When stuck with cold, flu, or COVID symptoms, we all want to know what we can do that will be effective to reduce discomfort and help us recover faster. With so many remedies available, it is important to determine which are backed by medical evidence and which just don’t seem to work.
Non-Medical Therapy
Let’s start with the basics! Some traditions are worth continuing, so there are a few things that we should keep doing!
Rest and Hydration. First and foremost, rest and hydration are key when recovering from a viral illness. This is your recovery foundation, from which you should not stray! In fact, adequate sleep has been shown to reduce risk of viral illnesses in the first place! Hydration, especially with warm fluids, helps to loosen mucus and alleviate nasal congestion. Chicken soup specifically has been found to reduce inflammation and improve viral symptoms.
Saline Sinus Rinse, Saline Nasal Spray. There are several studies that have shown nasal saline irrigation (like with a neti pot) to be effective in controlling symptoms of sinusitis and cold symptoms. This is also true of saline nasal spray. Use them regularly and often! Just remember that you need to be able to move air through both nostrils in order to use the saline rinse.
Honey. Honey has been shown to reduce cough frequency and improve sleep quality in children under 6. Generally the dose is a half-teaspoon prior to bedtime. It was better than antihistamines and is likely similar in effectiveness to dextromethorphan (a common cough suppressant, see below). Remember though, no honey in kids under 1 year of age due to the risk of botulism. Its use has been extended to older children and adults since it is so safe.
Over-the-Counter Medications: What Works?
There are any number of over-the-counter medications available to treat the common cold, some of which are shown to work and some which are not.
Pain relievers. Acetaminophen or ibuprofen can definitely help to reduce fever and treat muscle aches that are common, especially if you have the flu.
Zinc gluconate. Zinc gluconate, about 75 mg total per day (spread throughout the day) has been shown to reduce the duration of viral illnesses by up to 40% if started within 24 hours of symptom onset. Be careful though, as taking more than this can cause stomach upset or a metallic taste.
High dose vitamin C. Vitamin C has been shown to be effective in reducing the severity and duration of upper respiratory illness symptoms in adults, particularly when taken regularly or at higher doses during the onset of symptoms (6-8 grams per day). However effects vary among individuals and extremely high doses can cause side effects like gastrointestinal discomfort.
Decongestants. These are generally helpful, with the caveat that there are differences among them:
Phenylephrine (which is typically found in cold-and-flu remedies like Nyquil and Dayquil and when sold individually can be found branded as “Sudafed PE”) has mixed evidence, but it does not seem to help much for nasal congestion in studies. Still, you can use it if you feel it works.
Pseudoephedrine on the other hand, commonly sold as Sudafed, does seem to work. Unfortunately either of these can cause blood pressure and heart rate to rise, among other side effects, and this is more common with pseudoephedrine. Please speak to your physician before using either of these medications if you have heart problems or high blood pressure.
Nasal decongestants like oxymetazoline (Afrin) have been shown to be effective, but unfortunately they may also cause your blood pressure to go up when used, so please speak to your physician if you have heart problems or high blood pressure. Regardless, please note: nasal decongestant sprays should not be used longer than 3 days, and then it is important to stop for at least 3 days before using again.
Antihistamines. These are commonly found in combination medications for colds with forms such as chlorpheniramine, diphenhydramine, or doxylamine. These can help with runny nose and sneezing, but be careful - they can also make you sleepy. Unfortunately evidence for the non-drowsy antihistamines like cetirizine (Zyrtec) or loratadine (Claritin) generally don’t seem to work.
Cough suppressants. The main one available over-the-counter is dextromethorphan, sometimes sold alone and sometimes included in combination with other medications. This can help calm a persistent or dry cough, and works by suppressing the cough reflex, but to be honest, the evidence for its effectiveness is mixed, so feel free to try it but if it doesn’t help - forget about it! And this is really important - there is clear evidence that dextromethorphan should not be used in children under the age of 6.
Expectorants. An expectorant is used to thin mucus and make it easier to cough up. Guaifenesin is the most common expectorant available and it has mixed results - it seems to work in some people but mainly for lower respiratory infections like bronchitis or pneumonia, and it does not seem to work well for simple upper respiratory illness like the cold. So again, you can use it if you want, but be aware, it might not be doing anything.
What DOES NOT Work?
While it’s good to know what works, here are a few things to avoid for common viral symptoms.
Antibiotics. These should not be taken presumptively for any illness without speaking to your physician. They should only be used if your physician recommends after a bacterial infection is confirmed.
Echinacea. Studies are either mixed or negative on echinacea’s ability to shorten duration of illness or reduce symptoms.
Alcohol-based Remedies. Drinking alcohol can actually worsen symptoms and prolong duration of illness, so leave it on the shelf.
Ivermectin. Although ivermectin has been explored as a treatment for COVID-19 specifically, multiple rigorous studies have shown it is ineffective for this purpose. It is not recommended for treating viral illnesses, and misuse can lead to harmful side effects.
Preventive measures
The best treatment is prevention! The following is especially useful in avoiding that cold in the first place!
Vaccination. Annual flu vaccines and updated COVID vaccines significantly reduce the risk of severe illness.
Hand Hygiene. Regular handwashing minimizes the spread of germs.
Healthy Lifestyle. A balanced diet, regular exercise, and adequate sleep strengthen your immune defenses.
When to call your doctor
While most cold, flu, and COVID symptoms can be managed at home, there are times when medical attention is necessary. Contact your doctor if you experience:
High Fever: A persistent fever above 103°F (39.4°C) in adults or above 102°F (38.9°C) in children - especially if the fever went away and then suddenly returned our if fever is lasting longer than 4 or 5 days.
Shortness of Breath: Difficulty breathing, chest pain, or wheezing.
Prolonged Symptoms: Symptoms that last more than 10 days or worsen instead of improving.
Severe Fatigue or Confusion: Unusual drowsiness, confusion, or inability to stay awake.
Underlying Health Conditions: If you have a compromised immune system or chronic conditions, seek advice earlier.
Conclusion
While rest, hydration, and over-the-counter medications provide the foundation for managing cold, flu, and COVID symptoms, evidence also supports the use of zinc gluconate to shorten cold durations, and vitamin C might also help (though not as much as zinc). It’s equally important to avoid remedies that lack scientific backing, such as antibiotics for viral infections, alcohol, or ivermectin. By staying informed and focusing on proven treatments, you can recover more effectively and support your overall health.
Comments