What is a typical prescription for the common cold in India?

Common Cold Prescription in India

The most effective prescription for common cold in India is a fixed-dose combination (FDC) of paracetamol 500 mg, phenylephrine 10 mg, and chlorpheniramine maleate 2 mg, which has been proven efficacious and safe for symptomatic treatment in Indian adults. 1

First-Line Treatment Options

Recommended Medications

• Fixed-dose combination therapy:

  • Paracetamol 500 mg + Phenylephrine 10 mg + Chlorpheniramine maleate 2 mg
  • Dosing: One tablet every 6-8 hours as needed for symptom relief
  • This combination addresses multiple symptoms: paracetamol for pain/fever, phenylephrine for nasal congestion, and chlorpheniramine for runny nose/sneezing 1

• Alternative combinations:

  • Acetylsalicylic acid (ASA) 1000 mg + Pseudoephedrine 60 mg
  • This combination has shown significant efficacy for nasal congestion relief 2

Symptomatic Relief Medications

1. For nasal congestion:

   • Oral decongestants (pseudoephedrine/phenylephrine)
   • Use for ≤3 days to avoid rebound congestion 3
   • Nasal saline irrigation for additional relief 3

2. For cough:

   • Dextromethorphan for adults and children >4 years
   • Adult dosing: 10 mL every 12 hours, not exceeding 20 mL in 24 hours 4

3. For pain/fever:

   • NSAIDs (ibuprofen) or paracetamol as needed 3

Adjunctive Therapies

• Zinc lozenges:

  • ≥75 mg/day zinc acetate or gluconate
  • Start within 24 hours of symptom onset
  • Continue throughout the duration of the cold 5, 3

• Herbal preparations:

  • Andrographis paniculata extract
  • BNO1016 (Sinupret)
  • These have shown significant impact on common cold symptoms 5

Non-Recommended Treatments

• Antibiotics:

  • Not indicated for uncomplicated common colds
  • Ineffective against viral infections and contribute to antibiotic resistance 3

• Echinacea products:

  • Most have not been shown to provide significant benefits 5

• Homeopathic products:

  • No significant benefit compared to placebo 5

Special Considerations

For Children

• Avoid over-the-counter cough and cold medications in children under 4 years 6
• For children >4 years, use age-appropriate dosing of dextromethorphan 4
• Buckwheat honey may help relieve cough in children (not for infants under 1 year) 6

For Adults with Comorbidities

• Use decongestants with caution in patients with hypertension, diabetes, or thyroid disorders
• Consider medication interactions when prescribing combination products

When to Seek Further Medical Attention

• Symptoms persisting beyond 2 weeks
• Development of high fever after the first few days
• Severe facial pain or headache
• Shortness of breath or wheezing
• Complete voice loss or severe hoarseness persisting more than 2-3 weeks 3

Patient Education

• Common cold is self-limiting and typically resolves within 7-10 days
• Adequate hydration and rest are crucial for recovery
• Regular, moderate-intensity exercise may help prevent future colds 3

The evidence strongly supports using combination therapy for common cold in India, with the FDC of paracetamol, phenylephrine, and chlorpheniramine maleate showing excellent efficacy in the Indian population specifically. In a recent study, 84.3% of Indian patients had complete symptom resolution by day 5 of treatment with this combination 1.