Dealing With Addicts and Cold Remedies

December 31, 2006

I work part-time at a drug and alcohol detoxification unit.

I work part-time at a drug and alcohol detoxification unit.For my patients who have nasal congestion and other coldsymptoms, what antihistamines and decongestants can Iprescribe that do not mimic the stimulating or sedatingeffects of the drugs they are addicted to?
-- Mary-Margaret Richter, ARNP
    Melbourne, Fla
Many commonly prescribed or over-thecountermedications used for symptomatictreatment of upper respiratory tract infectionscan mimic the effects of drugs ofabuse. In addition, many of these medicationscan worsen underlying psychiatric disorders or interferewith the action of common psychiatric medications. Althoughthere are few published data regarding the effectsof these medications in patients with a history of substanceabuse, the Table provides some helpful general guidelines.Note that patients with a history of intranasal cocaineabuse often complain of nasal stuffiness and congestion.Cocaine is a powerful local anesthetic and vasoconstrictor.Most cocaine users suffer permanent damage to the nasalmucosa and can have large nasal septal perforations thatcontribute to the sensation of stuffiness. Nasal saline sprayhelps decrease dryness and crusting and may providesome relief of symptoms. Avoid oral decongestants in patientswith a history of cocaine use; these agents maymimic some of the effects of cocaine.
-- Robert T. Sataloff, MD, DMA
    Professor, Department of Otolaryngology
    Director, Arts Medicine Center
    Jefferson Medical College
    Chair, Department of Otolaryngology
    Graduate Hospital
    Philadelphia
-- Timothy D. Anderson, MD
    Instructor, Department of Otolaryngology-
    Head and Neck Surgery
    Jefferson Medical College
    Philadelphia