The pharmacist’s guide to treating COVID-19 symptoms with OTC drugs


The following article is not a substitute for medical advice. This information is a reference resource designed to supplement the expertise and judgement of healthcare practitioners. For the most up-to-date information regarding 2019 novel coronavirus, please visit the websites for the WHO and CDC.

The coronavirus continues to spread across the United States, with some estimates predicting that most Americans will be exposed to the virus. The good news is that about 80% of cases only experience mild to moderate symptoms, and the majority recover without needing special treatment.

Many mild cases can be managed with over-the-counter (OTC) treatments to help manage symptoms from the comfort of your home. We put together this guide to help you navigate all of the different OTC drug choices. 

To prevent hospitals and doctors from being overwhelmed by patients, doctors are urging people to only go to a clinic or emergency department if they are experiencing severe symptoms. If you have one of these emergency warning signs of COVID-19, the CDC recommends that you seek immediate medical attention:

  • Severe difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

In this situation, many emergency rooms and urgent care centers request that you call before visiting. Due to the high demand for COVID-19-related services, they may direct you to a different location, advise you to take a separate entrance, or provide other instructions.

Thankfully, it is much more common to have milder symptoms that do not require emergency treatment. For COVID-19, the most common symptoms to look out for are fever, dry cough, and shortness of breath. And as doctors treat more patients with the illness, news is spreading of other potentially common symptoms like digestive issues and changes to the sense of smell and taste; however, the main three symptoms still seem to be fever, dry cough, and shortness of breath.

Patients typically show symptoms around 5 days after contact with the virus, but it may take up to two weeks for symptoms to appear. 

If you have mild symptoms, the first step is to call your doctor and speak with them about how you are feeling, along with your risk factors such as underlying health conditions and potential contact with COVID-19 cases. They may instruct you to simply treat your symptoms as necessary with OTC medications and contact them if your symptoms get worse. 

If you end up in this position, here are some things to think about when considering OTC treatment options.

Fever

Definition: a measured temperature of at least 100.4 degrees Fahrenheit

Be sure to have a thermometer on hand and check your temperature throughout the day if you are feeling ill. If your temperature keeps going up, definitely reach out to your doctor.

Due to the highly contagious nature of the novel coronavirus, purchasing a non-contact thermometer or separate thermometers per person may be ideal. However, shortages of thermometers have been reported at some stores.

Call your doctor as soon as a fever is detected. If instructed to treat your fever at home, make sure to drink plenty of fluids. The Mayo Clinic recommends the following treatment options depending on the severity of a fever from a cold or flu:

  • Temperature up to 102 degrees: Rest and drink lots of fluids. Continue monitoring your temperature to see if it goes higher.
  • Temperature between 102 degrees – 103 degrees: Treatment may not be required. However, if the fever causes discomfort that interferes with your daily life, take a fever-reducing medicine (discussed further below).
  • Temperature above 103 degrees: Seek further medical assistance. 

In the case of COVID-19, seeking further medical assistance would involve reaching out to your doctor again to evaluate next steps. 

These Mayo Clinic recommendations were not developed specifically for COVID-19. There has not yet been enough investigation into the specific symptoms of the coronavirus infection to provide more targeted guidance for COVID-19 patients. However, because COVID-19 and the flu have some similar symptoms, these rules of thumb may still apply when handling your fever.

A fever is part of your body’s natural defense mechanisms against infections. Increasing body temperature can expedite or strengthen the body’s immune response by promoting the multiplication of white blood cells. It may also harm the bacteria or virus causing the illness; some of these pathogens can only reproduce or survive in a narrow range of temperatures. Taking their environment (your body) out of that narrow range keeps them from multiplying.

As a result, having a fever is not necessarily bad for you. In fact, there is debate in the scientific community regarding whether or not to treat fevers at all. Some doctors have more of a “let it ride” philosophy and recommend letting fevers run their course, rather than bringing down the patient’s temperature and potentially slowing their immune response.

There are certain cases in which the two philosophies agree in favor of treating the fever. Treating a fever is beneficial to patients whose symptoms prevent them from performing basic functions like sleeping and those with underlying conditions that can be exacerbated by the fever. In particular, changes in a patient’s metabolism due to fever can be harmful to patients with cardiovascular or pulmonary disease.

If your fever symptoms impact your daily life or if directed by your doctor, OTC medications may be used to reduce a fever. But which OTC option should you choose?

Commonly available treatments

Common fever treatments

Ibuprofen and naproxen treat pain and fever; dextromethorphan treats dry cough; guaifenesin treats productive cough; chlorpheniramine, diphenhydramine, and doxylamine treat runny nose; and phenylephrine treats nasal congestion.

Most preferred: Acetaminophen

In most cases, acetaminophen is a safe and effective choice for treating fever symptoms, along with aches and pains. As a result, it is the most frequently prescribed fever reducer, as well as the most common fever reducing ingredient in OTC combination medications (as you will notice in our table below). 

The way acetaminophen works in the human body is not yet fully understood. Acetaminophen is believed to treat fever by acting on the heat-regulating parts of the brain, resulting in reduced body heat through sweating and dilation of blood vessels. It is thought to alleviate pain symptoms by blocking brain chemicals that send signals of pain, so it increases the brain’s pain threshold. However, it does not reduce inflammation as some other pain relievers do, likely because it does not block those same chemicals outside the central nervous system (for example, in the arms or legs). 

  • Watch out! 
    • Avoid drinking alcohol while taking this, as it can lead to liver damage.
    • Do not exceed a total daily dose of 3000 mg. If you have liver disease, your doctor may instruct a lower maximum dose.
    • Avoid taking more than one product containing acetaminophen, as an overdose can also lead to liver damage. 
    • Do not take acetaminophen if you have severe liver disease.
  • Ask your doctor first if you…
    • Are pregnant or breast-feeding
    • Have liver disease
    • Drink 2 or more alcoholic beverages per day (3 or more for men)
    • Are taking warfarin
  • Common side effects
    • Nausea/vomiting
    • Headache
    • Constipation
    • Agitation
    • Insomnia
  • Serious side effects
    • Liver injury
    • Skin reactions or allergic reactions
  • Drug interactions: Major interactions with ethanol, leflunomide, and lomitapide. A drug interaction checker can help you determine if acetaminophen interacts with any of your medications.

For comparison: Ibuprofen

Ibuprofen, followed by other non-steroidal anti-inflammatory drugs (NSAIDs), is the main OTC alternative when treating fever. Comparing acetaminophen and the NSAIDs, each has its benefits and drawbacks. A recent scientific review claims that while acetaminophen is the medication most commonly prescribed for fever (in children and adults), ibuprofen matches acetaminophen in adults’ prescriptions for pain, and ibuprofen is also the most commonly prescribed for inflammation.

As with acetaminophen, the exact mechanisms by which ibuprofen works in the human body are not well understood. This drug inhibits the body’s production of substances that trigger fever and pain. Unlike acetaminophen, ibuprofen also disrupts the production of chemicals that trigger inflammation. And because of these differences in the ways these drugs function, ibuprofen comes with a different set of precautions for its use. 

  • Watch out!
    • Ibuprofen increases the risk of bleeding (particularly in the stomach) and cardiovascular problems.
    • Do not take this right before or after heart surgery.
  • Ask your doctor first if you…
    • Are over 60 years old
    • Are pregnant or breastfeeding
    • Have persistent or recurring stomach problems like heartburn, upset stomach, stomach pain, or ulcers
    • Have bleeding problems
    • Have high blood pressure or high cholesterol
    • Have a history of heart disease, stroke, or heart attack (or if a family member has such a history)
    • Have kidney disease or liver disease
    • Have diabetes
    • Have recently taken a diuretic
    • Are taking another NSAID
    • Are taking an anticoagulant or steroid
    • Smoke cigarettes
  • Common side effects:
    • Gastrointestinal issues like nausea, vomiting, diarrhea, and flatulence
    • Bleeding
    • Abnormally high or low blood pressure
    • Headache
    • Deficiencies of red blood cells, white blood cells, or platelets
  • Serious side effects: 
    • Gastrointestinal bleeding and peptic ulcer
    • Cardiovascular events (e.g. thrombosis, stroke)
    • Kidney disease
    • Skin reactions (e.g. Stevens-Johnson Syndrome, toxic epidermal necrolysis)
  • Drug interactions: Interactions with ACE inhibitors, aspirin, diuretics, lithium, methotrexate, warfarin-type anticoagulants, and H-2 antagonists. A drug interaction checker can help you determine if ibuprofen (or other NSAIDs) interacts with any of your medications.

Physical methods of cooling the body, including cool baths and ice packs, have demonstrated mixed results. These methods do not have a great effect on fever, as they do not cool the patient’s core as much as their skin, and they may cause shivering and further discomfort.

When it comes to the coronavirus in particular, the French health minister and WHO issued statements that taking ibuprofen can worsen effects of the virus. However, as of the time of writing, the WHO has updated their stance, stating that there is not enough evidence to support this. The FDA later released a statement echoing this stance. Researchers are still investigating this subject. 

Dry cough

Definition: a cough that does not produce phlegm or mucus. In contrast, a wet (or productive) cough produces phlegm or mucus from the lungs or sinuses. 

Other causes of dry cough include asthma, pulmonary fibrosis, and acid reflux. While the cough reflex is typically intended to clear irritants out of your airway, some scientists believe the mucus and inflammatory responses produced during a viral infection also trigger a coughing response.

Management of dry cough focuses on treating the underlying cause whenever possible. Treatment of the cough itself is advised if it interferes with daily life. Unfortunately though, scientific evidence evaluating potential OTC medications is limited and does not suggest a consistent therapeutic effect of cough medicines.

One factor that may contribute to this is that these treatments may work for some people and have no effect for others. Thankfully, side effects of cough medicines are rare and mild, including nausea, vomiting, headache, and drowsiness. Cough medicines are not associated with serious side effects when taken as instructed.

All things considered, if your cough is keeping you up at night, it may be worth seeing what OTC treatment might work for you. 

Commonly available treatments

Most preferred: This is mainly a matter of personal preference and what works for each individual; medications, lozenges, and/or other treatments may all be used. As previously discussed, medications for alleviating dry cough are not consistently effective or result in mild side effects for some people.

That being said, we can provide some advice for what to look for in your cough treatment. Depending on your particular symptoms, certain types of cough medicine ingredients may be more appropriate for you:

  • Cough suppressants: Dextromethorphan, the main OTC cough suppressant, is good for dry coughs and found primarily in medicines and sometimes in lozenges. You’ll notice the letters “DM” for dextromethorphan on the packaging of many cold and flu medicines. 
  • Expectorants: Guaifenesin, the main OTC expectorant, is better for coughs that come with chest congestion because it thins mucus and makes it easier to cough out. So if you have a dry cough, you likely don’t need a product with this ingredient. This is found primarily in medicines and sometimes in lozenges.
  • Anesthetics: Benzocaine, a topical pain reliever, may be added to throat lozenges to ease throat irritation.
  • Demulcents: Ingredients like zinc gluconate glycine and pectin help to coat the throat and relieve irritation.
  • Organic ingredients: Honey, menthol, spearmint, and peppermint extract may be added for flavoring and mild pain relief.

With your personal preference and these ingredients in mind, you can try to find the right treatment for your dry cough.

  • Watch out! 
    • Do not take products with dextromethorphan if you have taken a MAO inhibitor (e.g. isocarboxazid (Marplan) or phenelzine (Nardil)) in the past 2 weeks. 
    • High doses of dextromethorphan can become toxic. This is a particular concern because dextromethorphan is in a wide variety of OTC cough medicines.
    • Do not use benzocaine products if you have had allergic reactions to local anesthetics with “caine” in the name (e.g. lidocaine, procaine).
  • Ask your doctor before using dextromethorphan or guaifenesin products if you are pregnant or breastfeeding, if you have a cough with too much phlegm, or if you have a chronic cough relating to smoking, asthma, or emphysema.
  • Drug interactions: A drug interaction checker can help you determine if any of these ingredients interacts with your other medications.

One widely endorsed home remedy is simply drinking hot tea with honey. For young children who might choke on lozenges, this may also be the safest choice. 

Furthermore, the American Lung Association suggests that avoiding irritants like allergens or cigarette smoke, along with using a vaporizer, humidifier, or steamy shower to reduce nasal congestion and soothe the throat.

Shortness of breath

Definition: an experience of breathing discomfort, like feeling you aren’t able to breathe well enough or aren’t getting enough oxygen

In otherwise healthy patients, shortness of breath may be brought on by exercise, higher altitude, obesity, or extreme temperatures. Outside these cases, this symptom is likely caused by a medical problem like an infection, allergic reaction, heart condition, or lung condition.

In general, it is recommended to see a doctor in these situations:

  • Shortness of breath is severe, comes on suddenly, and affects your ability to function. This may be caused by heart attack, heart failure, an exacerbation of asthma or COPD.
  • Shortness of breath is accompanied by chest pain, fainting, nausea, bluish lips or nails, or a change in mental alertness. In general, this may be related to obesity, asthma or COPD, anemia, or heart conditions. Because this may also happen in more severe cases of COVID-19, the CDC recommends that coronavirus patients experiencing these symptoms seek emergency medical attention.

Treatment: Shortness of breath, or dyspnea, is usually not treated with OTC medications. As this is usually a symptom of a separate underlying condition, treatment is geared toward addressing the condition causing the shortness of breath. 

For patients not affected by COVID-19, lifestyle changes like exercise, quitting smoking, and avoiding pollutants and allergy triggers can help. Patients with the coronavirus infection may be prescribed an inhaler to help open up the airways and allow more air into the lungs. 

If your doctor does not prescribe an inhaler or if there is a shortage of inhalers (as reported in certain areas), there are still some things you can do at home.

The CHEST Foundation (part of the American College of Chest Physicians) recommends avoiding exposure to asthma triggers and air pollution, in addition to getting extra air into your lungs by

  • Sitting in front of a fan, so it blows on your face
  • Using the pursed lip breathing technique
  • Avoiding holding your breath

Of course, make sure that you take your prescribed medications to control any other conditions that may add to your shortness of breath. 

Finding the best treatment for you

When you go to your local drug store, many products you’ll see are intended for treating a combination of symptoms. The table below lists common branded cold and flu combination treatments, along with what symptoms they target. This can help you in three ways:

  1. It can help you make sure your OTC medicine actually targets the symptoms you have, and only those symptoms. Although potential side effects are rare, some sources advise patients not to take products that contain ingredients treating symptoms they do not have.
  2. It can help you avoid a dangerous overdose from taking two medications that happen to have the same active ingredient.
  3. It can help you avoid taking a medication that interacts with others you are already taking. A drug interaction checker can help you determine if any of these ingredients interacts with your other medications.

Combination medications may be the simplest and most cost-effective short-term solution for addressing your symptoms; you can buy just one product instead of three. However, if you have a different set of symptoms in the future, you would need to invest in another type of medicine. As a result, buying separate products for the individual ingredients may be a safer and more cost-effective long-term solution.

Common COVID-19 symptoms and treatments
* Shortness of breath not listed due to lack of OTC pharmaceutical treatments.

** Be sure to read the warning labels for these medications; ingredients may be contraindicated for those who are under 2 years old, are pregnant or breastfeeding, have taken MAOIs in the past 14 days, or have uncontrolled or severe hypertension, coronary artery disease, urinary retention, glaucoma, liver disease, or kidney disease.

Other general tips

No matter how numerous or severe your symptoms may be, please remember to stay hydrated. Drink lots of water. Some non-caffeinated tea with honey can also help with that dry cough. And rather than buying sports drinks like Gatorade, consider Pedialyte instead. It has more electrolytes and much less sugar, so your body retains the water more effectively. It comes in powdered and popsicle forms, and the internet also has some creative solutions for improving the flavor.

Whether you have symptoms or not, following social distancing recommendations, wearing a face mask in public, and washing your hands thoroughly are steps we can all take to help minimize the impact of this virus.

Again, this guide is not meant to replace medical advice. As of when this guide was written, scientists are still investigating potential treatments for the coronavirus, but there is still no vaccine or cure. We will do our best to update these recommendations as information is released by medical experts. In the meantime, we all can do our best to avoid transmission of the virus and treat the symptoms as necessary.

For more information, please visit the websites for the WHO and CDC.

Medical disclaimer:  Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as a supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient.

Honeybee Health does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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Dr. Jessica Nouhavandi

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