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 medications 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 medications 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 medication, and those medications 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.
With each type of OTC medication, 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. Rare but serious side effects have been reported, including death, convulsions, rapid heart rates, and decreased levels of consciousness. The FDA is still reviewing data about the safety of these products in children aged 2-11 years, since serious side effects have also been reported in this age group.
In one study, researchers concluded that nasal saline may reduce symptoms, medication use (eg, antipyretics, nasal decongestants, antibiotics), and school absence.
]]>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. Note that amantadine and rimantadine do not work in treating ]]>pandemic H1N1 flu]]> . These medications 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 medications. 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:
]]>Oseltamivir]]> (Tamiflu) and ]]>Zanamivir]]> (Relenza)
Oseltamivir and zanamivir are used in adults and children to prevent or treat infections with both type A and B influenza viruses. Both drugs interfere with specific viral chemical processes. Like other antiviral medications, 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 United States, but it can be used for pandemic H1N1 flu; however, resistance to oseltamivir has been reported. The FDA repeated its warning of possible adverse effects in patients, especially children, taking oseltamivir. In some cases, these effects (eg, hallucinations, delirium, abnormal behavior) resulted in injury and death.
Peramivir is an investigational medicine used to treat pandemic H1N1 flu. It is considered investigational because the FDA has not approved it. However, the FDA has allowed doctors to use the medicine on hospitalized patients with H1N1 flu if other antiviral medicines do not work.
The medicine is given through an IV (needle in the vein) one time each day for five days or more. Peramivir may cause ]]>diarrhea]]> , nausea, vomiting, and a decrease in white blood cells. Since researchers are still studying the effects of the medicine, there may be other side effects that are not yet known.
Codeine]]> by prescription is an effective cough suppressant. However, codeine carries the risk of addiction because it is a type of narcotic.
Common names include:
Decongestants are all related to adrenaline (epinephrine). Some are available topically (eg, 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.
As of 2006, with the Combat Methamphetamine Act of 2005, sale of pseudophedrine-containing compounds over the counter is no longer possible. Some manufacturers no longer use pseudoephedrine in their products. The Act does allow the sale of pseudoephedrine from locked cabinets or behind the counter, without a prescription.
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 medication produces the swelling and congestion that was originally being treated. This is a common problem with nose drops and sprays.
Common names include:
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 non-sedating and may be available without a prescription.
Possible side effects include:
- Drying of secretions, which impairs their clearance and may lead to complications (eg, ]]>sinusitis]]> , ]]>otitis]]> , and ]]>pneumonia]]> )
- Retention or difficulty passing urine
Talk to your doctor before taking these medications if you have the following conditions:
- Urinary problems due to an enlarged prostate gland
- Breathing problems
These side effects may worsen your condition.
Pain Relievers and Fever Reducers
- Note : Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of ]]>Reye's syndrome]]> . Ask your doctor which other medicines are safe for your child.
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 medication or giving medication to your child. In some cases, fever reduction may not be all that beneficial, since fever helps fight off the infection.
Prescription pain relievers like codeine and propoxyphene do not lower fever. Codeine also suppresses coughing.
Possible side effects of aspirin 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
- Overdoses can damage the liver or kidneys
Common names include:
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, either as a cold mist vaporizer or steamy shower.
Possible side effects include:
Common names include:
These medications help suppress the urge to cough, which is useful if your cough is dry but may not be a good idea if you have secretions to clear. According to a large review of OTC cough medications, there is no good evidence to support their effectiveness. Talk to your doctor about whether these medications might be useful in your individual case.
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 (eg, Strepsils) may be helpful.
There is inconsistent evidence that the use of herbal supplements, such as echinacea, may help in both prevention and treatment of upper respiratory tract infections. Before using any herbal supplement, discuss the pros and cons, possible side effects, and drug interactions with your doctor.
A natural remedy studied recently is honey]]> , which appears to improve nighttime cough and sleep disruption in children. Note: Do not give honey to infants younger than 12 months because of the risk of infant ]]>botulism]]> .
Herbal treatments may not be well studied, nor are the products regulated. The herbal supplements that you purchase may not have the same constituents as those described in the studies, and they also may contain impurities.
Whenever you are taking a prescription medication, take the following precautions:
- Take your medication 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 over-the-counter medication and 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 over-the-counter medications. 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 goo (secretions) on your tonsils
- Difficulty eating, drinking, or swallowing
- Difficulty breathing
- Changes in your mental status
- Neck stiffness
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Last reviewed December 2009 by ]]>David L. Horn, MD, FACP ]]>
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