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Medications for Viral Upper Respiratory Infections (Colds and Influenza)
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Medications for Viral Upper Respiratory Infections (Colds and Influenza)

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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 healthcare provider if you need to take any special precautions.

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

Only influenza can be specifically treated with medication, and those medications should be used only in serious cases because they may have unwanted side effects. Common colds 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 the common cold since it is a virus; 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 bath and humidified air, aren't enough, these OTC products may help you through the worst of the illness.

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 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.*2

In a study, researchers concluded that the nasal wash may reduce symptoms, medication use (eg, antipyretics, nasal decongestants, antibiotics), and school absence.*4

Decongestants

  • Pseudoephedrine (Dimetapp, Myfedrine, Sudafed, Triaminic Decongestant)
  • Phenylephrine (Alconefrin, Neo-Synephrine, Rhinall)
  • Naphazoline (Allerest, Comfort Eye Drops, Naphcon, VasoClear)
  • Oxymetazoline (Afrin, Dristan, Duramist, Neo-Synephrine, Nostrilla, Vicks Sinex)

Antihistamines

  • Diphenhydramine (Aller-Max, Banophen, Benadryl, Dormarex 2, Genahist, Nytol, Siladryl)
  • Chlorpheniramine (Chlorate, Chlor-Trimeton, Genallerate, Phenetron, Teldrin)
  • Brompheniramine (Bromphen, Cophene-B, Dimetapp, Nasahist B)
  • Loratidine (Claritin)

Pain Relievers/Fever Reducers (Antipyretics)

  • Aspirin
  • Acetaminophen (Aceta, Apacet, Feverall, Panadol, Tylenol)
  • Ibuprofen (Advil, Dolgesic, Genpril, Ibuprin, Motrin, Nuprin, Rufen)

Expectorants

  • Guaifenesin (Anti-Tuss, Fenesin, Halotussin, Robitussin)

Cough Suppressants

  • Dextromethorphan (Benylin, Cough-X, Pertussin Cough Suppressant, Trocal)

Herbal Supplements

Prescription Medications

Amantadine (Symmetrel) and Rimantadine (Flumadine)

Amantadine and rimantadine kill only influenza A viruses. They were used for treatment as well as for prevention in high-risk people during an epidemic. However, as resistance can emerge rapidly in influenza A viruses, use of these medications is no longer recommended for either prevention or treatment. These recommendations may change once susceptibility is re-established.

Possible side effects include:

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

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.

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.*5

Codeine

Codeine by prescription is an effective cough suppressant. However, codeine carries the risk of addiction because it is a type of narcotic.

Over-the-Counter Medications

Decongestants

Common names include:

  • Pseudoephedrine (Dimetapp, Myfedrine, Sudafed, Triaminic Decongestant)
  • Phenylephrine (Alconefrin, Neo-Synephrine, Rhinall)
  • Naphazoline (Allerest, Comfort Eye Drops, Naphcon, VasoClear)
  • Oxymetazoline (Afrin, Dristan, Duramist, Neo-Synephrine, Nostrilla, Vicks Sinex)

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 antihistimines. 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 "addicted" to the effects, so that stopping the mediation 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 (Aller-Max, Banophen, Benadryl, Dormarex 2, Genahist, Nytol, Siladryl)
  • Chlorpheniramine (Chlorate, Chlor-Trimeton, Genallerate, Phenetron, Teldrin)
  • Brompheniramine (Bromphen, Cophene-B, Dimetapp, Nasahist B)

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

Second generation antihistamines are nonsedating. For example, loratidine (Claritin) is available without a prescription.

Possible side effects include:

  • Sedation
  • Drying of secretions, which impairs their clearance and may lead to complications (eg, sinusitis, otitis, and pneumonia)
  • Retention or difficulty passing urine
  • Rashes
  • Dizziness
  • 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

The side effects may worsen your condition.

Pain Relievers and Fever Reducers (Antipyretics)

Common names include:

  • Aspirin
  • Acetaminophen (Tylenol, Aceta, Apacet, Feverall, Panadol)
  • Ibuprofen (Advil, Dolgesic, Genpril, Ibuprin, Motrin, Nuprin, Rufen)

These drugs reduce both pain and fever. Pain relief is desirable, but 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.

Aspirin lost favor a few decades ago because of its ability to precipitate Reye's syndrome in young children or teens, so most cold and allergy preparations contain acetaminophen instead. Ask your doctor which types are safe to give to your child. Children and adolescents should not take aspirin during a viral illness.

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

Expectorants

Common names include:

  • Guaifenesin (Anti-Tuss, Fenesin, Halotussin, Robitussin)

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:

  • Nausea
  • Vomiting
  • Headache
  • Rash
  • Dizziness

Cough Suppressants

Common names include:

  • Dextromethorphan (Benylin, Cough-X, Pertussin Cough Suppressant, Trocal)
  • Codeine (requires a prescription)

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 over-the-counter 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.

Herbal Remedies

There is inconsistent evidence that 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.

Based on a recent study, the roots of a South African geranium plant, called Pelargonium sidoides, may improve cold symptoms and help patients to recover faster. This herb is the main ingredient in Umcka ColdCare and Zucol products.*1

Another 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.*3

Herbal treatments are often not 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.

Special Considerations

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

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your healthcare provider.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your healthcare provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

When to Contact Your Healthcare Provider

If you have a common cold or if you are usually healthy, but have influenza, you can 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

Resources

Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy. 17th ed. Hoboken, NJ: John Wiley and Sons; 1999.

Drug Facts and Comparisons. 56th ed. Facts and Comparisons; 2001.

Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: The McGraw-Hill Companies; 2000.

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

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

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

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

*112/4/2007 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 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.

*21/30/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 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_cold_2008.htm. Accessed January 30, 3008.

*31/30/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 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.

*42/28/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Slapak I, Skoupá J, Strnad P, Horník P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg. 2008;134:67-74.

*53/12/2008 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.



Last reviewed January 2007 by Kari Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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