AH AH AH CHOOSE!

MICHAEL SLEZAK

It's good to have choices. But there can be too much of a good thing. That, apparently, is the situation with cough, cold and flu products, according to supermarket pharmacists.The plethora of new-product introductions and line extensions within the cough-and-cold category has customers scratching their heads trying to figure out which product is appropriate for their symptoms. Even some pharmacists admit to having trouble keeping up with this dynamic category.

"Customers are confused, and me, too," says Jenella Burton, supervising pharmacist at Son's Pharmacy, inside Son's Supermarket in Jasper, Ala., with a laugh. "The [line extensions and product launches] are happening too fast for customers to keep track of them all," she says.

"There used to be just Dimetapp and Drixoral for colds and a limited number of cough medicines," says Walter Braden, pharmacy manager at Fairland Markets, Hollywood, Md. "Now you have Advil Sinus and Advil for whatever. They have so many, I can't keep track. I can't memorize all of them."

"Line extensions create some confusion for consumers because, where they used to think they could just go up and buy a bottle of Bayer, now they look at the shelf and there are six Bayer analgesics and six Bayer cold and flu products to choose from," says Bill Harris, pharmacy manager at Brennan Pharmacy, located inside Owen's Super Market in Warsaw, Ind.

"It's the same with Tylenol. I used to be able to suggest to people to pick up a bottle of Tylenol," says Harris. "Now I have to ask, 'Do you want tablet or caplet? Tylenol Sinus? Tylenol P.M.?' "

The result has been an increase in the number of questions asked of pharmacists about cough, cold and flu products.

"There's more inquiries now than we've had in the past," says Hubie Mann, pharmacy manager at Lofino's, Beaver Creek, Ohio, which has two supermarkets with pharmacies. "Right now, we're getting 10 questions a day" about cough, cold and flu.

Harris finds that customers will come up with five or six products and ask him to explain what the differences are. Indeed, pharmacists responding to a Supermarket Pharmacy poll published last month reported recommending a cough syrup product 18 times per week, a pediatric cold remedy 17 times per week and a cold liquid 14.6 times per week. This is up from recommendations a year ago of 14.9, 11.4 and eight times per week respectively.

When asked for a recommendation, Braden says he will first find out what the customer's symptoms are, and then "pick up the products and look at the ingredients" to recommend an appropriate product.

Richard Hunt, pharmacy manager at Mr. Discount Drugs, located inside a Super Valu supermarket operated by Aultman Enterprises, Forest, Miss., agrees. "The number [of line extensions] is extremely confusing to the customer. There's certainly a concern about interaction. I try, when I see them purchasing a product that could interact with others, to explain how to use it.

"What scares me are the customers shopping in the grocery and discount stores with no pharmacist there to guide them," Hunt adds. "People would definitely be better off" if cough, cold and flu products were only sold in stores with a pharmacist, he says. Larry Haas, head pharmacist at Wray's Chalet Thriftway Pharmacy in Yakima, Wash., says he worries about interactions on extended brand-name lines, which have different formulations. "Bayer is an example. Someone on a blood thinner can take Bayer nonaspirin, but should not take the one for PMS [premenstrual syndrome] or the Bayer product containing ibuprofen," says Haas. The line extensions of Tylenol and Alka-Seltzer can similarly confuse customers, he adds. At the same time, many pharmacists say customers are becoming increasingly sophisticated about choosing products. For the most part, customers looking to purchase OTC cough-and-cold medications are savvy enough to read packages carefully and approach the pharmacy counter if they have questions, pharmacists say.

"The public is more educated today," says Braden. "They realize the pharmacist is available for them if they have questions."

Extension of product lines is "not a problem," according to Mann of Lofino's. "It brings more people to the counter to ask questions, though it might be an inconvenience for the customer," he says. "As far as interactions, I'm not too worried. Most people will ask. And when there are questions, I'll go out to the shelf with them." "People are more aware now that one medicine may not be right for everybody," says Hunt of Mr. Discount Drugs. "A lot more people are aware that medical conditions can interact with some medications."

When asked which products they recommend, no clear favorites emerged, although in nearly every case, pharmacists recommend single or, at most, dual-ingredient products.

"If it is just a cough, I'm a firm believer in the Robitussin line," says Harris of Brennan Pharmacy. "They split things down pretty well as far as how to treat specific problems," he says.

"I usually go with a product with as few drugs in it as possible to treat the condition, rather than having people take a lot of stuff they don't need," says Hunt of Mr. Discount Drugs.

"I prefer Delsym for a person who just has a cough. It's a 12-hour, time-release product just for cough that will last all night," says Haas of Wray's. "We recommend Benadryl Elixir for sore throats," though many customers believe the product is only for allergies, says Haas. "And I like Naldacon Senior for people who cannot take alcohol or are diabetic. It takes care of phlegm, the cough, and acts as a decongestant all at once."

"I'll recommend a product containing an expectorant in addition to a decongestant and antihistamine, because the biggest complaint I hear is a lot of mucous," says Richard Perry, pharmacy manager at a Ream's Food store in Salt Lake City. "A lot of times I'll recommend our store label."

Indeed, private-label products now outperform all other brands in sales of cough-and-cold products in food stores, according to Towne-Oller & Associates, New York.

Private-label leads with 12.7%, followed by NyQuil's 10.4%, Robitussin's 10.1%, Sudafed's 7.4% and Alka-Seltzer Plus, with 6.4% for the 12 months ended May 31.

Brand-name products, though, continue to dominate pharmacists'

recommendations. Favored products mentioned in last month's survey include Robitussin for cough, Sudafed as an oral nasal decongestant, Drixoral as a long-acting cold remedy and Dimetapp as a pediatric cold remedy.

Customers seem more concerned about children's products than they do about products for themselves, pharmacists note. "We get questions on children's products more than for adults," says Mann of Lofino's, such as,

" 'Is it all right to give this to my 3-year-old?' 'Is this safe for my 6-year-old?' Most OTC medications are very conservatively labeled," he says.

"Mostly, when people ask questions about children, they want to know what we'd recommend for a certain condition or what dosage," Hunt adds.

These child-related concerns also often spur sales of cough-and-cold products with no alcohol, sugar or dye.

"With kids, sometimes you don't wanted the added possibility of depression that comes with alcohol," agrees Harris.

But Haas says "alcohol is a good product for those who can take it because many times it kills the taste of the drug and makes it more palatable. I don't think it's a problem in cough syrups in amounts of 3% to 5%, and I also think alcohol helps cuts some of the phlegm in the throat. But you need the alcohol-free ones for some people," including diabetics and alcoholics.

Pharmacists were split on whether they receive more questions about cough or cold products.

Mann says, from his experiences, it's the "head symptoms, drainage, congestion, headache, nasal drip" that he gets asked about most. "A cough is usually secondary."

Braden of Fairland Markets says cold symptoms are more frequently asked about than cough symptoms.

Hunt says questions about the two are running neck and neck, but "people are probably more familiar through advertising with some of the cold remedies than they are on cough remedies, because those aren't advertised as much."

People might be more inclined to ask for a cough remedy than a cold remedy, says Perry of Ream's Food Stores, because "some people can't get rid of their coughs."

Harris says he also gets more questions for coughs than cold or flu. "Lots of times a cough just hangs in longer. It's more irritating and people are anxious to get rid of it. With a regular head cold, people view that as something they'll just suffer with for a while."