Prescription Medications for Colds or Flu

The first line of treatment for the common cold and influenza is self-care (and patience) as you allow these viral illnesses to simply run their course. But there are cases in which you may need a medical evaluation and prescription medication to tame severe symptoms, prevent a worsening of your condition, or avoid related complications.

Cough suppressants, antihistamines, decongestants, and nasal steroids are prescription cold and/or flu medications that can help provide you some symptom relief, while the main job of antivirals and antibiotics is to stop what's causing your illness in its tracks.

Many people with nagging symptoms of cough and colds will ask their doctor for antibiotics. Most colds are viral and will not respond to antibiotics. Your doctor should only prescribe them if your condition is due to a bacterial infection (such as strep throat) or you have developed a secondary bacterial infection (such as pneumonia).

For example, Pen-Vee K (penicillin), Amoxil (amoxicillin), or Keflex (cephalosporin) are all effective treatments for strep throat infections.

These medications are used to dry up secretions, relieving a runny nose or nasal stuffiness. They do not cure a viral respiratory illness, but they can reduce some discomfort. Many are available over the counter, but your doctor may prescribe a stronger version or combination medication.

An example is Promethazine VC, which contains promethazine (an antihistamine) and phenylephrine hydrochloride (a decongestant that constricts blood vessels to reduce pressure).

Your doctor should ensure these medications do not interact with other drugs you are taking, cannot worsen any existing conditions you have, and are appropriate for your age group.

Antivirals are medications that specifically target viruses in an effort to prevent them from reproducing. In the case of flu, antiviral medications are most effective when taken within 48 hours of the onset of symptoms. They can help relieve symptoms and shorten the course of the illness, as well as reduce the risk of complications.

Antiviral medications approved by the FDA for influenza include:

• Tamiflu (oseltamivir phosphate)
• Relenza (zanamivir)
• Rapivab (peramivir)
• Xofluza (baloxavir marboxil)

While antiviral medications may be prescribed to anyone for which they are indicated, they are especially important for people in high-risk populations to help prevent consequences of the flu such as bronchitis and pneumonia.

If you or someone you care for is younger than 2 years of age, 65 or older, immunocompromised, pregnant, extremely obese, living in a care facility, or in any other group considered at high risk for flu complications, contact a doctor as soon as you notice any symptoms of the flu or are aware of exposure to the virus.

Those who are not in a high-risk group may need an antiviral medication if they are hospitalized and have confirmed or suspected influenza, or their illness is severe, complicated, or progressive.

Coughing is your body's natural way of clearing your airways and preventing pneumonia. You can expect to cough at some phase of the cold or flu.

In general, your doctor will not want to treat such a cough unless it continues to disrupt your sleep or activities after it should have cleared up.

Some cough suppressants are available in over-the-counter strengths as well as prescription-strength medications (e.g., dextromethorphan).

The prescription medications used to control a severe cough often contain codeine or hydrocodone, both of which are narcotic medications. They prevent the brain from triggering the cough reflex.

Often, these narcotics are in combination medications that also include an antihistamine. An example is Tussionex PennKinetic, an extended-release oral suspension containing a combination of chlorpheniramine and hydrocodone. Another example is Nalex AC, which contains codeine and the antihistamine brompheniramine.

In 2017, the FDA updated warnings of prescription codeine cough products for children, adolescents, and those who are breastfeeding. In 2018, they changed labeling requirements for safety information on prescription cough and cold medications that contain codeine or hydrocodone to say that they should not be used by those under 18 years of age.

For children and teens, the risks outweigh the benefits of these products.

Sometimes, doctors will prescribe Tessalon Perles (benzonatate) for stubborn coughs. According to the FDA, benzonatate is not safe for children under age 10 because even a small amount can cause an overdose.

Nasal steroids relieve the symptoms of a runny nose or sinus pressure, although they won't cure a cold or the flu.

Flonase (fluticasone), formerly available by prescription only, is now sold over the counter. Your doctor can prescribe Nasonex (mometasone). These drugs are effective, but can take hours to be effective.

If you are concerned a cough is something more serious than a common cold virus, make an appointment. If anything, it will put your mind at ease, and if there is something wrong, your doctor can prescribe treatment before things get worse.