetamol overdose risk when taking multiple preparations containing this ingredient 5, 6

Duration of Treatment

• Limit treatment to 5-7 days
• If symptoms persist beyond one week, consider bacterial sinusitis or other complications 1

Red Flags Requiring Medical Attention

• Green or yellow sputum (suggesting bacterial infection)
• Persistent high fever not responding to antipyretics
• Severe headache with neck stiffness
• Persistent symptoms beyond 7-10 days 5

Practical Tips

• Start first-generation antihistamines at bedtime to minimize daytime sedation 1
• Ensure adequate hydration during treatment
• Fixed-dose combinations are convenient but may provide unnecessary components for some patients
• Consider cost-effectiveness when selecting brands

These recommendations align with evidence showing that antihistamine-decongestant-analgesic combinations provide general benefit in adults with common cold symptoms, with first-generation antihistamines being more effective than newer non-sedating alternatives for cough associated with common cold 1, 7.