Class | Selected medication options | Advantages | Disadvantages |
Oral analgesics and antipyretics (preferred) | - Acetaminophen
- NSAIDS (eg, ibuprofen, naproxen)
| - Provide systemic pain relief and fever control
- Generally well-tolerated
| - Acetaminophen use should be limited or avoided in patients with advanced-stage liver disease or decompensated cirrhosis
- NSAIDs are avoided or used with caution in patients with cardiovascular disease, chronic kidney disease, or advanced-stage liver disease or cirrhosis
- NSAIDs can be associated with increased risk of bleeding and gastrointestinal upset
|
Intranasal glucocorticoid sprays (preferred) | - Fluticasone propionate
- Mometasone
- Triamcinolone
| - Relieve congestion by reducing inflammation
- May be particularly helpful for patients with allergic rhinitis
| - Can cause epistaxis and sore throat
|
Intranasal saline spray | - Intranasal sterile saline
| - Moisturizes passages and loosens secretions
- May temporarily improve nasal passage patency
- Useful in combination with intranasal glucocorticoid sprays
| - Some patients may find this difficult or uncomfortable
- Saline must be sterile
|
Intranasal anticholinergic spray | | - Significantly reduces rhinorrhea
| - May not improve congestion
|
Intranasal decongestant sprays | | - Can improve nasal patency and promote drainage
| - May cause rebound congestion or mucosal damage when used for long-periods
- Should not be used for >3 days
|
Oral decongestants | - Pseudoephedrine
- Phenylephrine
| - Relieves congestion through vasoconstriction
- Pseudoephedrine may be more effective than phenylephrine
- May be particularly helpful for patients with Eustachian tube dysfunction (eg, ear pain, a sensation of ear fullness or pressure, hearing loss, and/or tinnitus)
| - Avoid or use with caution in patients with cardiovascular disease, hypertension, angle-closure glaucoma, or bladder neck obstruction due to sympathomimetic effects
|
Oral antihistamines | - First generation:
- Clemastine
- Diphendydramine
- Second generation:
- Fexofenadine
- Loratadine
- Cetirizine
| - First-generation agents can be useful for drying effect
- Second-generation agents can be useful in patients with allergies
- Available in combination with oral decongestants
| - Can lead to over-drying, thickened, difficult-to-mobilize secretions, and increased discomfort
- Can cause drowsiness, cognitive impairment, and anticholinergic effects
|
Oral expectorants | | - Can promote drainage by thinning secretions
| - Side effects can include gastrointestinal upset and drowsiness
|