More than 200 viruses cause upper respiratory infections (URIs), most frequently the common cold and influenza. Every year, there are about 1 billion colds in the United States. Experts estimate that 5% of the population has a cold at any given time. In this article, we will go over antiviral medications, prescribing considerations, and other over the counter (OTC) options for managing symptoms during cold and flu season.
Related: Common Respiratory Problems Package
What antiviral drugs can Nurse Practitioners prescribe to treat the flu?
Although there are no antiviral medications for the common cold, there are four currently available for the flu this cold and flu season. These are:
- Oseltamivir phosphate (Tamiflu®)
- Zanamivir (Relenza®)
- Peramivir (Rapivab®)
- Baloxavir marboxil (Xofluza®)
Oseltamivir can be prescribed as a pill. Providers usually prescribe it at 75 mg twice daily for five days. Zanamivir is an inhaled powdered medication, also prescribed twice daily (two puffs for each dose) for five days. Note that it should not be prescribed to patients with breathing problems including asthma or COPD. Peramivir and Baloxavir are both single-dose medications. Peramivir is given intravenously while Baloxavir is an oral pill.
As with all medications, there are side effects associated with each of these antiviral flu medications. The most common side effects associated with oseltamivir are nausea, vomiting, and diarrhea. It may also cause stomach pains, dizziness, or trouble sleeping.
Zanamivir may cause bronchospasm or shortness of breath in people with lung or respiratory disease. Peramivir may cause constipation, diarrhea, nausea, vomiting, and trouble sleeping. Finally, the most common side effects of Baloxavir are diarrhea, nausea, vomiting, and headache.
When should Nurse Practitioners prescribe antiviral medications for flu symptoms?
Antiviral medications work best when taken early in the presentation of flu symptoms. Oseltamivir and zanamivir, for example, both must be taken within 48 hours of flu symptoms onset to be effective.
Who should receive antiviral medications for the flu?
Antiviral medications for the flu should be taken by patients with the flu or who are at high risk for flu complications. People at high risk include:
- Children younger than 5 (but especially children under 2 years old)
- Adults over 65
- People who are pregnant
- People with a weakened immune system due to HIV/AIDS or certain cancers or cancer treatments
Health conditions that increase the risk of flu complications include:
- Asthma
- Blood disorders
- Chronic lung disease
- Diabetes
- Metabolic disorders
- Heart conditions like CHF
- Kidney disorders
- Liver disorders
When should Nurse Practitioners not prescribe antivirals during cold and flu season?
People who are otherwise healthy and not at risk for flu complications or hospitalization do not need to be treated with antivirals for the flu. In these cases, experts do not recommend antivirals because of their side effects and the risks of drug resistance. Instead, Nurse Practitioners should recommend patients treat their flu symptoms with over-the-counter medications.
Related: Cough, Cold and Fever Symptoms: Pharmacologic Therapies
What OTC medications help with Upper Respiratory Infections?
When antiviral medications are not indicated for patients with URIs, they can take over the counter medications to treat their symptoms. They can also consider natural supplements that can help reduce the duration of a cold such as echinacea, zinc, and Vitamin C.
Nurse Practitioners can recommend certain over-the-counter medications depending on the patient’s primary complaint. In about half of common cold cases, the first presenting symptom will be sore throat, but the primary complaint will be a nasal symptom, either such as congestion or nasal runniness.
Common OTC medications include antihistamines for runny nose, decongestants for nasal stuffiness, dextromethorphan for coughs, and acetaminophen for body aches. When suggesting antihistamines, Nurse Practitioners should note that second-generation antihistamines are better for cold and flu symptoms. Nasal corticosteroids are also helpful for individuals presenting with allergic rhinitis in addition to their cold or flu symptoms.
When should Nurse Practitioners recommend echinacea to patients with colds?
Echinacea is a possible immune system booster that is thought to reduce symptom severity and duration by 10-30%. A typical dose is 250-500 mg/daily with short-term use in the earliest stages of viral URI symptoms.
Echinacea should not be taken for more than three months as it can be potentially toxic. If it’s taken chronically, patients should take a one-week holiday from the medication every three months to reduce toxicity risks.
Echinacea should not be used by patients with immunocompromising conditions such as lupus, MS, or RA. It is also cautioned against in patients with ragweed, aster, chrysanthemum, and chamomile allergies as it could cause a cross-allergic response.
Does zinc help reduce cold symptoms?
Nurse Practitioners can also recommend zinc lozenges to patients with cold symptoms. One study found that zinc lozenges reduced the duration of cold symptoms in study participants by more than three days.
Zinc gluconate, specifically in the lozenge form, can reduce the duration of common cold symptoms if taken within 24 hours of the onset of symptoms. It must be in the lozenge form to bathe the virus. The zinc ions bind to the rhinovirus and prevent it from replicating. The recommended dose is 75 mg/day for the duration of the cold.
Should Nurse Practitioners prescribe Vitamin C for colds?
Research suggests that Vitamin C helps immune function by increasing antibody production. Evidence suggests that 1 gram per day can reduce the duration of cold symptoms by about half a day. There is no evidence that vitamin C can prevent URIs, but a low dose of Vitamin C also presents very minimal risks of harm. Therefore, Vitamin C can be used as another natural cold remedy.
How can you prevent getting sick during cold and flu season?
Nurse Practitioners can advise patients to practice good hygiene, like hand washing and not sharing beverages, to minimize chances of getting a cold or the flu. Additionally, everyone (over 6 months old) can and should get the annual flu vaccination to protect against common strains. Flu shots are especially important in older and immunocompromised patients for whom the flu can be life-threatening.
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