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I Have a Cold. Or Is It the Flu? What Should I Take?

Here’s what you need to know, including warnings on overdoing it with excessive use of over-the-counter drugs, vitamins and supplements.
By Steven Findlay
Published: January 4, 2018
Last updated: January 6, 2018
 

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

A Cold

  • Onset is gradual and usually involves a “prodrome” stage where you’ll have just a sore throat or mild symptoms.
  • Either no fever or low-grade fever
  • Symptoms of sore throat, runny nose, stuffed-up nose, chills, body ache, fatigue and cough are usually mild to moderate
  • Duration is variable but typically 4 to 7 days
  • Recovery varies but is typically 100% by day 7 to 10.

The Flu

  • Onset is sudden, usually within a few hours and symptoms can be intense right away
  • Fever is typical and can be high, 100 degrees or higher, even up to 102.5
  • Symptoms of sore throat, runny nose, stuffed up nose, chills, body ache, fatigue, and cough are moderate to severe, and may include muscle aches and weakness.
  • Duration of intense symptoms is typically 4 to 6 days but weakness and fatigue may linger for up to 10 to 14 days.
  • Full recovery — feeling totally back to normal — can take up to 3 weeks.

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.

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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?

Many over-the-counter drugs help relieve cold and flu symptoms. But there’s danger if you take too many drugs in combination and too much of any drug. Moderation is the key.

For these symptoms: Body aches and fever

Medicines: Acetaminophen (Tylenol), ibuprofen (Advil), and naproxen (Aleve).

How effective & risks? All ease body aches and reduce fever about equally.

Acetaminophen is the safest, when used as directed. But taking even a little more than the daily max can harm the liver.

Ibuprofen and Aleve can cause intestinal bleeding and have been linked to an increase in the risk of heart attack and kidney damage — primarily when taken in large doses for long periods.

Alternatives/home remedies + advice A cool compress or sponge bath can help if temperature spikes.

If your temp is 101° F or below, you don’t necessarily need to reduce it. A rise in temp with the flu is part of the body’s efforts to kill off the offending virus.

A fever over 102.5 or higher warrants reducing if it lasts more than 12 hours or so.


For these symptoms: Congestion

Medicines:

  • Oxymetazoline nasal spray (Afrin, Dristan Mucinex Sinus-Max Nasal Spray, Vicks Sinex Severe Nasal Spray)
  • Phenylephrine (Equate Congestion Suphedrine PE Nasal Decongestant, Sudafed PE Congestion)
  • Pseudoephedrine (Sudafed 12 Hour)
  • Camphor, eucalyptus, or menthol rubs (topical for skin -Mentholatum, Vicks VapoRub)

How effective & risks? The sprays work within minutes but can worsen stuffiness if taken for longer than 3 days.

The pills take a bit longer and work moderately well. But they can raise blood pressure, cause insomnia, heartbeat abnormalities, tremors, anxiety, and hallucinations.

The topicals improve the flow of air through your nasal passages but can irritate the skin.

Alternatives/home remedies + advice Chicken soup! Hot liquid and steam from any broth-based soup may help open up swollen airways and thin mucus. And it soothes a sore throat and tastes good if your appetite is low.

Neti pots and nasal irrigation. Yes, they ease congestion.

Steam inhalation: Warm water vapor helps loosen mucus and feels good. Though it’s unclear whether that translates into reduced congestion, many people swear by it. Showering may be safer than putting your head over a piping hot pot of water.


For these symptoms: Cough

Medicines:

  • Dextromethorphan (Robitussin Long-Acting CoughGels, Vicks DayQuil Cough)
  • Guaifenesin (Mucinex 12 Hour, Tab Tussin)
  • Topical rubs, patches, and lozenges that contain camphor or menthol (Halls Menthol Cough Drops, Mentholatum, Vicks VapoRub)

How effective & risks? All relieve coughing somewhat, but don’t eliminate it. And there’s no good evidence they reduce the number of coughing episodes or the duration of a cold- or flu-related cough.

All the oral drugs can lead to nausea and make you sleepy. And high doses of dextromethorphan can cause rapid heartbeat, loss of coordination, and hallucinations.

The topicals can trigger rashes and a burning sensation.

Warning! Cough suppressants can cause increased sedation when taken with narcotics, sleeping pills, antihistamines, or alcohol.

Alternatives/home remedies + advice Honey: It tastes good and feels soothing, and one 2014 review suggests that it’s better than a placebo at easing coughs. Add a teaspoon or 2 to a cup of tea or consume it straight off the spoon.

Caution: Honey should not be given to infants younger than a year old because it can contain the bacterium Clostridium botulinum.


For these symptoms: Runny nose and sneezing

Medicines:
Antihistamines, such as cetirizine (Zyrtec), chlorpheniramine (Aller-Chlor), diphenhydramine (Benadryl Allergy), fexofenadine (Allegra), and loratadine (Alavert, Claritin)

How effective & risks? These meds are very effective when symptoms stem from allergies, but a 2015 review of 18 studies concluded that they have little benefit when symptoms are from a cold.

Risks include drowsiness, nausea, blurred vision, and difficulty urinating, and, with diphenhydramine, impaired coordination.

Caution: Taking chlorpheniramine or diphenhydramine with opioids, sleeping pills, or alcohol makes sedation more likely.

Alternatives/home remedies + advice Honestly, there’s not much you can do besides stocking up on tissues.

But note that a runny nose and sneezing help rid your body of germs. If you find yourself without a tissue in hand, sneeze into your elbow so that the germs don’t end up across the room infecting others.


For these symptoms: Sore throat

Medicines:

  • Pain relievers such as acetaminophen, ibuprofen, and naproxen
  • Benzocaine (Cepacol Extra Strength Sore Throat Sugar Free, Chloraseptic Warming Sore Throat Lozenges)
  • Dyclonine (Sucrets Sore Throat Lozenges)
  • Menthol (Halls Triple Action Soothing Drops, Vicks VapoDrops)
  • Phenol (Chloraseptic Sore Throat Spray)

How effective & risks? Pain relievers help.

Benzocaine, dyclonine, and phenol work as local anesthetics, and menthol provides a cooling sensation in your throat. Medicated lozenges may work longer than the sprays.

For the risks of pain relievers, see Body Aches and Fever above.

High doses of benzocaine and dyclonine can in rare cases cause lightheadedness, shortness of breath, fatigue, or rapid heart rate.

Alternatives/home remedies + advice Gargling with salt water: It’s inexpensive, safe, and time-tested. Dissolve ½ to 1 teaspoon of salt into an 8-ounce glass of warm water, gargle in the back of the throat, then spit. Repeat a few times a day.

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?

Product and Purpose Acetaminophen per pill Acceptable dose per day Total
Tylenol Extra Strength 500 mg 6 pills 3,000 mg
Theraflu Express Max
Daytime Severe Cold & Cough
325 mg 8 pills 2,600 mg
NyQuil Cold and Flu Nighttime Relief 325 mg 2 pills 650 mg
Total 6,250 mg

The maximum daily dose recommended by most medical authorities: 3,250 mg

The daily dose linked to liver damage (even after only a single day’s use): 4,000 mg

The daily dose considered potentially fatal (even after a single day’s use): 7,500 mg

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:

Echinacea

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.

Vitamin C

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.

Zinc

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

Steven Findlay

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.

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