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by Polsdorfer R

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 medication. If you have the flu, check with your doctor to see if you need antiviral medication. 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

  • Pseudoephedrine
  • Phenylephrine
  • Naphazoline
  • Oxymetazoline
  • Diphenhydramine
  • Chlorpheniramine
  • Brompheniramine
  • Loratadine
  • Acetaminophen
  • Ibuprofen
  • Guaifenesin
  • Dextromethorphan
  • Codeine

Prescription Medications

Oseltamivir and Zanamivir
Oseltamivir and zanamivir are used in adults and children to prevent or treat infections with types A and B influenza viruses.
Oseltamivir and zanamivir 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 medications 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 US Food and Drug Administration (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 and Rimantadine
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 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:
  • Nausea
  • Lightheadedness
  • Insomnia
  • Mood and mental changes
  • Dry mouth
  • Constipation
  • Headache
  • Confusion
  • Loss of coordination

Over-the-counter Medications

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 FDA recommends that OTC cough and cold products should not be used to treat infants or children less than 2 years old and supports not using them in children less than 4 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.
Common names include:
  • Pseudoephedrine
  • Phenylephrine
  • Naphazoline
  • Oxymetazoline
Decongestants are all related to adrenaline (epinephrine). Some are available topically (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 2 on the list, naphazoline and oxymetazoline, are often found in eye drops.
Possible side effects include:
  • Over-stimulation, such as nervousness and insomnia.
  • Increase in 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:
  • 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 OTC sleep remedies.
Antihistamines may improve overall symptoms in adults for 1-2 days, but there is in sufficient evidence to support their long-term use.
Note: There is not enough evidence to determine if antihistamines improve cold symptoms in children.
Second-generation antihistamines, such as loratadine, 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 (sinusitis, otitis, and pneumonia)
  • Retention or difficulty passing urine
  • Rashes
  • Lightheadedness
  • Headache
  • Indigestion
  • Constipation
  • Anemia
Talk to your doctor before taking these medications 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 medication or giving medication to your child. In some cases, fever reduction may not be beneficial, since fever helps fight off the infection.
Note: Aspirin can cause serious complications in some children with certain infections. It is best to avoid aspirin or aspirin products for children with infections.
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
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
  • Lightheadedness
Cough Suppressants
Common names include:
  • Dextromethorphan
  • Codeine (available by prescription)
These medications 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 has not been shown to be as helpful. Talk to your doctor about whether these medications 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 may be helpful.
Special Considerations
If you are taking medications, follow these general guidelines:
  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.
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 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 secretions on your tonsils
  • Difficulty eating, drinking, or swallowing
  • Difficulty breathing
  • Changes in your mental status
  • Neck stiffness


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