Cold Care (respiratory symptom) Symptom Guide
It can be confusing to know what to buy at the drug store or when to take what. Please use the following information as a guide; send your doctor a portal message if after reading it you have more questions.
Anti-inflammatories—medications to help control the injury to the lining of the sinuses, nose, throat and airway that the virus is causing—these are mainstays of a good anti-virus strategy. We know there is confusion in the media about the use of NSAIDs in the treatment of Covid 19 but we believe based on current research it IS generally safe to use NSAIDs. See general cautions below.
Symptoms addressed: fever, chills, aches, sore throat, sinus pain, sore joints, swelling.
Examples of non-steroid anti-inflammatory drugs (NSAIDs): choose one.
Advil (ibuprofen) 800 mg (4 tabs) every 8 hours with food for up to 14 days,
Aleve (naproxen) 660 mg (3 tabs) every 12 hours with food x 14 days,
Aspirin 975 mg (3 tabs) every 4 hours with food for up to 14 days.
Cautions: Discuss with your doctor before taking these if you have vomiting, stomach pain, gastroesophageal reflux disease (GERD, heartburn); have a cardiovascular diagnosis like history of heart attack or stroke; are taking blood thinners or bruise easily; are being treated for Crohn’s disease or Ulcerative Colitis; or are pregnant or may become pregnant.
Antipyretics—fancy language for fever reducers.
Symptoms addressed: fever, aches, sore throat.
Examples:
Tylenol (acetaminophen, Paracetamol) 1000 mg every 8 hours; maximum 4 grams (4000 milligrams) daily from ALL SOURCES
Acetaminophen travels frequently in combination with many other over the counter medications. It is ok to take acetaminophen with an anti-inflammatory like ibuprofen or naproxen, both simultaneously or alternating the medication doses, but be careful and avoid mixing different combination which contain acetaminophen. For example, Dayquil and Theraflu both contain acetaminophen—don’t dose these at the same time.
Cautions: Discuss with your doctor before taking if you have liver disease, including Hepatitis B and Hepatitis C; if you drink more than 2 alcohol-containing beverages when you drink, or if you drink more than 3 days weekly.
NSAIDs are the MVPs of respiratory symptom control—they are more useful than acetaminophen is on its own. Acetaminophen is better than nothing if you are not able to take NSAIDs, but it will not control the inflammation, which can cause fever, pain, swelling, increased mucus production, body aches and fatigue. Steroid anti-inflammatory nasal spray – focused medication on inflammation caused by viruses, allergens and irritants on the linings of nasal and sinus passages, eyes, inner ears.
Symptoms addressed: nasal passage pain and swelling, sinus pain and pressure, nasal mucus production and post nasal drip; sometimes ear fullness and pressure; seasonal allergy provoked eye and nasal symptoms.
Examples: choose one
Flonase (fluticasone) 1-2 sprays each nostril 1-2 x daily,
Nasacort (triamcinolone) 1-2 sprays each nostril 1x daily,
Rhinocort (budesonide) 1-2 sprays each nostril 1-2 x daily.
Anti-inflammatory nasal sprays may be used in addition to any of the oral medications listed above. Cautions: Discuss with your doctor if you have cataracts, glaucoma or retinal disease; if you have been told not to take steroid medications; if you are being treated with oral or injection steroid medications; if you are having persistent nosebleeds; if you’ve had shingles of the eye or measles. Nasal Decongestants—help to relieve swelling of lining of nose and sometimes ear “stuffiness”:
Examples: choose one
Sudafed (pseudoephedrine) 30 mg every 6 hours;
Afrin (oxymetazoline) 3 sprays every 12 hours x 2 days, then skip a day.
Cautions: may make it difficult to get to sleep, may raise blood pressure or eye pressures. Discuss with your doctor if you have ever been told by another healthcare provider that you have elevated blood pressure or if you are or have been treated for increased blood pressure (Hypertension), increased eye pressure (Glaucoma) or increased pressure around your brain (Intracranial Hypertension); have been diagnosed with heart attack, stroke or abnormal heart rhythm; are being treated for abnormal thyroid function or taking a thyroid hormone supplement; are taking other supplemental hormones like testosterone, estrogen or hormonal birth control; are being treated for diabetes mellitus; are being treated with a stimulant medication for other conditions including ADD/ADHD, Narcolepsy, low blood pressure or weight management; taking recreational substances including cocaine, amphetamines, MDMA, bath salts, caffeine; rose hips.
For Cough— Expectorant—helps to make mucus thinner and easier to blow out of nose or cough up from lungs; does not stop cough but should make cough more productive to help to clear it out; use if mucus is blocking airways.
Example:
Mucinex/Robitussin (guaifenesin) 600-1200 mg tabs, twice daily; also in liquid form.
Cough suppressant—helps to decrease drive to cough. These will help to decrease sleep disruptions, but this is not always desirable if mucus is blocking airways.
Example:
Delsym (dextromethorphan) 30-60mg liquid twice daily.
Antihistamines—can help to decrease mucus production— “dry-up” cough.
Examples: pick one
Claritin (loratadine) 1-2 daily;
Zyrtec (cetirizine) 1-2 daily;
Allegra (fexofenadine) 1-2 daily;
Benadryl (diphenhydramine) 25 mg 1-2 tabs at night, up to 1 every 4-6 hours;
Chlor-Trimeton (chlorpheniramine) 1 every 4 hours.
Cautions: both cough suppressants and antihistamines can cause drowsiness—be careful when driving or operating heavy machinery. Antihistamines and expectorants can also cause dry eyes and mouth (kind of the opposite direction of all the mucus production), so drink plenty of water when taking these medications. Discuss with your doctor if you take medications that affect urine flow or enlargement of the prostate; experience intermittent or persistent dizziness; or take medicines for glaucoma, mood or insomnia.
Supportive measures
Rest—7.5-9 hours nightly. Protect your sleep—the immune system requires a lot of energy to function properly.
Hygiene—
Hand washing—this is key!! Use adequate amount of soap, running water, briskly rub hands together for 20-30 seconds, rinse thoroughly, dry completely, USE THE PAPER TOWEL TO TURN OFF THE FAUCET AND OPEN THE DOOR, dispose properly of the towel. Your hands are only as clean as the towel with which you dried them. Avoid sharing reusable towels to dry hands. Wash hands before and after you eat, before and after you touch your face (avoid touching your face), after you touch door handles and light switches.
Hand sanitizer— (if you can find it) purchase a product with 60-95% ethyl alcohol. Use when soap and water are not an option. Cover all surfaces of fingers and hands (read the label to determine the correct amount). Don’t drink it.
Cover coughs—cough into disposable tissues and dispose of properly. THEN, clean your hands. Every time you use a tissue.
Clean your daily-use objects daily, including cell phones.
Hydration —64oz water daily +/- 8-16 oz sports drink daily. Hydration is even more important if you have a fever (losing more water through sweat), cough (water vapor through cough), vomiting or diarrhea (losses from gastrointestinal sources). You don’t have to drink the sport drink, and some have a lot of sodium, which can make blood pressure go up, but if you can’t keep food down, sports drinks can help to replenish salt losses.
Food—Broth/Soup—avoid high sodium soups, homemade chicken soup is encouraged; Lean proteins, whole grains, fruits/vegetables. Avoid excessive amounts of high-sugar juices. Avoid drinking alcohol.
Sore throat care
Warm salt water gargles (1 tsp table salt in 1 C warm water. Gargle, DO NOT SWALLOW); Lozenges; Over the counter throat spray as needed (Cepacol, Chlorasceptic).
Adjuncts
Saline nasal rinse twice daily (use prior to any intranasal medications).
Zinc lozenges (zinc gluconate, zinc sulfate 50-100 mg daily) can help to shorten duration and severity of symptoms and may help to decrease the risk of certain respiratory infections when taken early, within 24 hours of symptom onset.
If fever >101.0, brownish sputum from nose or cough, progressive shortness of breath, symptoms worsening or lasting >10 days, please call. During the current coronavirus outbreak if you are short of breath we recommend you go to the ER rather than wait to speak to your doctor. This information is not intended to diagnose or treat any health condition.
This information does not substitute for a medical examination or conversation with your physician. Please call office at 202-728-9630 if you have further questions.
