Medications for Viral Upper Respiratory Infections (Colds and Influenza)

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. Adverse reactions are infrequent and usually mild, but may include nausea, vomiting, and headache.

Codeine

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

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.

Researchers recently studied a liquid preparation made from the roots of a South African geranium plant, called Pelargonium sidoides, as a treatment for the common cold. One hundred and three patients were randomized to receive the herbal solution (30 drops, three times daily) or placebo for a maximum of 10 days. At day 5 and day 10, those receiving Pelargonium sidoides showed a greater improvement in symptoms and recovered from the cold faster compared to the control group. This herb is the main ingredient in Umcka ColdCare and Zucol products, which are sold in the US.*

Another natural remedy studied recently is honey, which appears to improve nocturnal cough and sleep disruption in children. A randomized study involved 105 children, aged 2-18 years, with untreated upper respiratory tract infection and cough lasting at least 7 days. Thirty minutes prior to bedtime, the participants received either buckwheat honey, dextromethorphan (DM) with artificial honey flavor, or no treatment. Parents rated cough frequency and severity, bothersome nature of cough, and child and parent sleep quality. Significant improvements were seen with honey compared to DM and no treatment groups, although the study was limited to a single treatment and almost 1 in 5 children dropped out of the study. Note: Do not give honey to infants younger than 12 months because of the risk of infant botulism.*

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