Home Medications for Common Ailments
For common ailments at home, prescribe acetaminophen (paracetamol) 500-1000 mg or ibuprofen 400-800 mg as first-line therapy for pain and fever, with specific considerations based on the clinical scenario.
Fever and Pain Management
First-Line Options
- Acetaminophen (Paracetamol): 500-1000 mg orally every 4-6 hours is effective for fever and pain relief 1, 2
- Ibuprofen: 400-800 mg orally provides equivalent efficacy to acetaminophen for fever and pain 3, 4
- Both medications show similar onset of action (approximately 25-30 minutes) and comparable safety profiles in single-dose studies 1, 5
Combination Therapy for Enhanced Efficacy
When single-agent therapy is insufficient, combining ibuprofen + acetaminophen provides superior analgesia compared to either drug alone 6:
- Ibuprofen 400 mg + Acetaminophen 1000 mg: Achieves 73% of patients with at least 50% pain relief over 6 hours (NNT 1.5 vs placebo) 6
- Ibuprofen 200 mg + Acetaminophen 500 mg: Achieves 69% response rate (NNT 1.6 vs placebo) 6
- Combination therapy delays need for rescue medication to 7.6-8.3 hours compared to 1.7 hours with placebo 6
Acute Cough Management
Non-Pharmacological First
- Simple home remedies such as honey and lemon are recommended as initial therapy for acute viral cough, which is typically self-limiting 7
- Voluntary cough suppression may be sufficient to reduce cough frequency through central modulation 7
Pharmacological Options When Needed
- Dextromethorphan 60 mg: Maximum cough reflex suppression occurs at this dose, though most over-the-counter preparations contain subtherapeutic amounts 7
- Menthol inhalation: Provides acute but short-lived cough suppression 7
- Sedating antihistamines: Appropriate for nocturnal cough but cause drowsiness 7
- Avoid codeine or pholcodine: These have no greater efficacy than dextromethorphan but significantly more adverse effects 7
Gastrointestinal Symptoms
Nausea and Gastrointestinal Upset
- Metoclopramide 10 mg orally: Can be used as adjunctive therapy for severe symptoms, administered 20-30 minutes before other medications 8
Diarrhea
- Loperamide: Available for acute diarrhea, but use with caution 9
- Avoid in patients taking CYP3A4 inhibitors (itraconazole), CYP2C8 inhibitors (gemfibrozil), or P-glycoprotein inhibitors (quinidine, ritonavir) due to increased cardiac risk 9
- Monitor for CNS toxicity in patients with hepatic impairment 9
- Discontinue if no improvement within 48 hours or if blood in stools, fever, or abdominal distention develops 9
Headache-Specific Considerations
Mild to Moderate Headache
- NSAIDs alone (ibuprofen 400 mg) as first-line treatment 10
- Acetaminophen 1000 mg and aspirin 650 mg show clinically similar efficacy for tension headaches 2
Migraine
- Avoid ergotamine: Oral ergot alkaloids are poorly effective and potentially toxic, relegated to use only when migraine-specific drugs and NSAIDs fail 10
- Triptan + NSAID combination: Superior to either alone for moderate to severe migraine 10
- Limit acute medication use to ≤2 days per week to prevent medication-overuse headache 10
Important Safety Considerations
Contraindications and Cautions
- Dengue or suspected viral hemorrhagic fever: Use acetaminophen only; avoid NSAIDs due to bleeding risk with potential thrombocytopenia 8
- Gastrointestinal bleeding risk factors: Consider H2 receptor antagonists or proton pump inhibitors in patients with mechanical ventilation ≥48 hours, coagulation dysfunction, or liver disease 7
- Elderly patients: Exercise caution with loperamide in those taking QT-prolonging medications 9
Red Flags Requiring Immediate Evaluation
- Fever with significant hemoptysis, foreign body aspiration history, or voice changes requires specialist referral 7
- Acute cough with increasing breathlessness should be assessed for asthma or anaphylaxis 7
- Headache with altered mental status, severe abdominal pain with fever, or mucosal bleeding requires emergency evaluation 8
- Discontinue self-treatment if no improvement within 48 hours 7, 9