Your Health

Medications for Viral Upper Respiratory Infections (Colds and Influenza)

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions.

Use each of these medicines as recommended by your doctor or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Only influenza can be specifically treated with antiviral medicine, and those medicines should be used only in serious cases because they may have unwanted side effects. Most people with the flu do not need antiviral medicine. If you have the flu, check with your doctor to see if you need antiviral medicine. You will need it if you are in a high-risk group or if you have a severe illness (like breathing problems).

In general, uncomplicated influenza and the common cold should not be treated with antibiotics for several reasons:

  • Antibiotics, though generally safe, have side effects and are not as harmless as the common cold.
  • Antibiotics do not cure influenza or the common cold since both are caused by viruses; they only work against bacterial infections.
  • Misuse and overuse of antibiotics has caused a worldwide crisis—the emergence of resistant bacteria. Some infections are now resistant to every known antibiotic.

On the other hand, many over-the-counter (OTC) remedies are available to help minimize your symptoms. If the treatments recommended under lifestyle changes , such as a warm baths and humidified air, aren't enough, these OTC products may help you through the worst of the illness.

Over-the-counter Medications

Decongestants

  • Pseudoephedrine
  • Phenylephrine
  • Naphazoline
  • Oxymetazoline

Antihistamines

  • Diphenhydramine
  • Chlorpheniramine
  • Brompheniramine
  • Loratadine

Pain Relievers/Fever Reducers (Antipyretics)

  • Acetaminophen
  • Ibuprofen

Expectorants

  • Guaifenesin

Cough Suppressants

  • Dextromethorphan
  • Codeine

Throat Lozenges

Prescription Medications

Oseltamivir (Tamiflu) and Zanamivir (Relenza)

Oseltamivir and zanamivir are used in adults and children to prevent or treat infections with types A and B influenza viruses. For the 2012-2013 flu season, the Centers for Disease Control and Prevention (CDC) recommends the use of these two medicines.

Oseltamivir and zanamivir interfere with specific viral chemical processes. Like other antiviral medicines, oseltamivir and zanamivir do not cure the flu, but may shorten the duration of illness if taken within 48 hours of when symptoms first appear. In addition to treating flu symptoms, these medicines may reduce the spread of the flu virus to others.

Zanamivir may worsen asthma or chronic obstructive pulmonary disease (COPD) . Some kinds of seasonal influenza virus are resistant to oseltamivir in the US. The FDA has warned of possible adverse effects in patients, especially children, taking oseltamivir. In some cases, these effects (such as hallucinations, delirium, abnormal behavior) resulted in injury and death.

Amantadine (Symmetrel) and Rimantadine (Flumadine)

Amantadine and rimantadine affect only influenza A viruses. They are used for treatment, as well as for prevention in high-risk people during an epidemic. These medicines do not cure the flu, but may shorten the duration of illness if taken within 48 hours of when symptoms first appear. Viral resistance has often been a problem with both of these medicines. Amantadine is approved for the treatment and prevention of the flu for those aged one year and older. Rimantadine is approved for treatment in those aged 13 years and older and for prevention for those aged one year and older.

Possible side effects include:

  • Nausea
  • Dizziness
  • Insomnia
  • Mood and mental changes
  • Dry mouth
  • Constipation
  • Headache
  • Confusion
  • Loss of coordination

Over-the-counter Medications

With each type of OTC medicine, the active ingredients are listed. There are many brand name preparations for each of these active ingredients. Only a few brand names are listed here, but be aware that there are other brands to choose from. Read labels and look for the active ingredients when choosing a product.

The Food and Drug Administration (FDA) recommends that OTC cough and cold products should not be used to treat infants or children less than two years old and supports not using them in children less than four years old. Rare but serious side effects have been reported, including death, convulsions, rapid heart rates, and decreased levels of consciousness. OTC cough and cold products include decongestants, expectorants, antihistamines, and antitussives (cough suppressants). The FDA is still reviewing data concerning the safety of these products in children aged 2-11 years. There have been serious side effects reported in this age group as well.

Decongestants

Common names include:

  • Pseudoephedrine
  • Phenylephrine
  • Naphazoline
  • Oxymetazoline

Decongestants are all related to adrenaline (epinephrine). Some are available topically (such as nose sprays and eye drops), and others are taken by mouth. Decongestants constrict blood vessels, thereby reducing swelling in inflamed tissues like the nose. Because they can act as mild stimulants, they are often paired with antihistamines to counteract the sedative effect of antihistamines. The last two on the list, naphazoline and oxymetazoline, are often found in eye drops.

Possible side effects include:

  • Over-stimulation, such as nervousness and insomnia
  • Raised blood pressure
  • Rebound congestion—If these drugs are used for long periods of time, membranes get used to the effects, so that stopping the medicine produces the swelling and congestion that was originally being treated. This is a common problem with nose drops and sprays.
Antihistamines

Common names include:

  • Diphenhydramine
  • Chlorpheniramine
  • Brompheniramine

The main effect of these drugs is to dry up secretions. They are also sedating, so much so that they are ingredients in all OTC sleep remedies.

Second-generation antihistamines such as loratadine (Claritin) are considered nonsedating and may be available without a prescription.

Possible side effects include:

  • Sedation
  • Drying of secretions, which impairs their clearance and may lead to complications (such as sinusitis , otitis , and pneumonia )
  • Retention or difficulty passing urine
  • Rashes
  • Dizziness
  • Headache
  • Indigestion
  • Constipation
  • Anemia

Talk to your doctor before taking these medicines if you have the following conditions:

  • Urinary problems due to an enlarged prostate gland
  • Glaucoma
  • Breathing problems

These side effects may worsen your condition.

Pain Relievers and Fever Reducers
  • Acetaminophen
  • Ibuprofen

These drugs reduce both pain and fever. A combination of acetaminophen and ibuprofen may be more effective in reducing fever than acetaminophen alone. Talk to your doctor before combining medicine or giving medicine to your child. In some cases, fever reduction may not be beneficial, since fever helps fight off the infection.

Note : Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye syndrome . Ask your doctor which other medicines are safe for your child.

Prescription pain relievers, like codeine, do not lower fever. Codeine also suppresses coughing.

Possible side effects of ibuprofen include:

  • Stomach irritation, ulceration, and bleeding
  • Allergic reactions
  • Kidney damage (very rare)
  • Liver damage (very rare)

Possible side effects of acetaminophen include:

  • Allergic reactions that damage blood cells or cause rashes
  • Taking too much can damage the liver or kidneys
Expectorants

Common names include:

  • Guaifenesin

An expectorant decreases the thickness of respiratory secretions so that they can more easily be coughed up or blown out. The same effect can usually be obtained by breathing wet air, as either a cold mist vaporizer or steamy shower.

Possible side effects include:

  • Nausea
  • Vomiting
  • Headache
  • Rash
  • Dizziness
Cough Suppressants

Common names include:

  • Dextromethorphan
  • Codeine (available by prescription)

These medicines help suppress the urge to cough. This is useful if your cough is dry, but may not be a good idea if you have secretions to clear. Dextromethorphan appears to be effective in suppressing a cough based on studies. Codeine, though, has not been shown to be as helpful. Talk to your doctor about whether these medicines might be useful for you.

Throat Lozenges

Throat lozenges may be able to reduce the pain caused by a sore throat and may decrease how long it lasts. Lozenges with amylmetacresol and dichlorobenzyl alcohol (such as Strepsils) may be helpful.

Special Considerations

Whenever you are taking a prescription medicine, take the following precautions:

  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what results and side effects to look for. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes OTC medicine, herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.
When to Contact Your Doctor

If you have a common cold or if you are usually healthy but have influenza, you may be able to safely ride it out with home remedies and prescription or OTC medicines. However, be aware of these signs that your cold or influenza is transforming into a more serious condition:

  • New symptoms develop after the initial onset
  • Significant fever (over 101°F for colds, and fever beyond 3-4 days for influenza)
  • Yellow, green, or bloody sputum (secretions from your lungs)
  • Persistence of symptoms beyond two weeks (most colds last 1-2 weeks)
  • Localized pain anywhere (ears, sinuses, head, chest)
  • Yellow secretions on your tonsils
  • Difficulty eating, drinking, or swallowing
  • Difficulty breathing
  • Changes in your mental status
  • Neck stiffness

Revision Information

  • Reviewer:
  • Review Date: 09/2013 -
  • Update Date: 09/30/2013 -
  • Influenza antiviral medications. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm . Updated December 22, 2012. Accessed January 10, 2012.

  • Hulisz D. Efficacy of zinc against common cold viruses: An overview. J Am Pharm Assoc . 2004;44:594-603.

  • Influenza in adults. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated November 14, 2012. Accessed January 10, 2012.

  • Linde K, Barrett B, Wolkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev . 2006;1:CD000530.

  • Prevention and control of influenza. MMWR . 2006;55(RR10):1-42.

  • Schroeder K, Fahey R. Systematic review of randomized controlled trials of over the counter cough medicines for acute cough in adults. BMJ . 2002;324:1-6.

  • What you should know about flu antiviral drugs. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/flu/pastseasons/1112season.htm . Updated December 22, 2012. Accessed January 10, 2012.

  • 12/4/2007 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Lizogub VG, Riley DS, Heger M. Efficacy of a pelargonium sidoides preparation in patients with the common cold: a randomized, double blind, placebo-controlled clinical trial. Explore (NY) . 2007;3:573-584.

  • 1/30/2008 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Public health advisory: Nonprescription cough and cold medicine use in children—FDA recommends that over-the-counter (OTC) cough and cold products not be used for infants and children under 2 years of age. US Food and Drug Administration website. Available at: http://www.fda.gov/cder/drug/advisory/cough%5Fcold%5F2008.htm . Accessed January 30, 2008.

  • 1/30/2008 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med . 2007;161:1149-1153.

  • 3/12/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 2008 safety alerts for drugs, biologics, medical devices, and dietary supplements: tamiflu (oseltamivir phosphate). US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Tamiflu . Accessed March 12, 2008.

  • 10/13/2008 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Hay AD, Costelloe C, Redmond NM, et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial. BMJ . 2008;337:a1302.

  • 11/9/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Shun-Shin M, Thompson M, Heneghan C, Perera R, Harnden A, Mant D. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ. 2009;339:b3172.

  • 11/12/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Smith S, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev. 2010;(9):CD001831.

  • 11/30/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : US Food and Drug Administration. Propoxyphene: withdrawal—risk of cardiac toxicity. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm234389.htm . Published November 19, 2010. Accessed November 30, 2010.