Finiflu – A cold and flu remedy, but is it?

In the northern hemisphere, cold and flu peaks during the winter months and during this time there is a peak in the number of sufferers visiting general practitioner surgeries and hospitals. To help ease the burden on these public services, people are advised to ‘self-treat’ with traditional or herbal medicines and to consult pharmacists when considering taking medications. There are a huge amount of remedies available to the consumer and so how do sufferers know if a product is effective for their symptoms? This article explores this issue based on a natural remedy (‘Finiflu’) recently launched in Australia and not available in Europe.

Public Health England’s weekly national influenza report up to the 7th April 2016 provides a national perspective of the activity rate for influenza. [1] This information is collected weekly from 90,000 people working in general practitioner surgeries, hospitals, pharmacies and nursing homes. [2] What was interesting about this report [1] was the global assessment which stated that “…elevated levels of influenza activity continued to be reported in the northern hemisphere with influenza B virus detections increasing.” [2] It is also noteworthy that the World Health Organisation has published their recommendations for influenza virus vaccinations for the 2016/2017 season in the northern hemisphere with the continued inclusion of influenza B virus (i.e., composition to include an A/California/7/2009 (H1N1) pdm09-like virus; an A/Hong Kong/4801/2014 (H3N2)-like virus; and a B/Brisbane/60/2008-like virus plus a B/Phuket/3073/2013-like virus for quadrivalent vaccines). [3]

The rate of weekly influenza-like illnesses reported in general practitioner surgeries lies between 10.0 per 100,000 to in Northern Ireland to 21.8 per 100,000) in England and Scotland. [1] These latest figures are slightly skewed by the fact that the Easter holiday meant that general practitioner surgeries would have only been open 4 days. [1] And, even if the surgeries are open it can be difficult getting an appointment unless it is urgent. In such cases it is advised that to help ease the burden on general practitioners and hospitals, people should ‘self-treat’ with traditional or herbal medicines and consult pharmacists when considering taking medications such as painkillers. [2]

The market for self-treating cold and flu symptoms was a whopping £337 million in 1999. [4] It is not surprise that the choice of therapies can be slightly overwhelming and with mixed messages coming from the media as news tries to keep-up with new science and best practice. The general advice for the management of cold and flu is to maintain a healthy lifestyle, to eat plenty of fruit and vegetables to get the benefit from vitamin C, and to drink plenty of fluid. [2] There are, however, a number of natural therapies [5] and medications [4] that can help to manage the symptoms of cold and flu. A search on the internet also revealed an interesting natural remedy available in Australia can called Finiflu. [6]

Finiflu was approved by the Therapeutic Goods Administration (TGA) in 2009. [7] Finiflu contains natural extracts of garlic, onion and chilli and taken in the form of chocolate squares. [8] This natural product claims to “Assist with the relief of symptoms associated with cold and flu and other mild respiratory conditions” including runny nose, congestion, mucous and cough. [9] The immediate question to ask before buying such a therapy, is whether it effective for the relief of the on-pack claims. (see Figure 1) This was addressed in a recent review article [10] that sought to identify the characteristic properties of Finiflu based on published reports and assess the level of evidence, again from published reports, supporting the effectiveness of the product and also its main ingredients.

Evidence from published reports
A review was conducted of the scientific literature using PubMed using two filters: ‘humans’ and ‘review.’ With these filters in place a search was conducted using the product name (‘Finiflu’) or its main ingredients (‘garlic’, ‘onion’ and ‘chilli’) in combination with the symptoms of cold and flu (i.e., ‘common cold’, ‘flu’, ‘congestion’, ‘cough’, ‘mucous’ and ‘runny rose’). These combinations

These searches identified 25 reports (see Figure 2) and showed that no studies had been conducted or had not yet been published for Finiflu. The majority of the evidence (11 of 25 reports) related to the use of garlic for the relief of cold symptoms. For all other symptoms the evidence base identified was 2 or less reports, which suggests the evidence certainly would be extensive or conclusive.

This analysis shows that the weight of evidence relates to the use of garlic with 11 reports relating to the cold symptoms per se; 2 reports for flu symptoms; 2 reports for cough; and, 1 report for mucous. (Figure 2) A deeper dive into the literature actually revealed that only one of the 1 of 16 reports for garlic actually referred to cold and flu symptoms per se and the other concerned the management of cold and flu. (see Figure 2)

Conclusions
The use of natural or herbal based products to managed cold and flu symptoms has been recommended to help reduce the burden on general practitioners and hospitals. [2] It also means the suffered can self-treat their symptoms whilst they wait for an appointment with a doctor. If someone is not sure they are advised to consult a pharmacist, especially if painkillers are being used to manage symptoms such as muscle aches or headaches. [11] However, the use of natural or herbal remedies also needs to be considered in-light of the current findings. Finiflu is not available in Europe and to be advised for cold and flu it would need to present data supporting its use as a cold and flu remedy for each of the on pack claims. (see Figure 1) Current research [10] revealed no reports supporting the use of Finiflu and that the majority of evidence supporting its use would be based on reports relating to the use of garlic. (see Figure 2) The advice to use natural or herbal products has a cost implication for the customer buying the product and sufferers need to be better informed when buying remedies over-the-counter. The use of Finiflu cannot be recommended on the current based of evidence, even though it has been approved by the TGA in Australia.