Options for relieving cold, flu and COVID-19 symptoms
1/27/2022 by Danielle Hess, Pharm.D., R.Ph.
As cold and flu season is underway and COVID-19 continues in a series of waves, you may be in search of over-the-counter products to combat your symptoms. However, it's important to take steps to determine which medication is the correct choice for you.
First, read the medication label so you are aware of each ingredient. Many over-the-counter brands have different products that contain various ingredients. For example, what's the difference between Mucinex DM and Mucinex Sinus-Max? Mucinex DM contains dextromethorphan, a cough suppressant, and guaifenesin, which thins and looses mucus. On the other hand, Mucinex Sinus-Max contains acetaminophen, a pain reliever; dextromethorphan, guaifenesin; and phenylephrine, a nasal decongestant. Do you need each of these ingredients? Are you already taking acetaminophen for pain or fever? What about a separate nasal decongestant?
Second, talk with your health care team to determine if the product is safe to take with your prescription medications and current health conditions, or if you may be pregnant.
To help with the above steps, here are the main medication categories:
Antihistamine treat a runny nose by blocking the effects of a substance called histamine. However, not all antihistamines have the same effects. The older class of antihistamines includes medications such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl) and doxylamine (Vicks NyQuil, Tylenol Cold and Cough Nighttime). These medications are known to cause drowsiness and are often used in nighttime formulations to aid with sleep. Older adults, and people taking medications that cause dizziness, drowsiness or balance issues, should use these antihistamines with caution.
On the other hand, newer antihistamines, such as cetirizine (Zyrtec), loratadine (Claritin), levocetirizine (Xyzal) or fexofenadine (Allegra) are often considered to be safer options, as they do not tend to cause drowsiness and interact with fewer medications.
In addition to treating a runny nose, antihistamines can reduce swelling and congestion in the nasal passages and improve postnasal drip, the mucus in the nose or sinuses that drains into the throat. Postnasal drip is one of the most common causes of long-lasting cough.
Cough is a common symptom of a cold, flu or COVID-19. However, COVID-19 typically presents with a dry cough rather than a productive cough with mucus. Although antihistamines and decongestants can help treat a cough by decreasing nasal congestion and postnasal drainage, other medications are designed to target a cough.
Dextromethorphan, often labeled as "DM" on medication labels, works on the part of your brain responsible for the cough reflex and disrupts the communication between your brain and the nerves that cause a cough. If using a liquid formulation of this medication, make sure to use the dosing cup that is provided with the bottle to ensure you are taking an accurate dose. Dextromethorphan is sold under the brand name Delsym or commonly found in combination products like Robitussin DM. If you have diabetes, purchase sugar-free options to avoid raising your blood sugar. If you take medications that affect serotonin levels to treat depression, such as sertraline (Zoloft), fluoxetine (Prozac) or venlafaxine (Effexor), dextromethorphan may enhance the effect of your medication and should be used with caution. This combination may lead to a rare, serious side effect called serotonin syndrome. If you experience confusion, heavy sweating, diarrhea, rapid heart rate, vomiting or muscle spasms, contact your health care provider or seek medical attention immediately.
Guaifenesin, a common ingredient in Mucinex or Robitussin, acts by loosening and thinning mucus in the airways to relieve congestion in acute or chronic coughs. However, guaifenesin does not suppress a cough itself. Also, adequate hydration is required to loosen and thin mucus.
A stuffy or congested nose may present with a cold, flu or COVID-19. Common decongestants include pseudoephedrine or phenylephrine, often labeled as "PE." These decongestants work by narrowing blood vessels, which temporarily relieves nasal congestion. However, they also can increase blood pressure in people with high blood pressure. Therefore, patients with hypertension, ischemic heart disease or kidney disease should use these medications with caution. When comparing these two medications, pseudoephedrine is more effective than phenylephrine. Pseudoephedrine does not require a prescription. However, it is placed behind the counter at pharmacies and requires a photo ID to purchase it.
In addition to oral options, decongestants are also available as nasal sprays, including oxymetazoline, which is sold under the brand names of Afrin and Vicks Sinex. This option can relieve congestion with less of an effect on blood pressure. Oxymetazoline should be used for a maximum of three days. Otherwise, it can lead to rebound nasal congestion, which means the nasal congestion can recur or worsen.
Natural or homeopathic products
Although homeopathic products may be marketed to relieve the symptoms of colds or the flu, the evidence for their safety and effectiveness is lacking. Because there is little evidence to support their use, it is usually best to avoid them.
There is also limited evidence for the use of other natural products, such as vitamin C, echinacea, zinc and ginseng. Vitamin C has been studied for years as a possible treatment for colds. Studies have demonstrated little to no benefit for preventing or treating the common cold. Echinacea also has been shown to have minimal benefits and may only shorten cold symptoms by about a half-day. Similarly, zinc lozenges or syrup have been shown to reduce the length of a cold by one day, especially when taken within 24 hours of the first signs and symptoms of a cold. Studies with ginseng have concluded that there is not enough evidence for its use. North American ginseng may be effective in shortening the duration of colds when taken preventatively for eight to 16 weeks. If you are considering one of these products, it is important to talk to your health care provider to avoid drug interactions. For example, ginseng may reduce the effects of warfarin.
Other natural products, such as honey — alone or mixed with chamomile tea or lemon — may help relieve your cough and loosen chest congestion.
Pain, headache or fever
Acetaminophen (Tylenol) can be used to treat a fever, pain or headache. It is recommended to take 500 milligrams every four hours as needed or 1,000 milligrams every six hours as needed. You should not take more than 3,000 milligrams in a 24-hour period. If you have a liver condition, confirm your maximum recommended dose with your health care provider.
Ibuprofen (Advil or Motrin) also can be used to treat a fever, pain or headache. The recommended dose is 200 to 400 milligrams every four to six hours as needed. The maximum dose is 1,200 milligrams in a 24-hour period. You should avoid ibuprofen if you have kidney disease, coronary heart disease, heart failure, or a history of a gastric ulcer or gastric surgery.
Other important considerations
If you have cold, flu or COVID-19 symptoms, stay home from school or work to avoid spreading these germs. If you are experiencing COVID-19 symptoms, get tested and appropriately quarantine if you receive a positive result.
Washing your hands frequently with soap and water or using hand sanitizer is important to prevent the spread of these illnesses. If you need to cough or sneeze, use a tissue to cover your mouth and nose. If you do not have a tissue, cough or sneeze into your elbow — not your hands. Remember to immediately wash your hands after blowing your nose, coughing or sneezing.
Protect yourself and others from the spread of the flu and COVID-19 by receiving your annual flu shot and the appropriate series of the COVID-19 vaccine, including the booster dose.
If your symptoms last for more than a week, or if you develop a fever, rash or persistent headache, contact your health care provider for further evaluation.
Danielle Hess, Pharm.D., R.Ph., is a pharmacy resident at Mayo Clinic in Rochester, Minnesota.