Complementary and Alternative Medicine Products . Table 5 summarizes the herbal preparations that may be effective in adults. 10 , 14 , 18 , 20 , 35 – 38 An herbal solution containing P. sidoides was shown to reduce the duration and severity of 10 different cold symptoms in a randomized controlled trial. 37 Another randomized controlled trial demonstrated the benefit of Andrographis paniculata (Kalmcold) in improving symptom scores. 35 A systematic review also indicated that A. paniculata , alone or in combination with Acanthopanax senticosus , may be more effective for symptom relief than placebo. 36
Selective serotonin reuptake inhibitors (SSRIs) transfer into breast milk to varying extents. Paroxetine is reported to have the lowest transfer into breast milk (weight-adjusted infant dose 1-3%). Fluoxetine transfers to a greater extent (weight-adjusted infant dose ≤ 14%) and its active metabolite, norfluoxetine, has a long half-life of one to two weeks and may accumulate in a breastfed infant. Data on citalopram (weight-adjusted infant dose approximately 5%) suggest that the relative infant dose of citalopram is intermediate between paroxetine and fluoxetine. Based on these data, paroxetine is the preferred SSRI in breastfeeding women.
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.