It’s cold and flu season and a majority of us will get one or the other, perhaps even both, between now and the end of April.
As minor miseries go, these 2 ills consistently top most people’s list. And, of course, for some people, colds and the flu are not so minor. People over 60 are at significantly higher risk of pneumonia when they contract the flu and bronchitis when they catch a cold or the flu.
Other than rest, staying warm, drinking fluids, and getting lots of sleep, what’s the best approach to treating a cold or flu?
Consumer Reports took a deep dive into that question for its January 2018 cover story. Here’s what you need to know, including warnings on overdoing it with excessive use of over-the-counter drugs, vitamins and supplements.
When is it a cold and when is it flu?
Confusion on this point persists. The table below distinguishes the symptoms. And, by the way, there’s no such thing as “stomach flu.” Flu viruses rarely cause any gastrointestinal symptoms, such as diarrhea, nausea and throwing up.
COLD V. FLU
Should you stay at home?
With the flu, yes, absolutely. You are contagious from day one and really don’t want to infect co-workers (and other on public transportation). With a cold, you probably should stay home as you can shed virus from day one as well. But if staying home is not possible, avoid public places, limit direct contact with others and practice scrupulous hygiene when sneezing and coughing. (Actually, research has shown that people are contagious a day or two before symptoms appear.)
Do you need to call or see a doctor?
No, with a cold, but lots of people still do. With the flu, generally no as well. But exceptions with the flu are kids whose fevers spike above 103 and adults over 60 who do not recover or get better after 7 to 10 days, especially if their symptoms worsen. The exception is the same for older adults with a bad cold that does not resolve in 7 days. In that case, you might have developed a bacterial infection on top of the viral one, and need an antibiotic.
When is an antibiotic needed?
Way too many people with a cold or the flu end up taking an antibiotic, which are completely ineffective against viral infections. By one estimate, some 50 million antibiotic prescriptions are dispensed every year for people with colds, flu and other viral respiratory infections. Again, antibiotics won’t help.
Taking antibiotics when they aren’t needed unnecessarily exposes you to their possible side effects—diarrhea, nausea, and potentially serious allergic reactions. But it also breeds antibiotic-resistant bacteria among the broader population, undermining the effectiveness of antibiotics when they’re really needed.
Which non-prescription drugs work and which don’t, and which are safest?
Are combination drugs safe?
Many cold and flu products take a scattershot approach. For example, Vicks NyQuil Severe Cold & Flu Relief contains acetaminophen for aches and fever, dextromethorphan for coughs, phenylephrine for congestion, and doxylamine to help you sleep.
When you feel lousy all over, such products can be tempting. But, safety-wise, it’s better to stick to single-ingredient products as much as possible. Why? Because the more drugs that are included in a product, the greater the risk of side effects.
For example, sedating antihistamines such as diphenhydramine, found in many combos, make falls more likely for older adults, and especially people who may take other medications that cause drowsiness. And too much acetaminophen, which is included in more than 600 OTC products, can cause serious liver damage. (See below.)
If you do opt for a combo drug, stick to one that treats the symptoms you actually have. “It just doesn’t really make sense to expose your body to ingredients you don’t need,” says Leigh Ann Mike, a pharmacist at the University of Washington.
Also, compare prices of brand-name combo drugs, such as Nyquil and Theraflu, with store-brand versions. The latter have the same ingredients and are almost always cheaper.
The danger of too much acetaminophen (Tylenol)
Acetaminophen is generally the safest pain and fever reducer on the market. But it has a big downside risk with excessive use and high doses. And studies have shown excessive use is common for people with colds and the flu—people who (a) assume that this widely available and taken pill is totally safe and (b) may not be aware that acetaminophen is an ingredient in hundreds of different cold and flu symptom products. As shown in this table, it’s easy to consume more than is safe.
High doses of acetaminophen cause an estimated 59,000 emergency room visits each year, most related to liver damage.
HOW MUCH ACETAMINOPHEN ARE YOU TAKING?
Do supplements relieve symptoms or shorten the duration of a cold or the flu?
Some recent research is suggestive, but overall the evidence backing up most supplements in treating colds or the flu ranges from weak to non-existent.
And remember, unlike drugs, the FDA doesn’t require that supplements be proved safe and effective before they head to market. Here’s the run-down on a few popular remedies:
A 2014 review of 24 trials hinted that echinacea teas or supplements might help prevent colds. But the results weren’t conclusive. And echinacea can trigger nausea and worsen asthma for some people. Any hot tea can help soothe cold and flu symptoms.
People who take 200 mg of vitamin C every day might have slightly shorter colds than other people, according to a 2013 review of 29 trials. But loading up with megadoses after symptoms appear doesn’t help at all. Vitamin C can raise the risk of kidney stones and interacts negatively with cancer drugs, blood thinners, and estrogen.
A 2015 analysis found that zinc lozenges and syrup reduced the length and severity of colds when started within 24 hours after symptoms start. But the possible side effects can be nasty. They include diarrhea, nausea, stomach cramps, and vomiting. Long-term use, especially in high doses, may cause copper deficiency, which can trigger anemia.
Read the label
“Nighttime.” “Non-Drowsy.” “Maximum Strength.” When you see those terms on an over-the-counter drug label, you might assume they have a uniform meaning. Not true. The FDA has no set definition for these terms. That means drug makers can improvise.
“These claims are basically advertising copy—meant to catch your eye,”
says Barbara Young of the American Society of Health-System Pharmacists.
For example, the terms “non-drowsy” or “daytime” suggest that a product doesn’t contain a sleep aid, as in the case of Contac Cold & Flu Day. But it can also mean that a product includes a stimulant, such as the pseudoephedrine in Advil Cold & Sinus Non-Drowsy. Some people react badly to pseudoephedrine; it amps them up. So, yes, non-drowsy but not always in a good way.
Similarly, the terms “night.” “nighttime,” or “pm” often indicate that a product contains an antihistamine with drowsiness as a side effect. But different brands use different sleep aids: Alka-Seltzer Plus Maximum Strength Night Cold & Flu relies on doxylamine, and Tylenol PM opts for diphenhydramine. Again, you may react better or worse to one or the other.
The terms “express,” “fast,” “maximum,” and “extra strength” can also be misleading, and vary from product to product. For example, Theraflu puts “ExpressMax” on all its products other than hot-drink powders. And Mucinex put “Fast-Max” on all its multi-symptom products, though nothing in the packaging explains how the products work faster. And Robitussin Maximum Strength Cough & Chest Congestion DM has twice as much guaifenesin as the regular version—but both versions have the same amount of dextromethorphan.
Most important, higher doses of any ingredient aren’t always needed—and pose greater risk for little or no extra benefit.
Get your flu shot!
If you’re one of the millions of Americans who either skips or does not believe in the flu vaccine, it might be time to take a fresh look at the evidence. You’re putting yourself at risk of one to three weeks of misery. Every year.
Since 2010, the flu has resulted in 140,000 to 710,000 hospitalizations each year and contributed to between 12,000 and 56,000 deaths, according to the Centers for Disease Control and Prevention.
That’s why the CDC urges everyone 6 months and older to get vaccinated. But in a recent CR survey of 744 adults who had a cough, a cold, or the flu in the previous 12 months, only 48 percent said they get the flu shot. That’s consistent with previous studies over many years—roughly half who should get the shot don’t.
Here are rebuttals to 3 common excuses to avoid the flu shot:
Excuse: The vaccine doesn’t work
In a typical year, the flu shot cuts your risk of getting the flu by 40 to 60 percent. And if you get the flu anyway, your symptoms will be milder and “you’re less likely to have complications, less likely to be admitted to the hospital, and less likely to die,” says William Schaffner, MD, medical director of the National Foundation for Infectious Diseases.
Excuse: It can cause the flu
Almost all flu vaccines use an inactivated virus that can NOT trigger the flu. But because the vaccine doesn’t eliminate your chance of getting the flu, only reduces it, some people who develop the flu after getting the shot wrongly blame the vaccine.
Excuse: There’s harmful mercury in flu vaccines
A mercury-containing preservative called thimerosal is in certain vaccines. But it’s only a trace amount. And that kind of mercury—ethylmercury—is eliminated by the body more quickly than is methyl-mercury, the form in some seafood.
Numerous well-designed studies have discredited the idea that thimerosal is linked to autism. In any case, there are many thimerosal-free options for people of any age. So if you’re still concerned, ask your healthcare provider for one of those.
Which vaccine should you have?
Most years, teens and adults should consider a quadrivalent vaccine, which protects against 4 flu strains.
People 50 and older have another option: Flublok Quadrivalent, which has triple the dose of other quadrivalents.
Those 65 and older have 2 more choices: Fluzone High-Dose and Fluad. Both protect against only 3 strains, but Fluzone has 4 times the dose and Fluad adds an ingredient to boost the immune system’s response.
Should you take Tamiflu or other antiviral drugs if you have the flu?
Three drugs are FDA-approved to treat the flu: Tamiflu and generics (oseltamivir), Relenza (zanamivir) and Rapivab (peramivir). They are modestly effective, but not everyone responds to them. If taken right when symptoms first appear, they reduce the severity of those symptoms and cut short the duration of illness by about a day, on average. They might also reduce the risk of complications (such as pneumonia and bronchitis, or even death) but that’s not yet been proven.
Experts and doctors differ on prescribing these medicines. Most doctors today only prescribe them for people who have other illnesses and/or are at high risk for complications from the flu. That includes older people and pregnant women. Prescribing them for healthy, young people is becoming less common. One prominent reason: side effects. All three drugs can cause nausea, vomiting, and headache.
You shouldn’t take any of the three drugs if you have already had symptoms for 48 hours or more; they are essentially not effective after that point.
Steven Findlay is an independent medical and health policy journalist and a contributing editor/writer for Consumer Reports. He derives some of his posts and insights from Consumer Reports Best Buy Drugs, a grant-funded public information and education program that evaluates prescription drugs based on authoritative, peer-reviewed research.