What medications are recommended for treating cold, cough, fever, pain, headache, and cramps?

Recommended Medications for Common Cold, Cough, Fever, Pain, Headache, and Cramps

For common cold symptoms, cough, fever, pain, and headache, first-line treatments include paracetamol (acetaminophen) for fever and pain, first-generation antihistamine/decongestant combinations for nasal symptoms, and dextromethorphan for cough. These medications have the strongest evidence for effectiveness while maintaining good safety profiles 1, 2.

Cold and Nasal Symptoms

First-line options:

• First-generation antihistamine/decongestant combinations - Strongly recommended for common cold symptoms 1
  • Examples: Chlorpheniramine + pseudoephedrine combinations
  • Mechanism: Antihistamines reduce rhinorrhea while decongestants reduce nasal congestion
  • Note: May cause drowsiness; use caution when driving or operating machinery

Second-line options:

• Nasal decongestants (oral or topical)

  • Examples: Pseudoephedrine (oral), Oxymetazoline (nasal spray)
  • Evidence shows small positive effects on nasal congestion 1
  • Caution: Avoid in patients with hypertension, heart disease, glaucoma, or BPH

• Ipratropium bromide nasal spray

  • Effective for reducing rhinorrhea but not congestion 1
  • Side effects are generally mild and self-limiting

Not recommended:

• Nasal corticosteroids - Evidence does not support use for common cold 1
• Newer-generation non-sedating antihistamines - Less effective than first-generation for cold symptoms 1

Cough

For dry, non-productive cough:

• Dextromethorphan (30mg every 6-8 hours, max 120mg/24 hours) 2
  • First-line cough suppressant with better safety profile than codeine
  • Avoid in patients taking MAOIs or SSRIs due to risk of serotonin syndrome

For productive cough:

• Guaifenesin (200-400mg every 4 hours, max 2400mg daily) 2
  • Helps loosen phlegm and thin bronchial secretions
  • First-line expectorant for productive cough

Not recommended:

• Codeine or pholcodine - No greater efficacy than dextromethorphan but higher side effect profile 2
• Antibiotics - Ineffective for viral coughs and contribute to antibiotic resistance 2

Fever and Pain

First-line options:

• Paracetamol/Acetaminophen (500-1000mg every 4-6 hours, max 4g/day) 1

  • Effective for fever, headache, and mild to moderate pain
  • Safer gastrointestinal profile than NSAIDs
  • May help relieve nasal obstruction and rhinorrhea in colds 1

• NSAIDs:

  • Ibuprofen (400mg every 6-8 hours, max 1.2g/day) 1, 3

    • As effective as paracetamol for fever and pain
    • Better tolerated than aspirin for cold/flu symptoms 3

  • Naproxen (Naprosyn, Aleve) 1, 4

    • Strongly recommended for common cold symptoms
    • Typical dose: 220-440mg every 8-12 hours
    • Caution: May increase risk of cardiovascular events with prolonged use 4

Second-line option:

• Aspirin (500-1000mg every 4-6 hours) 3, 5
  • Similar efficacy to paracetamol for fever and pain 5
  • Higher risk of gastrointestinal side effects than ibuprofen 3
  • Contraindicated in children under 16 years due to risk of Reye's syndrome 1

Menstrual Cramps

First-line options:

• NSAIDs:
  • Ibuprofen (400mg every 6-8 hours)
  • Naproxen (220-440mg every 8-12 hours)
  • Most effective for menstrual pain due to prostaglandin inhibition

Special Considerations

For children:

• Paracetamol/Acetaminophen - First-line for fever and pain in children
• Ibuprofen - Alternative for fever and pain
• NEVER use aspirin in children under 16 years due to risk of Reye's syndrome 1
• Use pediatric formulations with appropriate dosing based on weight/age

For pregnant women:

• Paracetamol/Acetaminophen - Safest option for pain and fever
• Avoid NSAIDs especially in third trimester

For elderly patients:

• Use lower doses of all medications
• Avoid decongestants if hypertension or heart disease is present
• Monitor for drug interactions with chronic medications

Non-Pharmacological Approaches

• Nasal saline irrigation - May provide relief for nasal symptoms, especially in children 1
• Honey and lemon mixtures - Effective for nighttime cough relief 2
• Adequate hydration - Drinking plenty of fluids 1
• Rest - Important for recovery 1
• Menthol lozenges - May provide symptomatic relief for cough 2

Common Pitfalls to Avoid

1. Overuse of decongestant nasal sprays - Can lead to rebound congestion if used >3-5 days
2. Combining multiple products containing paracetamol - Risk of overdose
3. Using antibiotics for viral infections - Ineffective and contributes to antibiotic resistance
4. Using sedating antihistamines when alertness is required - Can impair driving and work performance
5. Using NSAIDs in patients with gastrointestinal risks - Can cause ulceration and bleeding

Remember that most cold symptoms resolve within 7-10 days regardless of treatment. If symptoms persist beyond this timeframe or worsen after initial improvement, medical evaluation is recommended 1.