Under the weather? Here’s what meds to take!
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I didn’t plan on writing a healthcare-related post this soon, but is it just me or does it seem like everybody has been sick lately? It had been a while since I had gotten sick, but even I had to do a telemed visit recently. It always seems like it hits you at the most ill-fitted (hehe! ehhh…) time— I had to miss an in-person audition and everything! Being sick just sucks. But I will say, being a pharmacist definitely has its advantages, one of the main ones being: you know what to take when you feel horrible. So I’d love to share some insight with you when that nasty lil bug hits ya! Direct from the pharmacist’s mouth!
Now before we get any further, this is not meant to replace a consultation with a medical provider—even if I were to “see” you directly, I can’t prescribe medication to you or formally diagnose you. That’s not what I went to school for. This is merely to give you some guidance on what’s available, how to alleviate your symptoms with some over-the-counter (OTC) and behind-the-counter medications, how to help boost your immunity, and what to expect when you see your healthcare provider.
**This is not an all-inclusive breakdown of all these medications—how to take them, important warnings/precautions associated with these drugs, pertinent drug interactions, under which disease states you cannot take certain medications, etc.—that would take far too long for me to get into here! So please refer to your healthcare provider and the package inserts included with each drug for more information :)
In this blog post, I will be covering upper respiratory tract illnesses (stuffed/runny nose, cough, sore throat, headache, fever, etc.) in adults between the ages of 18 and 65. I’ll break down the symptom relief management by category. Medication therapy can get a bit more complicated in the pediatric and geriatric populations, so to keep things concise, adults between 18 and 65 will be my target audience in this article. So without further ado, let’s get into it!
Dr. Berry's Cold / Flu / Covid Symptom Relief Cheat Sheet
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Dr. Berry's Cold / Flu / Covid Symptom Relief Cheat Sheet 〰️
Fever and/or Pain
There are two major OTC categories for fever reduction and pain relief- Acetaminophen and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).
Acetaminophen (abbreviated “APAP”) is the generic name for Tylenol, and although it is over-the-counter, you can take too much of this medication. When overdosed, it forms a toxic metabolite, called NAPQI, which causes liver toxicity, which is obviously a very serious issue. So right off the bat, let’s dispel the notion that just because it’s over-the-counter, it must be safe. That’s simply not true. It doesn’t mean that we need to avoid it either- it is an invaluable asset for all kinds of patients, especially for those who can’t take NSAIDs for one reason or another. Since acetaminophen falls in a separate category to NSAIDs, it can be given together with or alternated with NSAIDs which is also a major bonus!
Acetaminophen (Tylenol)
Comes as 325 mg, 500 mg, 650 mg tablets and liquid formulations.
Directions: Take 325 mg to 1000 mg every 8 hours as needed. Do not exceed 3,000 mg (or 3 grams) within a 24 hour period.
A lot of medications have acetaminophen in them. Make sure to check the “Drug Facts” section of each OTC product plus any prescription medications you are taking (a lot of prescriptions abbreviate acetaminophen to “APAP”) to make sure you are not taking more than recommended!
Seek medical attention immediately if your fever is 103 F or above or if it persists for more than 3 days or if the fever is accompanied with severe signs/symptoms (severe headache, rash, confusion, vomiting, chest pain, difficulty breathing, painful urination, seizures, etc.)
Unlike Gucci or Louis Vuitton bags, there are relatively few medications where the brand is better than the generic so save yourself some money and get generic!
NSAIDs have a leg up from acetaminophen in that they not only treat pain and fevers but also inflammation. The two most common NSAIDs are Ibuprofen (brand: Advil, Motrin) and Naproxen (brand: Aleve). It’s a known phenomenon that if one NSAID doesn’t really work for you, a different NSAID very well could! So if you don’t get much relief from ibuprofen, try naproxen! And vice versa. Just make sure you separate the two medications out from each other by at least 8 to 12 hours (wait 8 hours after ibuprofen before taking naproxen or wait 12 hours after naproxen before taking ibuprofen). Unlike acetaminophen, NSAIDs can thin the blood so it’s not recommended for those with stomach ulcers or bleeding conditions. For this reason, you may have been told by your medical provider to avoid NSAIDs and aspirin-containing products before a medical procedure or surgery.
NSAIDs: Ibuprofen (Advil, Motrin)
Comes as 200 mg tablets OTC and liquid formulations
Directions: Take 200 mg to 400 mg (1 to 2 tablets) every 8 hours as needed. Do not exceed 1,200 mg in a 24 hour period.
NSAIDs: Naproxen (Aleve)
Comes as 220 mg tablets OTC
Directions: Take 220 mg to 440 mg (1 to 2 tablets) for the first dose, then only 220 mg (1 tablet) every 12 hours thereafter as needed. Do not exceed 660mg in a 24 hour period.
Still have a gnarly sore throat despite acetaminophen and NSAIDs? Try these!
Chloraseptic Lozenges
Contains Benzocaine & Menthol which help numb and soothe sore throats
Directions: Take 1 lozenge every 2 hours as needed. Allow lozenge to dissolve slowly in the mouth.
Chloraseptic Throat Spray
Contains Phenol which numbs the sore throat within seconds.
Directions: Apply 1 spray every 2 hours as needed. Allow it to remain in place for at least 15 seconds before spitting it out.
I love to use this one at bedtime so my throat is soothed to avoid coughing
Nasal Congestion & Runny Nose
This is one of the main reasons why I personally don’t like taking Dayquil/Nyquil. There are better drugs out there. Your typical Dayquil and Nyquil usually have a nasal decongestant in them called phenylephrine. Although available in so many cold/cough OTC medications, the FDA advisory committee is looking into having it removed from market because “it works no better than placebo” at relieving nasal congestion. So let’s talk about meds that do actually work! It’s “cousin” if you will, works beautifully, and although you don’t need a prescription, you can only get it behind the counter in the pharmacy- it’s pseudoephedrine (Sudafed). The alternative options are nasal sprays- Oxymetazoline (Afrin) and Steroid Nose Sprays such as Triamcinolone (Nasacort), Mometasone (Nasonex) & Fluticasone (Flonase).
Oral Decongestants
***NOT THE SAME AS SUDAFED PE WHICH IS OTC*** Sudafed PE is just phenylephrine which is the weak nasal decongestant I mentioned earlier.
Pseudoephedrine (Sudafed)
Works by constricting the blood vessels in the nose and sinuses, thereby reducing swelling, draining fluids, and allowing you to breathe through your nose again
Not OTC or Rx, but behind the counter in the pharmacy. This means you don’t need a prescription to get it, but without a prescription, you must show your ID at the pharmacy counter, sign the pharmacy log book and are limited in how much you can buy (only one box at a time).
Comes as generic pseudoephedrine 30 mg given every 4 to 6 hours, brand Sudafed 12 Hour Extended-Release (ER) 120 mg given every 12 hours, and brand Sudafed 24 Hour ER 240mg given every 24 hours. It also comes in formulations with antihistamines like Allegra (fexofenadine) and Zyrtec (cetirizine) called Allegra-D or Zyrtec-D respectively.
Cons: Pseudoephedrine is what they call a sympathomimetic which means that it works in conjunction with your sympathetic nervous system, or fight-or-flight system. Because of this, it is known to cause an increased heart rate and blood pressure which is particularly unfavorable if you are trying to sleep. I recommend taking pseudoephedrine in the morning to counteract this potential side effect. You can also try taking it in the Allegra-D or Zyrtec-D formulation since antihistamines can cause drowsiness (especially if you suffer from allergies and could benefit from the antihistamine anyway).
Intranasal Decongestants
Since we are at the nasal spray options, I’d figure it’d be a good idea to address proper nasal spray technique! Make sure to blow your nose beforehand, then gently insert the tip of the nasal spray 1/4 to 1/2 inch into your nose. The key is pointing the spray away from the center of your nose and instead back more towards your ear. Lean forwardly slightly (unless instructed otherwise) and close the nostril you are not treating. Then follow the instructions on the packaging as to whether to inhale when you spray or not. Try to avoid blowing your nose for 15 minutes post-treatment.
Oxymetazoline (Afrin)
Provides fast and powerful relief of nasal congestion for 12 hours by causing constriction of the blood vessels in the nose
If you are having a hard time breathing through your nose, this drug can be such a lifesaver!
Directions: Spray 2 to 3 sprays in each nostril every 12 hours as needed. Do not exceed 2 doses in a 24 hour period.
Cons: You can only use this drug for up to 3 to 5 days. Otherwise, it can cause rebound congestion, so save it for when you really need it!
Steroidal Intranasal Decongestants (ending in “-one”)
They work by reducing inflammation in the nose, thereby helping to relieve sneezing and a runny or blocked up nose.
Unlike Afrin, steroid-based sprays can be used long-term with relatively few side effects or risks.
There are several to choose from so it really just comes down to preference.
Fluticasone (Flonase)
Directions: Spray 1 spray in each nostril every 12 hours or spray 2 sprays in each nostril once daily as needed. Do not exceed 2 sprays in each nostril in a 24 hour period.
Triamcinolone (Nasacort)
Directions: Spray 1 to 2 sprays in each nostril once daily as needed.
Mometasone (Nasonex)
Directions: Spray 2 sprays in each nostril once daily.
Cough- Is it wet or dry?
The OTC options for cough are really pretty easy thankfully and dwindle down to two main medications: Dextromethorphan and Guaifenesin. Dextromethorphan is a cough suppressant. Guaifenesin is an expectorant; the purpose of an expectorant is to thin and loosen any mucus caught in your throat and help expel it (yum!). So if you have a cough, it’s important to ask yourself—is it a wet or dry cough? If it’s a dry cough, you really only need Dextromethorphan. If it’s a wet cough, you would probably benefit from taking both Dextromethorphan and Guaifenesin.
Dextromethorphan (Delsym)
Comes as 15 mg and 30 mg IR (immediate release) tablets, and ER (extended release) liquid formulations
Directions (30 mg/5 mL ER liquid): Take 10 mL every 12 hours as needed. Do not exceed 20 mL within a 24 hour period.
Guaifenesin (Mucinex)
Comes as 600 mg ER, 1200 mg ER, and liquid formulations
Directions: Take 600 mg to 1200 mg ER every 12 hours as needed. Do not exceed 2400 mg in a 24 hour period.
Guaifenesin & Dextromethorphan (Mucinex DM)
Comes as an immediate release (IR) formulation- Guaifenesin 400mg/Dextromethorphan 20mg IR to be taken every 4 hours as needed
Comes as extended release (ER) formulations- Guaifenesin 600mg/ Dextromethorphan 30mg ER or Guaifenesin 1200mg/Dextromethorphan 60mg ER to be taken every 12 hours as needed
Stomach Upset
There are several options when it comes to stomach upset, so I like to break it down based off the type of GI upset: indigestion, flatulence and diarrhea.
Calcium Carbonate (Tums)
It’s an antacid used to treat indigestion (upset stomach) and heartburn.
Works by neutralizing stomach acid within minutes and lasts a few hours
Comes as chewable tablets and liquid formulations
Directions (1000mg Chewable Tablet): Chew 2 to 3 tablets as symptoms occur. Do not take more than 7 tablets in a 24 hour period.
Simethicone (Gas-X)
It treats flatulence by providing quick relief of excess gas and bloating.
Comes as capsule/softgel, chewable tablet and liquid formulations.
Directions (180 mg Softgel): Take 1 to 2 softgels once daily as needed after a meal. Do not exceed 2 softgels within a 24 hour period.
Loperamide (Imodium A-D)
It’s an antidiarrheal used to treat bouts of diarrhea.
Comes as tablets, capsules and liquid formulations.
Directions (2 mg Tablet): Take 2 tablets (4 mg) after the first loose stool, then take 1 tablet (2 mg) after each subsequent loose stool. Do not exceed 4 tablets in a 24 hour period.
Vitamins for Everyone!
Regardless of what symptoms you are experiencing, consider taking some vitamins to help boost your immunity! Unfortunately, not all vitamins and supplements have the data to back up their use since the regulations to have them brought to market are much less rigid compared to prescription medications. From the FDA’s perspective, they fall under the umbrella of food, not drugs. For this reason, these are the vitamins I like to recommend since they have the most favorable clinical research behind them: Vitamin C and Zinc.
Vitamin C
It’s a supplement that helps the immune system and offers antioxidant support.
Comes as tablets, chewable tablets and capsules
Directions: Take 1000 mg (2 tablets of 500 mg) once daily with a meal.
Zinc
Zinc is a trace element that plays a vital role in immune support.
Comes as tablets
Directions: Take 1 tablet daily with a meal.
Multivitamin
Who doesn’t love a gummy vitamin?! Make sure to take a multivitamin for general wellness and to help prevent any nasty bugs in the future :)
Directions (for the multivitamin linked): Chew 2 gummies once daily.
COVID Testing from Home!
If you’d like to figure out whether or not you have COVID, you can get a test shipped directly to you! This one contains 5 tests and you get your results in 15 minutes!
Summary!
If you’re reading this and you’re not sure where to begin, fear not! I have created a flowchart cheat sheet for you! Just identify what your symptoms are and follow the prompts to determine what meds may be best suited for you. Feel free to refer above for more information on each medication. I have also included a legend in the bottom right corner of the flowchart for easy access :)
If on your desktop, just click on the photo and it will expand for you, or if on mobile, you can zoom in and out of the photo directly.
I hope this information has equipped you with knowledge on how to treat your symptoms and that you are on your way to feeling so much better! When that nasty bug gets you, I recommend seeing your PCP or urgent care sooner than later so you can get better as quickly as possible. They will be able to prescribe you an antibiotic (if bacterial), antiviral (if viral) and/or steroid (to reduce inflammation and help you overcome infections more quickly) as necessary which will treat the underlying issue(s). It’s recommended for many antibiotics, antivirals, and steroids that you take them with food so make sure to ask your prescriber how to best take them to help avoid any side effects and get the most out of them. Some even have some dietary restrictions (a common antibiotic, doxycycline hyclate, for example, can bind with calcium-containing products in the stomach, making it less absorbed and therefore less effective) so also ask if there are any foods, supplements, or medications to avoid while on your prescriptions.
There’s only so much that OTC medications can help you since they are largely symptom-relief medications, but hopefully they will help you feel better as you also take prescribed treatment medications. When you see your healthcare provider, make sure to discuss all medications you are taking and ask them which one(s) to continue or if they think a prescription-only medication would work better for you. Hope you feel better soon, my friends!
Pro tip: Whenever buying any product over the counter, do not rely on the name on the front of the box to tell you what exactly is in the box. This might sound crazy, but although some boxes may say different things in BIG BOLD letters, they may actually be the exact same thing. To know what you are truly getting, check the back of the box in the “Drug Facts” section. There it will tell you what the active ingredients are, their dosages, and what function they serve.
If pregnant or breastfeeding, please ask a healthcare professional before use of any of these medications.
Keep these medications out of reach of children. In case of overdose or accidental poisoning, get medical help or contact the Poison Control Center at 1-800-222-1222 immediately.
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