What antihistamine is recommended for a patient presenting with common cold symptoms, including headache, throat pain, and rhinorrhea?

Antihistamine Selection for Common Cold

For a patient with common cold symptoms including headache, throat pain, and rhinorrhea, use a combination product containing a first-generation antihistamine (such as brompheniramine or diphenhydramine) plus a decongestant (pseudoephedrine) and an analgesic (ibuprofen or acetaminophen), as this provides the most effective symptom relief with 1 in 4 patients experiencing significant improvement. 1

Why Combination Therapy Over Antihistamine Alone

Antihistamines as monotherapy are NOT recommended for the common cold. 1

• Antihistamines used alone have more adverse effects than benefits, with only limited short-term benefit (days 1-2) on overall symptom severity in adults but no clinically significant effect on nasal obstruction, rhinorrhea, or sneezing 1
• Non-sedating (newer generation) antihistamines like loratadine are completely ineffective for common cold symptoms and should not be used 1

Recommended Combination Approach

Use antihistamine-decongestant-analgesic triple combinations:

• These provide general benefit in adults and older children with an odds ratio of treatment failure of 0.47 (95% CI 0.33-0.67), meaning approximately 1 in 5-6 patients will experience significant relief 1, 2
• Specific effective formulation: first-generation antihistamine (brompheniramine) + sustained-release pseudoephedrine + analgesic (ibuprofen or naproxen) 1, 2

For your patient's specific symptoms:

• Headache and throat pain: NSAIDs (ibuprofen 400-800 mg every 6-8 hours or naproxen) provide significant benefits for headache, throat pain, and malaise 1, 2
• Rhinorrhea: The combination of first-generation antihistamine plus decongestant addresses this more effectively than either agent alone 1
• Acetaminophen may help nasal obstruction and rhinorrhea but does not improve throat pain as effectively as NSAIDs 1

Alternative If Combination Not Available

Antihistamine-decongestant (without analgesic):

• This two-drug combination shows stronger evidence than triple therapy, with odds ratio of treatment failure 0.31 (95% CI 0.20-0.48) and number needed to treat of 4 1
• On final evaluation (3-10 days), 70% of patients on active treatment had favorable response versus 55% on placebo 1
• Add a separate NSAID for the headache and throat pain 1, 2

Critical Caveats

Age restrictions:

• There is no evidence of effectiveness in young children for any antihistamine combination 1, 3, 4
• Benefits are established only in adults and older children 1, 3

Adverse effects:

• First-generation antihistamines cause sedation, which is the most common side effect 1, 5, 6
• The antihistamine-decongestant group experiences more adverse effects overall (31% vs 13% with placebo), though the difference is not always statistically significant 1
• Analgesic-decongestant combinations have significantly more adverse effects (OR 1.71,95% CI 1.23-2.37) with number needed to harm of 14 3, 4

What NOT to prescribe:

• Do not use non-sedating antihistamines (loratadine, cetirizine, fexofenadine) as they are ineffective for common cold 1, 7
• Do not prescribe antibiotics—they provide no benefit and cause harm 1, 2, 7
• Nasal corticosteroids are not effective for acute common cold symptoms 1

Expected Timeline and Follow-up

• Throat pain typically resolves by day 3-4 of illness 2
• Overall cold symptoms last 7-10 days, with up to 25% of patients having symptoms for 14 days 1, 2, 7
• This prolonged duration is normal and does not indicate bacterial infection 1, 2, 7