What medications can be prescribed for a patient presenting with common cold symptoms?

Specific Medications for Common Cold Prescription

For adults with common cold symptoms, prescribe combination antihistamine-decongestant therapy using first-generation antihistamines (brompheniramine 6 mg or dexbrompheniramine 6 mg) with sustained-release pseudoephedrine 120 mg twice daily, along with NSAIDs (ibuprofen 400-800 mg every 6-8 hours or naproxen) for pain and fever. 1, 2, 3

First-Line Prescription Medications

Combination Antihistamine-Decongestant Therapy

• Brompheniramine 6 mg + pseudoephedrine 120 mg (sustained-release) twice daily OR dexbrompheniramine 6 mg + pseudoephedrine 120 mg (sustained-release) twice daily 1, 2, 3
• These first-generation antihistamine-decongestant combinations provide substantial benefit for nasal congestion, postnasal drainage, rhinorrhea, sneezing, and throat clearing 1, 3
• The anticholinergic properties of first-generation antihistamines are essential for effectiveness—newer nonsedating antihistamines like loratadine, cetirizine, or fexofenadine are ineffective for common cold symptoms and should not be prescribed 1, 3
• Approximately 1 in 4 patients will experience significant symptom improvement with these combinations 3

Analgesics and Anti-Inflammatory Agents

• Ibuprofen 400-800 mg every 6-8 hours OR Naproxen 220-440 mg every 8-12 hours 2, 3
• NSAIDs effectively relieve headache, ear pain, muscle/joint pain, malaise, and improve sneezing symptoms 1, 2, 3
• Naproxen has specific evidence for reducing cough associated with common cold 4
• Acetaminophen 650 mg every 6 hours as an alternative 1, 2, 5
• Acetaminophen may help relieve nasal obstruction and rhinorrhea but does not improve other cold symptoms like sore throat, malaise, sneezing, or cough 1, 3

Nasal Decongestants (Short-Term Only)

• Pseudoephedrine 60 mg every 4-6 hours (oral) 2, 6, 7
• Oxymetazoline 0.05% nasal spray, 2-3 sprays per nostril twice daily (topical) 3
• Multiple doses of decongestants have a small positive effect on subjective measures of nasal congestion 1, 8
• Critical warning: Limit topical nasal decongestants to 3-5 days maximum to avoid rebound congestion 2, 3, 4

Ipratropium Bromide for Rhinorrhea

• Ipratropium bromide 0.03% nasal spray, 2 sprays per nostril 3-4 times daily 1, 3, 4
• Specifically effective for ameliorating rhinorrhea, but has no effect on nasal congestion 1, 3
• Side effects are generally well-tolerated and self-limiting (nasal dryness, minor irritation) 1, 3

Adjunctive Over-the-Counter Recommendations

Zinc Supplementation

• Zinc acetate or zinc gluconate lozenges ≥75 mg/day 2, 3, 4
• Must be started within 24 hours of symptom onset to significantly reduce cold duration 2, 3, 4
• Potential side effects include bad taste and nausea 3

Non-Pharmacological Measures

• Saline nasal irrigation provides modest symptom relief, particularly helpful in children 1, 3
• Adequate hydration to dilute secretions and favor recovery 2

Medications to AVOID

Ineffective Medications

• Do NOT prescribe antibiotics—they have no evidence of benefit for common cold and cause significant adverse effects 1, 2, 3
• Do NOT prescribe intranasal corticosteroids—current evidence does not support their use for symptomatic relief 1, 3
• Do NOT prescribe newer antihistamines alone (loratadine, cetirizine, fexofenadine)—they are ineffective for common cold symptoms 1, 3, 4
• Do NOT prescribe dextromethorphan for children and adolescents—effectiveness has not been demonstrated in these age groups 9

Treatment Algorithm

1. Start with combination therapy: First-generation antihistamine + decongestant (brompheniramine or dexbrompheniramine 6 mg + pseudoephedrine 120 mg twice daily) 1, 2, 3

2. Add analgesic/anti-inflammatory: NSAID (ibuprofen 400-800 mg every 6-8 hours or naproxen) for pain, fever, and malaise 2, 3

3. For predominant rhinorrhea: Add ipratropium bromide 0.03% nasal spray 1, 3, 4

4. If within 24 hours of symptom onset: Recommend zinc lozenges ≥75 mg/day 2, 3, 4

5. For severe nasal congestion: Consider short-term (3-5 days maximum) topical oxymetazoline nasal spray 2, 3, 4

6. Patient education: Inform that symptoms typically last 7-10 days, with approximately 25% continuing up to 14 days 2, 3

Common Pitfalls and Warnings

• Sedation management: Initiate first-generation antihistamines once daily at bedtime for a few days before advancing to twice-daily dosing to minimize sedation 1
• Decongestant side effects: Monitor for insomnia, urinary difficulty (especially in older men), jitteriness, tachycardia, worsening hypertension, and increased intraocular pressure in glaucoma patients 1
• Rebound congestion: Emphasize the 3-5 day maximum for topical nasal decongestants 2, 3, 4
• Antibiotic resistance: Inappropriate antibiotic use contributes to antimicrobial resistance and has no role in common cold treatment 1, 2, 3
• Zinc timing: Zinc supplementation is only effective if started within 24 hours of symptom onset 2, 3, 4
• Complications: Advise patients to return if fever persists beyond 3 days, symptoms worsen after 10 days without improvement, or new symptoms develop (otalgia, purulent conjunctivitis, severe headache) 2