Wednesday, September 26, 2007

Protect yourself from the bad virus going around - The Flu and Colds: Tips on Feeling Better

The Flu and Colds: Tips on Feeling Better

How can I tell if I have a cold or the flu?

A cold and the flu cause many of the same symptoms. But a cold is generally mild, while the flu tends to be more severe.

A cold often starts with feeling tired, sneezing, coughing and having a runny nose. You may not have a fever or you may run a low fever--just 1 or 2 degrees higher than usual. You may also have muscle aches, a scratchy or sore throat, watery eyes and a headache.

The flu starts suddenly and hits hard. You'll probably feel weak and tired, and have a fever, dry cough, a runny nose, chills, muscle aches, severe headache, eye pain and a sore throat. It usually takes longer to get over the flu than a cold.

Get tips for preventing the flu.

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What causes colds and the flu?

Viruses. Over 100 different viruses can cause colds. There aren't as many viruses that cause the flu. That's why there's a shot for the flu and not for colds.

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What can I do to feel better?

There's no cure for a cold or the flu. Antibiotics don't work against viruses. All you can do to feel better is treat your symptoms while your body fights off the virus (see the box below).

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Ways to treat your cold/flu symptoms

  • Stay home and rest, especially while you have a fever.
  • Stop smoking and avoid secondhand smoke, which can make cold symptoms worse.
  • Drink plenty of fluids like water, fruit juices and clear soups. Fluids help loosen mucus. Fluids are also important if you have a fever because fever can dry up your body's fluids, which can lead to dehydration.
  • Don't drink alcohol.
  • Gargle with warm salt water a few times a day to relieve a sore throat. Throat sprays or lozenges may also help relieve the pain.
  • Use saline (salt water) nose drops to help loosen mucus and moisten the tender skin in your nose.

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Should I take medicine for a cold or the flu?

No medicine can cure a cold or the flu. Medicine can, however, help relieve some of your cold or flu symptoms. Check with your doctor before giving any medicine to children.

Many cold/flu products are available without a prescription. See the box below for a guide to the common ingredients in these products.

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What's in over-the-counter cold/flu medicines?

The ingredients listed below are found in many cold/flu medicines. Read labels carefully. If you have questions, talk to your doctor or pharmacist.
  • Analgesics relieve aches and pains and reduce fever. Examples: acetaminophen, aspirin, ibuprofen, ketoprofen, naproxen. Warning: Children and teenagers shouldn't be given aspirin.
  • Antitussives tell your brain to stop coughing. Don't take an antitussive if you're coughing up mucus. Example: dextromethorphan.
  • Expectorants help thin mucus so it can be coughed up more easily. Example: guaifenesin.
  • Oral decongestants shrink the nasal passages and reduce congestion. Examples: ephedrine, pseudoephedrine.

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What about prescription medicines for the flu?

Some prescription medicines can relieve flu symptoms. These medicines may help reduce the severity of symptoms if they are started soon after you begin to get sick.

These medicines come as pills or as an inhaler. The inhaled type may cause problems for some people with asthma or chronic obstructive pulmonary disease (COPD).

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Should I call my doctor?

In most cases, you don't need to see your doctor when you have a cold or the flu. However, if you have any of the symptoms in the box below, call your doctor.

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Emergency Cold/Flu Symptoms:

In children:
  • High (above 102 F) or prolonged fever
  • A cold that lasts for more than 10 days
  • Trouble breathing, fast breathing or wheezing
  • Bluish skin color
  • Not drinking enough fluids
  • Earache or drainage from the ear
  • Changes in mental state (such as not waking up, irritability or seizures)
  • Flu-like symptoms that improve, but return with a fever and a worse cough
  • Worsening of chronic medical condition (such as diabetes or heart disease)

In adults:
  • High (above 102 F) or prolonged fever
  • A cold that lasts for more than 10 days
  • Trouble breathing or shortness of breath
  • Pain or pressure in the chest
  • Fainting or feeling like you are about to faint
  • Confusion or disorientation
  • Severe or persistent vomiting
  • Severe pain in your face or forehead
  • Hoarseness, sore throat or a cough that won't go away

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Written by editorial staff.


American Academy of Family Physicians

With best wishes and respect,

Muhammad Ayub, MD MPH

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Common Cold

From the sniffles and sneezes to a sore throat and annoying cough, the common cold usually catches up with us at one time or another. With kids getting as many as eight colds per year or more, this contagious viral infection of the upper respiratory tract is the most common infectious disease in the United States and the number-one reason children visit the doctor and stay home from school.


Most colds are caused by rhinoviruses (the name comes from "rhin," the Greek word for nose) that are in invisible droplets in the air we breathe or on things we touch. More than 100 different rhinoviruses can infiltrate the protective lining of the nose and throat, triggering an immune system reaction that can make your child's throat sore, his or her head ache, and can make it hard for your child to breathe through the nose.

Air that's dry - indoors or out - can lower your child's resistance to infection by the viruses that cause colds. And so can being a smoker or being around someone who's smoking. People who smoke are more likely to catch a cold than people who don't - and their symptoms will probably be worse, last longer, and are more likely to lead to bronchitis or even pneumonia.

But despite what old wives' tales may have you believe, not wearing a jacket or sweater when it's chilly, sitting or sleeping in a draft, and going outside while your hair's wet do not cause colds.

Signs and Symptoms

The first symptoms of a cold are often a tickle in the throat, a runny or stuffy nose, and sneezing. Kids with colds may also have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of appetite. The discharge from your child's nose may change from watery to thick yellow or green.


Colds are most contagious during the first 2 to 4 days after symptoms appear, and may be contagious for up to 3 weeks. Your can catch a cold from person-to-person contact or by breathing in virus particles that are spread through the air by sneezing or coughing. Touching the mouth or nose after touching skin or another surface contaminated with a rhinovirus can also spread a cold.


Because so many viruses cause them, there isn't a vaccine that can protect against catching colds. But to help prevent them, kids should:

  • try to steer clear of anyone who smokes or who has a cold. Virus particles can travel up to 12 feet (3.7 meters) through the air when someone with a cold coughs or sneezes, and even secondhand smoke can make your child more likely to get sick.
  • wash their hands thoroughly and frequently, especially after blowing their noses.
  • cover their noses and mouths when coughing or sneezing.
  • not use the same towels or eating utensils as someone who has a cold. They also shouldn't drink from the same glass, can, or bottle as anyone else - you never know who might be about to come down with a cold and is already spreading the virus.
  • not pick up other people's used tissues

Researchers aren't sure whether taking extra zinc or vitamin C can limit how long cold symptoms last or how severe they become, but large doses taken every day can cause negative side effects. The results of most studies on the value of herbal remedies, such as echinacea, are either negative or inconclusive, and few properly designed scientific studies of these treatments have been done in children. Talk to your child's doctor before you decide to give your child any herbal remedy or more than the recommended daily allowance (RDA) of any vitamin or supplement.


Cold symptoms usually appear 2 or 3 days after exposure to a source of infection. Most colds clear up within 1 week, but some last for as long as 2 weeks.


"Time cures all." That may not always be true, but in the case of the common cold, it's pretty close. Medicine can't cure the common cold, but it can be used to relieve such symptoms as muscle aches, headache, and fever. You can give your child acetaminophen or ibuprofen based on the package recommendations for age or weight.

However, aspirin should never be given to children younger than 12, and all children and teens under age 19 should avoid aspirin during viral illnesses. Use of aspirin by kids or teens with colds or other viral illness may increase the risk of developing Reye syndrome, a rare but serious condition that can be fatal.

Although you may be tempted to give your child over-the-counter (OTC) decongestants and antihistamines to try to ease the cold symptoms, there's little or no evidence to support that they actually work. In fact, decongestants can cause hallucinations, irritability, and irregular heartbeats in infants and shouldn't be used in children younger than 2 without first consulting a doctor.

Some ways you can help ease cold discomfort include:

  • saltwater drops in the nostrils to relieve nasal congestion (you can buy these - also called saline nose drops - at any pharmacy)
  • a cool-mist humidifier to increase air moisture
  • petroleum jelly on the skin under the nose to soothe rawness
  • hard candy or cough drops to relieve sore throat (for kids older than 3 years)
  • a warm bath or heating pad to soothe aches and pains
  • steam from a hot shower to help your child breathe more easily

But what about chicken soup? There's no real proof that eating this soothing, warm concoction can cure a cold, but sick people have been swearing by it for more than 800 years. Why? Chicken soup contains a mucus-thinning amino acid called cysteine, and some research shows that chicken soup helps control congestion-causing white cells, called neutrophils.

The best plan, though, is not to worry about whether to "feed a cold" or "starve a fever." Just make sure your child eats when hungry and drinks plenty of fluids like water or juice to help replace the fluids lost during fever or mucus production. Avoid giving your child caffeinated beverages, though, which can cause frequent urination and, therefore, increase the risk of dehydration.

When to Call Your Child's Doctor

Your child's doctor won't be able to identify which specific virus is causing your child's cold symptoms, but can examine your child's throat and ears and take a throat culture to make sure the symptoms aren't from another condition that may need specific treatment. (If your child's symptoms get worse instead of better after 3 days or so, the problem could be strep throat, sinusitis, pneumonia, or bronchitis, especially if your child or teen smokes.) Taking a throat culture is a simple, painless procedure that involves brushing the inside of the throat with a long cotton swab. Examining the germs that stick to the swab will help the doctor determine whether your child has strep throat and needs treatment with antibiotics.

If symptoms last for more than a week, appear at the same time every year, or occur when your child is exposed to pollen, dust, animals, or another substance, your child could have an allergy. If your child has trouble breathing or wheezes when he or she catches a cold, your child could have asthma.

You should also see your child's doctor if you think your child might have more than a cold, or if he or she is getting worse instead of getting better.

Also call the doctor if your child has any of these symptoms:

  • coughing up a lot of mucus
  • shortness of breath
  • unusual lethargy/tiredness
  • inability to keep food or liquids down or poor fluid intake
  • increasing headache or facial or throat pain
  • severely painful sore throat that interferes with swallowing
  • fever of 103 degrees Fahrenheit (39.3 degrees Celsius) or higher, or a fever of 101 degrees Fahrenheit (38.0 degrees Celsius) or higher that lasts for more than a day
  • chest or stomach pain
  • swollen glands (lymph nodes) in the neck
  • earache

Like most virus infections, colds just have to run their course. Getting plenty of rest, avoiding vigorous activity, and drinking lots of fluids - juice, water, and noncaffeinated beverages - all may help your child feel better while on the mend.

Keeping up regular activities like going to school probably won't make your child's cold any worse. But it will increase the likelihood that the cold will spread to classmates or friends. So you might want to put some daily routines aside until your child is feeling better.

Reviewed by: Steven Dowshen, MD

Runny Nose in Children

What causes a runny nose during a cold?

A runny nose usually starts when a cold is starting to get better. When the cold virus first infects the nose and sinuses, the nose starts making lots of clear mucus. This mucus helps wash the virus out of the nose and sinuses. After 2 or 3 days, as the body fights back, the mucus changes to a white or yellow color. As the bacteria that usually live in the nose grow back, they change the mucus to a greenish color. This is normal. It doesn't mean your child has an infection that needs to be treated with medicines like antibiotics.

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Does a runny nose need to be treated?

No. Runny nose, cough, fever, headache and muscle aches may bother your child during a cold, but medicine won't make them go away faster. Using a cool mist vaporizer or giving your child an over-the-counter decongestant medicine may help. Check with your doctor to see which medicines are okay to use.

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Why not take antibiotics?

Taking antibiotics that your body doesn't really need can be harmful. After each antibiotic, your child is more likely to have resistant germs in his or her nose. If your child gets infected again, it's more likely to be with these resistant germs. Resistant germs aren't killed by the usual antibiotics. If your child gets infected with a resistant germ, it might be necessary to use more expensive and powerful antibiotics or even antibiotics that have to be given in the hospital. Since a runny nose generally gets better by itself, it's best to wait and take antibiotics only when necessary.

Chilling Out With Colds

You wake up in a cranky mood. Your head hurts. You don't have the energy to even get out of bed. And you can't breathe out of your nose. What's wrong? You have a cold!

Having a cold is the number-one reason kids visit the doctor and stay home from school. Kids get up to eight colds per year with each cold lasting an average of 5 to 7 days. Let's find out more about them.

What Is a Cold?

A cold is an infection of the upper respiratory system. This just means it affects the nose, throat, and ears. A cold virus gets inside your body and makes you sick. There are over 200 viruses that cause colds. The rhinovirus (say: rye-no-vye-rus) is the most common cold virus, but there are more than 200 viruses that cause colds. Because there are so many, there isn't a vaccination, or shot, to prevent you from getting colds.

Fortunately, your body already has the best cold cure - your immune system. The immune system defends your body against illness. White blood cells are the immune system's main warriors. They're your own private army working to help you feel better. Take that, cold viruses!

How Kids Catch Colds

Mucus (say: myoo-kus) is the wet, slimy stuff inside the nose. When someone sneezes or coughs, mucus drops float in the air. Breathing in these droplets can spread a cold from one person to another.

You can also catch a cold if you touch your eyes or nose after handling something with cold viruses on it. Video games, the doors at the mall, and your school desk are all hot spots for viruses. So be sure to wash your hands regularly.

Getting a cold works like space travel - the virus actually has docking points that stick to the inside of your nose - just like a small spaceship attaching to a mother ship! The virus takes over the cells lining the nose and begins creating more viruses.

White blood cells charge to the nose's rescue and cause cold symptoms, while also killing the virus that caused the cold. Runny noses and sneezing actually help to prevent viruses from invading other parts of your body.

You sneeze because your nerves detect the irritation in your nose and get the lungs to push a blast of air out through your nose and mouth. Your body can sneeze over 100 miles an hour (161 kilometers per hour) - faster than a car travels on the road, unless you're at a racetrack!

Cold Clues

Symptoms (say: simp-tumz) are signs or clues that tell doctors you're sick. Once you've been in contact with a cold virus, it takes 2 to 3 days for cold symptoms to begin. If you have some of the following symptoms, you probably have a cold:

  • low fever (100 to 101 degrees Fahrenheit or 37.2 to 37.8 degrees Celsius)
  • body chills
  • itchy or sore throat
  • sneezing, runny nose, and watery eyes
  • coughing
  • feeling tired and not hungry
  • congestion (when your nose is stuffy and it's hard to breathe)

Helping Kids Feel Better

Although medicine doesn't make colds go away faster, some medicines can help you feel better while you wait for your cold to go away. Don't take any medicine unless your parent or doctor gives it to you. They might suggest acetaminophen or ibuprofen, which helps aching heads and muscles.

Decongestants sometimes can make it easier to breathe by shrinking the swollen lining of the nose. Antihistamines (say: an-teye-his-tuh-meenz) dry up mucus and may help stop runny noses and sneezing.

Here are some other feel-better tips:

  • Bring on the heat. Hot drinks soothe coughs and sore throats while also clearing mucus. So eat (or drink) your chicken soup!
  • Get steamed up. A steamy shower helps stuffy or irritated noses. Or run a humidifier (a small, quiet machine that sprays fine cool mist in the air) to relieve your scratchy throat, stuffy nose, and itchy eyes. Humidifiers make room air moist, which loosens mucus.
  • Practice healthy habits. Your immune system will be ready to fight colds if you eat a balanced diet, get plenty of sleep, and keep your body fit through regular exercise.
  • Blow your horn. Blowing your nose is the best way to get rid of mucus.
  • Rest. Take a nap or go to bed a little earlier for a few nights.
  • De-stress. Kids who are stressed out feel worse when they have colds. Relax and use the time to read, listen to music, or watch a movie. In other words, chill out and you might prevent a cold!
Updated and reviewed by: Kevin P. Sheahan, MD

Types of OTC Medicines and How They Work

This information was developed as part of an educational program made possible by an unrestricted educational grant from McNeil Consumer & Specialty Pharmaceuticals.

In this section, you'll learn what you need to know to make wise choices about over-the-counter (OTC) medicines for you and your family. The following information has been adapted from the AAFP guide for physicians, "Appropriate Use of Common OTC Analgesics and Cough and Cold Medications."

What does OTC mean?

Do you know what's in the medicines you take?

Many OTC medicines contain the same ingredient found in prescription medicines. By combining your prescription medicine with an OTC medicine, you may be getting more than the recommended daily dose of the active ingredient. This medication chart can help you sort out what medicines have the same ingredient so you can avoid taking too much. If you have any questions, ask your pharmacist or family doctor.

A PDF version of this medication chart is available. Download PDF now (2 pages / 78 KB). About PDFs.

OTC is short for over-the-counter. These are medicines you can buy without a prescription from your doctor. Chances are, you've used OTC medicines many times to relieve pain and treat symptoms of the common cold, the flu, and allergies. In this section, you'll learn about four of the most common types of OTC products and how each works.

Pain Relievers

The OTC products that relieve your headache, fever, or muscle aches are not all the same. That's because the pain relievers you see in the aisles of your local drug store or pharmacy are either nonsteroidal anti-inflammatory drugs (called NSAIDs), which include aspirin, ibuprofen, naproxen and ketoprofen, or acetaminophen. Each of these drugs has a different way of working:

Aspirin and NSAIDs relieve pain by stopping the production of prostaglandins, which are natural chemicals in the body. Prostaglandins irritate nerve endings, triggering the sensation of pain. Commonly used NSAIDs include:

  • Aspirin, the medicine in products such as Bayer and St. Joseph
  • Ibuprofen, the medicine in products such as Advil and Motrin IB
  • Naproxen, the medicine in products such as Aleve
  • Ketoprofen, the medicine in products such as Orudis KT
Acetaminophen relieves pain and reduces fever. We don't completely understand the way acetaminophen relieves pain. We do know that unlike aspirin and NSAIDs, which work in the skin, muscles, and joints, acetaminophen blocks painful sensation in the brain and the spinal cord.
  • Acetaminophen is in products such as Tylenol and Tempra.


Antihistamines work by blocking the receptors that trigger itching, nasal irritation, sneezing, and mucus production. The three types of antihistamines are:

  • Diphenhydramine, the medicine in products such as Banophen, Benadryl Allergy, and Diphenhist
  • Brompheniramine, the medicine in products such as Dimetapp Allergy
  • Chlorpheniramine, the medicine in products such as Aller-Chlor, Chlo-Amine and Chlor-Trimeton Allergy


Decongestants work by narrowing blood vessels in the lining of the nose. As a result, less blood is able to flow through the nasal area, and swollen tissue inside the nose shrinks. Pseudoephedrine is the only decongestant used in OTC products.

  • Pseudoephedrine is in products such as Allermed, Genaphed and Sudafed.

Cough Medicines

Cough medicines are grouped into two types: antitussives and expectorants. Antitussives, or cough suppressants, block the cough reflex.

  • Dextromethorphan is a common antitussive and is in products such as Delsym, Drixoral, Pertussin CS, and Robitussin Pediatric.
Expectorants, on the other hand, are thought to thin mucus and make coughing more productive in clearing the mucus from the airway.

  • Guaifenesin is the only expectorant used in OTC products and is in products such as Guiatuss, Robitussin, and Tusibron.

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Timeline of Symptoms Associated with the Common Cold

There is no cure for the common cold. Medicine can only make your symptoms less bothersome until your body can fight off the virus. Medicine won't make your cold go away completely. The following are tips to help you feel better when you have a cold:

  • Stay home and rest, especially while you have a fever.
  • Don't smoke and avoid secondhand smoke.
  • Drink plenty of fluids like water, fruit juices and clear soups.
  • Don't drink alcohol.
  • Gargle with warm salt water a few times a day to relieve a sore throat. Throat sprays or lozenges may also help relieve the pain.
  • Use salt water (saline) nose drops to help loosen mucus and moisten the tender skin in your nose.

Many cold medicines are available over-the-counter (without a prescription from your doctor). If you decide to use an over-the-counter (OTC) medicine to treat your cold symptoms, consult the chart below.

Day Symptoms OTC Medicine
1 Fatigue, mild sore throat Acetaminophen (some brand names: Panadol, Tempra, Tylenol) or nonsteroidal anti-inflammatory drug (ibuprofen [some brand names: Advil, Menadol, Motrin])
2 Runny nose Antihistamine (diphenhydramine [some brand names: Benadryl Allergy, Banophen, Diphenhist], chlorpheniramine [some brand names: Aller-Chlor, Chlo-Amine, Chlor-Trimeton Allergy])
3 "Stopped up" nose Decongestant (pseudoephedrine [some brand names: Allermed, Genaphed, Sudafed])
4 Dry cough Antitussive (dextromethorphan [some brand names: Drixoral, Pertussin CS, Robitussin Pediatric])
5&6 Moist, productive cough Expectorant (guiafenesin [some brand names: Guiatuss, Robitussin, Tusibron])
7 Voice "breaks" or disappears altogether No medicine will help your voice come back sooner. Resting it is the only thing that will help.

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How to Read an OTC Drug Label

You don't need a prescription to buy OTC medicine. But like prescription drugs, OTC medicines can also cause unwanted and sometimes dangerous side effects. Before you buy an OTC medicine, it's important to read and thoroughly understand the information on the drug label. Use the following as a guide. If you have questions about a medicine, ask your pharmacist or family doctor.

  1. Active Ingredient -- The active ingredient is the chemical compound in the medicine that works to relieve your symptoms. It is always the first item on the label. There may be more than one active ingredient in a product. The label will clearly show this.
  2. Uses -- This section lists the symptoms the medicine is meant to treat. The U.S. Food and Drug Administration (FDA) must approve these uses. Uses are sometimes referred to as indications.
  3. Warnings -- This safety information will tell you what other medicines, foods, or situations (such as driving) to avoid while taking this medicine.
  4. Directions -- Information about how much medicine you should take and how often you should take it will be listed here.
  5. Other Information -- Any other important information, such as how to store the product, will be listed here.
  6. Inactive Ingredients -- An inactive ingredient is a chemical compound in the medicine that isn't meant to treat a symptom. Inactive ingredients can include preservatives, binding agents, and food coloring. This section is especially important for people who know they have allergies to food coloring or other chemicals.
  7. Questions or Comments -- A toll-free number is provided to address any questions or comments you may have about the medicine.

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How to Get the Most from Your Medicine

OTC medicines can help you feel better. But if they are taken the wrong way, they can actually make you feel worse. To use OTC medicines correctly, follow the guidelines below.

Talk to your family doctor

If there is something you don't understand about a medicine you're taking or are planning to take, ask your doctor or pharmacist. If you still don't understand, ask him or her to explain things more clearly. If you are taking more than 1 medicine, be sure to ask how the medicines will work together in your body. Sometimes medicines cause problems when they are taken together (called a drug interaction).

Below is a list of questions you can ask your doctor to learn how to use each medicine correctly and safely:

  • What does the medicine do?
  • When and how should I take the medicine?
  • What are the possible side effects (reactions your body may have to the medicine)?
  • Will the medicine react to any other medicines, foods or drinks?
  • Should I avoid any activities while I'm taking the medicine?
  • How will I know if the medicine is working?
Know about the medicine you take

You should know the following things about each medicine you take:

  • Name (generic name and brand name)
  • Reason for taking it
  • How much to take and how often to take it
  • Possible side effects and what to do if you have them
  • How long to continue taking it
  • Special instructions (taking it at bedtime or with meals, etc.)
Know what to avoid while taking the medicine

Some foods can cause side effects, such as stomach upset, if you are taking medicine. Drinking alcohol is generally not a good idea while you are taking medicine. Some medicines cause reactions such as sun sensitivity (getting a sunburn or sun rash), so you may have to limit your outdoor activities or protect your skin from the sun.

Read the label to see what to avoid while you are taking an over-the-counter medicine. Follow the instructions just as you would with a prescription medicine. If you have questions, ask your doctor or pharmacist.

Follow these dos and don'ts:
  • Do read the label carefully.
  • Do take your medicine exactly as your doctor tells you to.
  • Do make sure that each of your doctors (if you see more than one) has a list of all of the medicines you're taking.
  • Do make sure everyone you live with knows what medicine you're taking and when you're supposed to take it.
  • Don't combine prescription medicines and OTC medicines unless your doctor says it's OK.
  • Don't stop taking a medicine or change how much you take or how often you take it without first talking to your doctor.
  • Don't take someone else's medicine.
  • Don't use medicine after its expiration date.
  • Don't crush, break or chew tablets or capsules unless your doctor tells you to. Some medicines won't work right unless they are swallowed whole.
Understand generic vs. brand name

Just like foods, some medicines come in both brand names and generics. Generic medicines are generally cheaper. Compare the list of ingredients. If the generic has the same ingredients as the brand name, you may want to consider using it. But be careful: The generic may contain different amounts of certain medicines. Ask your doctor or pharmacist if you have questions about which medicine to choose.

Follow these tips for choosing medicines
  • If you have questions, ask your doctor or pharmacist.
  • Although it can seem overwhelming, take the time to look at all the choices.
  • Read the label carefully and note what symptoms the medicine will treat.
  • Look for a medicine that will treat only the symptoms you have. For example, if you only have a runny nose, don't pick a medicine that also treats coughs and headaches.
  • Note how much medicine you should take, and what side effects it may cause.
  • Note what medicines or foods you should not take with the medicine.
  • Check to see if the medicine causes problems for people with certain health problems (such as asthma or hypertension).
Know when to call your doctor

If you're taking an OTC medicine and it doesn't seem to be helping, call your doctor. Your sickness can get much worse if you wait too long to get treated by your doctor.

You should also call if you have side effects or any concerns about the medicine you're taking

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Potential Side Effects of OTC Medicines in Adults

While OTC medicines have a low risk of side effects when used occasionally by healthy adults, they can pose risks for very young children, the elderly, people with kidney problems, and people taking more than one medicine. These people have an increased risk of side effects when they take OTC medicines. Potential side effects are described below.

Aspirin and NSAIDs

The main side effect associated with aspirin and other NSAIDs is gastrointestinal (GI) problems. These problems can range from upset stomach to GI bleeding, a serious event that is more likely to occur in older people. The chances of experiencing GI problems from NSAIDs or aspirin increase the larger the dose you take and the longer you take them.

NSAIDs can cause a variety of side effects related to kidney function. These side effects range from reversible inflammation to permanent kidney damage.

Aspirin and NSAIDs may make high blood pressure worse or interfere with blood pressure medicines.

High doses of aspirin pose a risk of liver damage for people who have liver disease, juvenile arthritis, or rheumatic fever.


Although safe in the majority of users, long-term use of high doses of acetaminophen, especially in products that also contain caffeine (such as Excedrin) or codeine (such as Tylenol with Codeine), has been shown to cause a form of kidney disease called analgesic nephropathy. This serious condition may develop after years or decades of daily use.


Antihistamines can cause sedation or drowsiness and, therefore, can significantly impair a person's ability to drive or operate machinery. The sedative effects of antihistamines may increase the risk of falling. Antihistamines can also cause temporary dry mouth or eyes.


Pseudoephedrine can temporarily cause nervousness, dizziness and sleeplessness. It can make you lose your appetite or retain urine. It can also cause heart palpitations, high blood pressure, or high blood sugar levels.

Cough Medicines

Codeine, when used as a cough suppressant, can temporarily cause nausea, sedation and constipation. Dextromethorphan, the medicine in Drixoral, Pertussin CS and Robitussin, has a lower risk of sedation and GI side effects. It can, however, cause feelings of confusion, agitation, nervousness, or irritability.

Drug-Drug Interactions

The body processes -- or metabolizes -- every drug differently. If drugs are used together, their metabolism and effect on the body can change. When this happens, the chance that you will have side effects for each drug may become greater.

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Alcohol and OTC Medicines

Pain Relievers

If you drink more than 1 alcoholic beverage per week and use NSAIDs, including aspirin, you may be at increased risk of GI bleeding. People who consume 3 or more alcoholic beverages each day should consult their physician before using any pain reliever.

Acetaminophen is much less likely than NSAIDs to be associated with GI problems, including bleeding. But to minimize the risk of serious liver injury, you should never take more than the recommended daily dose (4g per day).

Antihistamines, Decongestants, and Cough Medicines

The combination of OTC antihistamines and alcohol can increase drowsiness, especially in elderly people. In addition, alcohol makes the drowsiness, sedation and impaired motor skills associated with the cough suppressants dextromethorphan (in products such as Drixoral, Robitussin) and codeine worse.

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Special Groups

Some groups of people may be particularly liable to have the side effects associated with OTC products. The sections below include tips for using OTC medicines in the following special populations:


When used properly, OTC medications pose little risk to children. However, children metabolize drugs differently than adults. You should know how OTC drugs will affect your children before you use them. Talk with your family doctor if you have any questions about giving your child OTC medicines.

  • Acetaminophen is generally considered the treatment of choice for children's pain relief.
  • Children who are allergic to aspirin are also likely to have problems using ibuprofen. Ibuprofen can make your child's asthma worse, for example.
  • Avoid using aspirin in children under the age of 18 because of the risk of Reye's syndrome (a drug reaction that can lead to permanent brain injury).
  • It's very easy to accidentally give too much of a decongestant to a young child. Use these medicines with extreme care, if at all, and talk with your doctor first.
  • Don't use cough suppressants that contain codeine in young children. Talk to your doctor before using other cough medicines.
It can be helpful for parents and other caregivers to keep track of the medicine a child is taking. One way to do that is with a medication log. Using a log can help avoid "double dosing" -- giving too much medicine or giving it too often. It can also provide important information to your family doctor if there is a problem.

A PDF version of the medication log is available. Download PDF now (1 page / 15 KB). About PDFs.

Medicine and Your Child: How to give the right dose

Here are some tips on giving the right dose:

  • When your doctor says to give the medicine "every 6 hours" that generally means the medicine is taken 4 times a day (for example, at breakfast, lunch, supper and bed time). It doesn't generally mean to wake the child up in the night to take medicine. And "take every 8 hours" generally means the medicine should be taken 3 times a day.
  • Pay close attention to the dosage given on the label. Labels for liquid medicines give measurements in both teaspoons (tsp) and in milliliters (mL). Your pharmacist can give you a measuring device -- a spoon that's made especially for measuring medicine, a syringe or a cup -- that's labeled with both tsp and mL. Your pharmacist should also show you how to use it. One tsp is not the same as 1 mL -- read the label carefully and make sure you give the right amount of medicine to your child. An ordinary kitchen teaspoon may not hold the right amount of medicine.
  • Measure the medicine carefully. If you're using a measuring cup, set it on a level surface such as a countertop and then pour the medicine in it.
  • "If a little medicine is good, a lot is better (or will work quicker)" is wrong. Giving too much medicine can be harmful. Be sure you only give the recommended dose of each medicine.
  • If you use a syringe-type measuring device to give liquid medicine to your child, first throw away the small cap of the syringe. Children can choke on these caps.
  • If your child has a bad reaction to a medicine or is allergic to a medicine, tell your doctor right away. Also, keep a record of the following information at home: the name of the medicine, the dosage directions, the illness the medicine was used for and the side effects the medicine caused.

Older Adults

The elderly use a number of medications at the same time and therefore need to pay careful attention to drug-drug interactions between OTC medications and prescription medications. See the drug-to-drug interaction chart. (PDF file: 3 pages/ 32 KB; More information about PDF files). Older adults talk with their doctor about the medications they take and potential interactions with OTC medicines.
  • There is a relatively high risk of kidney disease and GI bleeding in elderly patients who use NSAIDs. Discuss this risk with your family doctor.
  • Pseudoephedrine can increase blood pressure and the pressure in your eye that can lead to glaucoma. It can also make existing blockages in the urinary tract worse. Pseudoephedrine interacts negatively with many other drugs such as beta-blockers, antidepressants, insulin, and some medications that treat low blood sugar.
  • If you use a monoamine oxidase inhibitor (MAOI), a type of prescription antidepressant, or take any medication for a seizure disorder, you should avoid using pseudoephedrine. Pseudoephedrine can change the way these drugs work in your system. Some common MAOIs include Marplan (generic: isocarboxazid), Nardil (generic: phenelzine sulfate) and Parnate (generic: tranylcypromine sulfate).
  • If you use a MAOI, you should not use dextromethorphan. Dextromethorphan interferes with the way MAOIs work.

Pregnant or Breastfeeding Women

Pregnant or breastfeeding women should talk with their doctor before using any medicine. Some can affect your baby. The following are some general guidelines.


  • Acetaminophen is generally considered safe for short-term pain relief during pregnancy.
  • Avoid using aspirin during pregnancy. It can cause abnormalities in the baby or problems during delivery.
  • Avoid using other NSAIDs, especially during the third trimester of pregnancy. They can cause heart abnormalities in the baby.

  • Acetaminophen and NSAIDs such as ibuprofen provide safe pain relief for women who are breastfeeding.
  • Avoid using aspirin because is excreted in breast milk and can cause rashes and bleeding problems in nursing infants.
  • Limit long-term use of antihistamines. Antihistamines are excreted in breast milk, and may cause side effects such as sedation, irritability, crying, and sleep disturbances in nursing infants. Antihistamines may also interfere with the production of milk.
General Tips

These steps can help minimize the risk of side effects during pregnancy and breastfeeding:

  • Talk to your doctor about possible alternatives to medicine.
  • Avoid the use of medications during the first trimester.
  • Take oral medications after nursing or before the infant's longest sleep period.
  • Avoid the use of extra-strength, maximum-strength, or long-acting medications.
  • Avoid "combination" products.
  • Watch your infant for possible side effects, such as a rash, difficulty breathing, headache or other symptoms that your child didn't have before taking the medicine.

Other Groups

People with health problems such as kidney disease, heart disease, diabetes, asthma, blood clotting disorders, or gout may be at increased risk of side effects associated with OTC medicines.

The chart contains detailed information on use of OTC pain relievers in patients with these and other medical conditions.

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