Medications for Viral Upper Respiratory Infections (Colds and Influenza)

Oseltamivir and zanamivir are used in adults and children. These medicines are used to treat A and B influenza viruses. They do not cure the flu. However, they may shorten the length of the illness if taken within the first 2 days of symptoms. They may also reduce the spread of the flu virus to others.

Zanamivir may worsen asthma or chronic obstructive pulmonary disease (COPD). Some kinds of seasonal flu viruses are resistant to oseltamivir in the US. Possible side effects may include mental status changes and abnormal behavior.

Peramivir is used to treat influenza A and B. It is given to those with uncomplicated flu symptoms for 2 days or less. It helps make the symptoms less severe and shortens recovery time. Peramivir is given by injection and baloxavir is given by pill.

Some problems may be:

• Diarrhea
• Constipation
• Nausea
• Problems sleeping
• Throat irritation

Amantadine and rimantadine affect only influenza A viruses. They are used for treatment and prevention in high-risk people during an epidemic. These medicines do not cure the flu. They may shorten the length of illness if taken within the first 2 days of symptoms. Many flu strains resist these medicines.

Some problems may be:

• Nausea
• Light-headedness
• Insomnia
• Mood and mental changes
• Dry mouth
• Constipation
• Headache
• Confusion
• Loss of coordination

Common names include:

• Pseudoephedrine
• Phenylephrine
• Naphazoline
• Oxymetazoline

Decongestants are available in nose sprays, eye drops) or pills. They reduce swelling in inflamed tissues like the nose.

Some problems may be:

• Nervousness and insomnia.
• Increase in blood pressure.
• Rebound congestion—If used for a long time, stopping these drugs can cause more swelling and congestion. This is a common with nose drops and sprays.

Common names include:

• Diphenhydramine
• Chlorpheniramine
• Brompheniramine

The main effect of these drugs is to dry up mucus. They can also cause drowsiness.

These medicines may improve symptoms in adults for 1 to 2 days. There is not enough evidence for their use in children.

Other OTC antihistamines may not cause drowsiness. Examples are loratadine.

Some problems may be:

• Feeling tired or sleepy
• Drying of mucus, which impairs their clearance and may lead to sinusitis, otitis, and pneumonia)
• Problems passing urine (pee)
• Rashes
• Light-headedness
• Headache
• Indigestion
• Constipation
• Anemia

Those who have the following problems should talk to their doctor before using these drugs:

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

These side effects may worsen the condition.

• Acetaminophen
• Ibuprofen

These drugs reduce both pain and fever.

Note: Aspirin can cause serious problem in some children with certain infections. It is best to avoid aspirin or aspirin products for children with infections.

Some problems may be:

• 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
• Damage the liver or kidneys—if too much of the drug is taken

Common names include:

• Guaifenesin

An expectorant decreases the thickness of mucus. This helps a person cough up or blow the mucus out. Breathing warm, moist air can have the same effect.

Some problems may be:

• Nausea
• Vomiting
• Headache
• Rash
• Light-headedness

Common names include:

• Dextromethorphan
• Codeine (available by prescription)

These medicines help stop the urge to cough. They are useful for dry coughs. If there is lots of mucus, it should be coughed up. Codeine has not been shown to be as helpful.

Cough drops may help ease sore throat and decrease the time it lasts. Cough drops with amylmetacresol and dichlorobenzyl alcohol may be helpful.

If you are taking medicine, follow these general guidelines:

• Take the medicine as advised. Do not change the amount or schedule.
• Be aware of the side effects of your medicine. Tell your doctor if you have any.
• Talk to your doctor before you stop taking any prescription medicine.
• Do not share your prescription medicine.
• Medicines can be harmful when mixed. This includes over the counter products or supplements.
• Plan for refills.