[I don't think my malpractice insurance will cover me if you overdose on Robitussin. But all of the doses I'm giving you here are the same as what is written on the box. And all of the financial stuff is moot, because I am a salaried PGY-1. I see as many patients in the office as needed, and make no extra money from it.]
And even if I could make money off of office visits, let's be honest: While I love explaining some things to patients, I HATE talking about the common cold and OTC meds. So here you go.
Do you have a cold? Before you even attempt to call your doctor in a feeble attempt to garner antibiotics for your VIRAL infection, take these medicines. And remember, if you have any liver, heart, or other problems, or are pregnant, do call your doctor first. These are adult doses; if you are treating children, make sure you adhere to the child dosing guidelines.
Headache:
Take acetaminophen (brand name Tylenol), anywhere between 325-650 mg every 4-6 hours. Do not take with alcohol. You can also take ibuprofen (brand name Motrin, Advil), 400 mg every 4 hours, or 600 mg every 6 hours. Take with a little bit of food. It is OK to mix these two pain medicines, as they do not interact.
Fever:
The definition of a fever is a temperature of 100.4 or greater. A "low-grade fever" means a fever between 100.4 and 101.0. A temperature of 99.8 is NOT a fever, and is NOT a low-grade fever.
Take acetaminophen 325-650 mg every 4-6 hours, and/or ibuprofen 400 mg every 4 hours or 600 mg ever 6 hours. If the fever keeps coming back, keep taking the medicine. If you truly have a fever, be sure to call your doctor, to make sure nothing else more serious is going on.
Sore Throat:
1. Take acetaminophen 325-650 mg every 4-6 hours (the range of doses is because your standard OTC pills come in different doses. "Regular" strength is usually either 250 or 325 mg, while "Extra Strength" is usually 500 or 650 mg.
2. Also take ibuprofen, 400 mg every 4 hours, or 600 mg every 6 hours, with a little food. The ibuprofen is very important for sore throats because it is an anti-inflammatory and decreases the throat swelling that is giving you pain in the first place.
3. Warm salt water gargles really do work.
Nasal Congestion: For stuffy noses, especially during a cold.
1. Saline nose spray, just like babies use. Really. It rinses out your nostrils and keeps your mucous membranes moist. You should strongly consider using the Neti pot method (you don't need the actual Neti pot). Mix 16 oz of warm water with 1 tsp salt, or use store-bought saline solution in a regular squeeze-and-drip bottle (not the kind that sends a misting spray up when you depress an activator). Tilt your head to one side (do it over a sink or in the shower), and pour/spray the saline into your top nostril. It will run into your other nostril and probably into your mouth -- just spit it out. Tilt your head to the other side and repeat with the other nostril. Blow your nose to get rid of any extra liquid. Congratulations! You've rinsed out your sinuses. Do this regularly.
2. Pseudoephedrine. This is a really good nasal decongestant. It constricts your nasal blood vessels, thus decreasing all the liquid/stuffiness that builds up in your nose. Do not take if you have high blood pressure without talking to your doctor first. The key to taking pseudoephedrine is that in most states it is sold behind the pharmacy counter, because otherwise people buy it in bulk and use it to make crystal meth. You don't need a prescription (although some states are considering changing that), but they'll take down your information to make sure you're not buying too much of it. The most common brand name is Sudafed. The dosing is 30-60 mg every 4-6 hours. A common side effect of pseudoephedrine is a woozy sensation, because of the vessel constriction throughout your body. For me, I've found that 30 mg every 4 hours is the best balance between symptomatic relief and not feeling woozy. See what works for you. It's important to stay well hydrated while taking this medicine, so push the fluids. Don't bother buying the still-on-the-shelf version of Sudafed, which is the active ingredient "phenylephrine." It doesn't work as well as pseudoephedrine. And also remember that you need to take the medicine every 4-6 hours on the dot. I can't tell you how many times a patient has said to me, "Yeah, I took some Sudafed, and it worked, but then it wore off after a few hours." I'm sorry, but that is how medicines work. You need to keep taking it for it to keep working. If it's working, keep using it.
3. Oxymetazoline. Commonly known as Afrin. This medicine is very effective, but should be used with caution. The official dosing is 2 sprays in each nostril every 12 hours. DO NOT USE FOR MORE THAN 3 DAYS IN A ROW. The reason for this is "Afrin addiction," which isn't really an addiction, but rather what happens is you develop rebound nasal congestion. So even though you are using the medicine, your nasal membranes become more swollen, instead of less. Not good news. I recommend using it only at night, to ensure that you get a good night's sleep. During the day, stick to the pseudoephedrine.
4. Cetirizine (Zyrtec) or loratadine (Claritin, Alavert). These are anti-histamines, which are good if you think any portion of your nasal congestion or runny nose are related to allergies. You may not have allergies regularly (or may not know it), but when you have a cold, it may contribute to some of your symptoms. In any case, there are almost no side effects to giving these medicines a shot.
Cough: There are two types of cough. One is the kind where you are hacking up all sorts of thick mucus. The other is a dry, spasmodic cough that you just can't control.
1. For the mucousy cough, take guaifenisen. This is sold under the brand names Robitussin or Mucinex. Make sure that you get the right kind, as Robitussin in particular has many different formulations. Guaifenisen 200-400 mg every 4 hours. Take LOTS of fluids with this medicine, as it dries you out. Guaifenisen is a cough expectorant, meaning it helps thin out your mucus and makes it easier for you to bring up and spit out. Comes in liquid and pill/capsule formulations.
2. For the dry, hacking, spasmodic cough, the medicine you are looking for is dextromethorphan. It is commonly referred to in cough formulations as "DM." The dosing is 10-20 mg every 4 hours. Again, drink plenty of fluids with this. Comes in liquid and pill/capsule formulations.
I stock all of these medicines in my home, especially during cold season. Is it annoying to take medicines every 4-6 hours throughout the day and night? Sure. But it works, and it's only temporary. If it's really that much trouble, most medicines come in "extended-release" formulations that allow once a day or twice a day dosing; just read the labels.
A lot of people take combination formulas like Dayquil or Nyquil, which usually contain a combo of acetaminophen, pseudoephedrine, guaifenisen, and dextromethorphan. In general, I don't recommend those formulations. If you don't particularly have a mucousy cough, then you don't need the guaifenisen, so it's just going to dehydrate you unnecessarily. Instead, take each medicine separately so you can mix and match what you need. The only exception I would make is for Nyquil, because the active ingredient that makes it a night-time formula, doxylamine, is difficult to find as a sole ingredient. Doxylamine is a good sleep-aid agent, so if you need it, then Nyquil is good. Just be sure to calculate the doses of everything else in there so you know what you're taking.
Maximum doses: Be sure to read the label of each medicine and do not exceed the maximum amount of any medicine in a 24-hour period. Acetaminophen will damage your liver if you take too much; ibuprofen will damage your stomach and kidneys if you take too much. These are potentially serious side effects that should be taken seriously.
Reasons to call your doctor:
- Fever greater than or equal to 101.0. This can signify something potentially more serious, like pneumonia.
- All over body aches and pains. Call your doctor quickly, as this can be a sign of influenza infection, and taking Tamiflu within the first 48 hours can limit the course of infection.
- Shortness of breath or trouble breathing
- Chest pain
- Vomiting or diarrhea, especially if you can't keep anything down and are becoming dehydrated.
- Symptoms that last longer than 10 days. This can be a sign of sinusitis (which would warrant antibiotics), or a post-infectious cough, which can be treated with medicine.
Otherwise, if your sinuses are tender and your head hurts and your nose is stuffy and you have a cough, for two days, DO NOT CALL ME. Take these medicines. A cold can take 7-10 days to resolve completely. As long as you are getting slightly better day by day, just keep doing what you are doing. I will not give you antibiotics. You will get better. It will suck, but you will survive. I know this, because it has happened to me, too.
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