What medication and dosage would you recommend for a generally healthy adult with a common cold, headache, and slight cough?

Management of Common Cold with Headache and Slight Cough

For a generally healthy adult with common cold, headache, and slight cough, recommend ibuprofen 400 mg every 4-6 hours as needed (maximum 3 doses in 24 hours) for headache and body aches, combined with honey and lemon for cough, avoiding routine use of prescription medications for this self-limited condition. 1

Duration of NSAID Treatment

• Ibuprofen should be used for 3-5 days maximum for common cold symptoms, as the condition is self-limited and typically resolves within 1-2 weeks 1
• Use the lowest effective dose for the shortest duration to minimize gastrointestinal and cardiovascular risks 2
• If symptoms worsen or persist beyond 2 weeks, the patient should seek medical evaluation rather than continuing self-treatment 1

Specific Medication Recommendations for Casual Advice

When a friend asks what to take for common cold with headache and cough:

For Headache and Body Aches:

• Ibuprofen 400 mg every 4-6 hours as needed (not to exceed 1200 mg/day for OTC use) 1, 2
• This provides effective relief for headache, muscle pain, and malaise associated with common cold 1
• Acetaminophen (paracetamol) 500-1000 mg every 4-6 hours is an alternative option 1

For Cough:

• Honey and lemon mixture as first-line treatment - this is as effective as pharmacological options and has no side effects 3, 4
• If pharmacological treatment is needed: Dextromethorphan 30-60 mg (maximum 120 mg/day) for dry cough 3, 4
• For nighttime cough disrupting sleep: first-generation antihistamine like diphenhydramine 25-50 mg at bedtime 3

Can You Prescribe NSAIDs Alone?

Yes, ibuprofen alone is appropriate for casual common cold management - you do not need to prescribe multiple medications 1

• Ibuprofen addresses headache, body aches, and malaise effectively 1
• Antibiotics are never indicated for common cold and cause significant adverse effects 1
• Nasal corticosteroids have no proven benefit for common cold 1
• Antihistamines alone have only limited short-term benefit (days 1-2) and no clinically significant effect on nasal symptoms 1

Acetaminophen Classification

Acetaminophen (paracetamol) is an analgesic and antipyretic agent - it is NOT an NSAID 1

• It provides pain relief and fever reduction through central mechanisms
• Unlike NSAIDs, it has minimal anti-inflammatory effects 1
• It may help relieve nasal obstruction and rhinorrhea but does not improve other cold symptoms like sore throat, sneezing, or cough 1
• At OTC doses, acetaminophen has comparable safety to ibuprofen, though there is growing concern about gastrointestinal toxicity at higher doses 5

Practical Prescribing Algorithm

Step 1: Assess Severity

• Red flags requiring immediate evaluation: hemoptysis, high fever >38.5°C, tachypnea, abnormal chest examination, symptoms >2 weeks 1, 3
• If red flags present, do not treat empirically - evaluate for pneumonia or other serious conditions 1

Step 2: First-Line Recommendations

• Ibuprofen 400 mg every 4-6 hours as needed for 3-5 days maximum 1, 2
• Honey and lemon mixture for cough (1-2 teaspoons as needed) 3, 4
• Adequate hydration and rest 1

Step 3: Additional Options if Needed

• If headache persists despite ibuprofen: can alternate with acetaminophen 500-1000 mg 1
• If dry cough is bothersome: add dextromethorphan 30-60 mg every 6-8 hours 3, 4
• If nasal congestion is prominent: oral decongestant (pseudoephedrine 30-60 mg) for short-term use 1
• If nighttime cough disrupts sleep: diphenhydramine 25-50 mg at bedtime 3

Common Pitfalls to Avoid

• Do not prescribe antibiotics - they provide no benefit and cause harm in viral upper respiratory infections 1
• Do not use subtherapeutic doses of dextromethorphan - standard OTC doses (15 mg) are often inadequate; 30-60 mg is needed for effective cough suppression 3, 4
• Avoid codeine-containing products - they have no greater efficacy than dextromethorphan but significantly more adverse effects including drowsiness, constipation, and dependence risk 3, 4
• Do not combine multiple OTC products without checking ingredients - many contain acetaminophen or other overlapping components that can lead to overdose 3
• Do not suppress productive cough - if the patient is coughing up sputum, this serves a protective clearance function 3

Patient Counseling Points

• Symptoms typically last 7-14 days and are self-limited 1
• Seek medical attention if fever persists >3 days, symptoms worsen after initial improvement, or breathing difficulty develops 1, 3
• Good hand hygiene is the best prevention method 6
• Antibiotics will not help and may cause side effects 1