Cold And Flu Warning: The Dangers Of Too Much Acetaminophen
- By Susan Farrell, MD, Contributing Editor
Cold and flu season is here.
Peruse the aisles of a local pharmacy or grocery store and you will find more than 30 over-the-counter medications available to treat the symptoms of fever, headache, sore throat, and achy muscles. Many of these multi-symptom products contain acetaminophen, the active ingredient in Tylenol. This means cold and flu sufferers who are using multiple combination cough and cold remedies may inadvertently be taking more acetaminophen than they intend and putting themselves at risk for a serious complication: acetaminophen-induced liver toxicity.
Acetaminophen is the most commonly available pain-relieving and fever-reducing medication. It is an ingredient in more than 600 over-the-counter and prescription medications, and it has a remarkable safety profile: the dose at which potential toxicity occurs is dramatically higher than the amount that most adults need to effectively treat their symptoms . Moreover, acetaminophen does not cause the unwanted effects that are associated with non-steroidal anti-inflammatory drugs or prescription opioids. As a result, acetaminophen is known as a very safe and effective over-the-counter medication for the treatment of pain and fever, and is taken by millions of people.
When Should You See A Gp
It’s important to get medical help if your COVID-19 symptoms get worse. You should use the NHS 111 online coronavirus service if:
You feel breathless and it’s getting worse
You feel you cannot cope with your symptoms at home
Your symptoms get worse and you’re not sure what to do
Youre worried about your baby or child’s symptoms
Remember, to help stop the spread of COVID-19, you should not visit your GP surgery, hospital or pharmacy.
If you have a cold or the flu, you should speak to your GP or get advice from 111 if:
Your symptoms dont improve after seven days for the flu, or three weeks for a cold
Your symptoms get suddenly worse
Your temperature is very high or you feel hot and shivery
You’re concerned about your baby or child’s symptoms
You’re finding it hard to breathe or develop chest pain
You have a long-term medical condition
You have a weakened immune system
People who are pregnant or aged 65 or over should also speak to their GP or get advice from 111 if they have the flu.
Information correct at time of publication
Differences Between Shot And Nasal Vaccine
People taking immunosuppressive drugs should get the flu shot, not the nasal-spray flu vaccine . LAIV, which contains live, weakened flu virus, is not recommended for anyone who has a chronic disease, including IBD. LAIV should also not be taken by anyone receiving medications that can weaken the immune system, such as the IBD drugs mentioned above.
The inactivated flu shot contains dead viruses and will not give the recipient the flu.
What Treatment Options Are Safe During Pregnancy
According to the Cleveland Clinic, natural remedies like saline nasal drops and warm salt-water gargling are ideal cold and flu treatments during pregnancy.
Vicks VapoRub and cough drops are also considered safe during pregnancy.
Women who are pregnant or trying to get pregnant should check with their healthcare provider before taking any drug. While no medication can be considered 100 percent safe for pregnant women, the Cleveland Clinic lists the following as among those generally considered to be okay:
- Acetaminophen
- Guaifenesin
Note: Do not take the sustained action or multisymptom forms of these drugs.
As for the decongestant pseudoephedrine, the Cleveland Clinic recommends that pregnant women avoid it in the first trimester , while a review published in the journal American Family Physician concluded that women should use it only sparingly later in pregnancy.
For pregnant women with the flu, oseltamivir is the preferred medication because it has the best safety and efficacy record, according to the CDC.
The CDC recommends that pregnant women with a fever take acetominophen and contact their doctors immediately.
RELATED: 7 Natural Flu Remedies That Actually Work
Should I Still Get A Flu Vaccine
Yes. Antiviral drugs are not a substitute for getting a flu vaccine. While flu vaccine can vary in how well it works, a flu vaccine is best way to help prevent seasonal flu and its potentially serious complications. Everyone 6 months and older should receive a flu vaccine every year. Antiviral drugs are a second line of defense that can be used to treat flu if you get sick.
Looking After Yourself When You Have The Flu
The best things you can do to look after yourself when you have the flu are:
- Rest you will probably feel very weak and tired until your temperature returns to normal . Rest provides comfort and allows your body to use its energy to fight the infection.
- Stay at home stay away from work, school and any places where you may have contact with others, especially while you are contagious. The period during which adults are contagious is usually around 35 days from when the first symptoms appear, and up to 7 days in younger children.
- Drink plenty of fluids extra fluids are needed to replace those lost because of the fever . If your urine is dark, you need to drink more. Try to drink a glass of fluids, such as water, every hour while you are awake.
Antivirals For Treating The Flu
Even though antibiotics arent effective against the flu, there are antiviral medications that your doctor can prescribe within a certain time frame.
If these drugs are started within two days of developing flu symptoms, they can help to make your symptoms less severe or shorten the duration of your illness.
Antiviral drugs that are available to treat flu include:
- oseltamivir
- zanamivir
- peramivir
Theres also a new medication called baloxavir marboxil . This antiviral drug was created by a Japanese pharmaceutical company, approved by the U.S. Food and Drug Administration in October 2018, and is now available to treat people 12 years or older who have had flu symptoms for no more than 48 hours.
Some antiviral drugs, including oseltamivir, zanamivir, and peramivir, work by preventing the virus from being properly released from an infected cell. This inhibition prevents newly formed virus particles from going along the respiratory tract to infect healthy cells.
The newly approved medication above, Xofluza, works by reducing the virus ability to replicate. But theyre arent usually necessary to get over the flu, and they dont kill the influenza virus.
Its not an antiviral medication like those noted above, but the seasonal flu vaccine is available every year and is the best way to prevent becoming ill with the flu.
Can Colds And The Flu Be Cured With Medications
No medicines can “cure” colds and flu. However, there are many over-the-counter medicines that can ease the discomfort caused by the symptoms of colds and flu. In addition, there are prescription medicines and a vaccine that can treat and prevent the flu.
Note on antibiotics: Colds and the flu are causes by viruses and cannot be cured with antibiotics. Antibiotics are used to treat bacterial infections, such as strep throat and ear, skin and urinary tract infections. Using antibiotics for infections they are not able to treat makes the antibiotics less effective for infections they are supposed to treat . Never take antibiotics to treat colds and flu.
To ease the discomfort from specific cold and flu symptoms, consider using the following types of OTC medicines:
Promising Treatments To Talk To Your Doctor About
The official Centers for Disease Control and Prevention guidance on what to do if you get sick with Covid-19 advises you to wear a mask, wash your hands, and clean high-touch surfaces to avoid infecting those around you. If your breathing deteriorates or you show signs of severe illness like confusion or an inability to stay awake, the CDC advises you to go to the hospital.
All sound guidance but advice on what treatments to get is harder to come by.
Dr Fauci Reveals Which Medications You Shouldnt Take Before Your Coronavirus Vaccine
As the COVID vaccination effort in the US continues to pick up steam, Dr. Anthony Fauci and the CDC have recently cautioned that anyone preparing to get vaccinated shouldnt take pain relievers like Advil, Motrin, or Tylenol before their appointment. The underlying rationale is that these medications might prevent COVID vaccines from working exactly as intended. While theres no conclusive proof that this is the case with the vaccines from Pfizer and Moderna, the CDC and Fauci are naturally erring on the side of caution.
There are data in the vaccine literature, long predating COVID-19 and almost all in children, that premedication with like acetaminophen or ibuprofen decrease the antibody response to the first dose of vaccine, Dr. David Cennimo told the Miami Herald a few weeks ago.
More from BGR
The mixed advice is based on the fact that theres very little data on that. I mean, if youre going to take something that suppresses an immunological response, then obviously, you dont want to take something like that.
Something thats a true anti-inflammatory, such as one of the nonsteroidal anti-inflammatories, should not be given.
Consequently, the CDC currently advises against taking medication before getting vaccinated if the sole objective is to try and prevent side effects from manifesting.
Its also worth noting that taking Advil of Tylenol post-vaccination is perfectly acceptable, with the CDC noting:
Which Flu Treatment Is Best For My Sore Throat
Drinking lots of fluids and using salt water gargles can often be helpful for easing the pain of a sore throat. Over-the-counter pain relievers and medicated lozenges and gargles can also temporarily soothe a sore throat. Get your doctor’s approval before using any medications, including over-the-counter drugs, and don’t use lozenges or gargles for more than a few days. Call your doctor if your throat is still sore after a couple of days or if it is severe.The medications could mask signs of strep throat, a bacterial infection that should be treated with antibiotics.
A Public Health And Communications Failure
Symptom-based treatment options like fluvoxamine and budesonide arent sure things. The research that exists is promising, but its limited. The effect sizes that studies have found are moderate.
But they are safe, they have been FDA-approved for other use cases for decades, and theres strong published evidence supporting them as options. Despite that, many patients have likely never heard of them and some doctors have felt unsure if its acceptable to prescribe them.
I literally gave fluvox for the 1st time recently. . Despite 2 RCTs, I almost felt dirty doing it, though I think was right call. The nurses were like wtf is fluvoxamine?!
Jeremy Faust MD MS
The National Institutes of Health publish guidelines on Covid-19 treatments that are meant to help physicians and patients sort through confusing, mixed, sometimes misleading evidence. The NIH guidelines on fluvoxamine and on budesonide both state that there is too little information to recommend in favor of or against their use. But some doctors and researchers feel that position is too conservative.
With nirmatrelvir and molnupiravir not yet available, and the most widely used MAbs lacking activity against Omicron , is it time to bump up fluvoxamine at least to “consider use” status on the treatment guidelines? Two well-done RCTs show benefit.
Paul Sax
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Is There An Antiviral Pill That Can Reduce My Risk Of Being Hospitalized If I Get Covid
At least two oral antiviral drugs have performed well in clinical trials and show promise in reducing the risk of COVID-related hospitalization and death.
Molnupiravir
In November 2021, Merck released study results about an oral antiviral drug to treat COVID-19. Compared to placebo, the antiviral drug, called molnupiravir, reduced the risk of hospitalization and death by 30% in people with mild or moderate COVID-19 who were at high risk for severe COVID. An advisory panel to the FDA recommended emergency use authorization for molnupiravir, but the FDA has not yet made a decision.
The study results were based on data from 1,433 study participants from the US and around the world. To be eligible for the study, the participants had to have been diagnosed with mild-to-moderate COVID-19, have started experiencing symptoms no more than five days prior to their enrollment in the study, and have at least one risk factor that put them at increased risk for a poor outcome from COVID-19. None of the participants were hospitalized at the time they entered the study. About half of the study participants took the antiviral drug molnupiravir four capsules, twice a day, for five days, by mouth. The remaining study participants took a placebo.
Molnupiravir was developed by Merck and Ridgeback Biotherapeutics. It works by interfering with the COVID viruss ability to replicate.
Paxlovid
Treating The Cold Or Flu When You Have Covid
Its possible to catch more than one respiratory virus at the same time. That means you could get a cold or the flu along with COVID-19. But so far, these coinfections havent happened enough for scientists to study them very much. Experts think thats due to all the physical distancing and other safety measures we took to prevent the spread of COVID-19.
Theres some evidence your immune system might protect you from viral coinfections. But we need more research to know if thatll happen with COVID-19.
Ellen Foxman, MD, PhD, an immunobiologist with Yale Medicine and assistant professor of laboratory medicine and immunobiology at Yale School of Medicine, says it doesnt matter if you get the rhinovirus — the main cause of the common cold — or the viruses that cause flu or COVID-19.
Within a few days, your body turns on a really rapid antiviral defense system that protects against all viruses.
That means your odds of a second virus most likely go down shortly after you get the first one.
There was a huge drop in cold and flu illnesses during the COVID-19 pandemic. In turn, that lowered the chances of coinfections. Though, Foxman says this year might be different. If schools and workplaces reopen and there is less use of masks and social distancing, we are likely to see more flu, and this may include some flu and COVID-19 coinfections.
If you do get sick, here are some expert tips on how to get well.
What Are Monoclonal Antibodies Can They Help Treat Covid
Three monoclonal antibody treatments for COVID-19 have been granted emergency use authorization by the FDA. The treatments may be used to treat non-hospitalized adults and children over age 12 with mild to moderate symptoms who have recently tested positive for COVID-19, and who are at risk for developing severe COVID-19 or being hospitalized for it. This includes people over 65, people with obesity, and those with certain chronic medical conditions. Newer research suggests that monoclonal antibody treatment may also help to save lives in a specific subgroup of hospitalized COVID-19 patients.
Monoclonal antibodies are manmade versions of the antibodies that our bodies naturally make to fight invaders, such as the SARS-CoV-2 virus. All three of the FDA-authorized therapies attack the coronavirus’s spike protein, making it more difficult for the virus to attach to and enter human cells.
The monoclonal antibody treatments that have EUA approval are: a combination of casirivimab and imdevimab, called REGN-COV, made by Regeneron a combination of bamlanivimab and etesevimab, made by Eli Lilly and sotrovimab, made by GlaxoSmithKline. These treatments must be given intravenously in a clinic or hospital. These treatments are not currently authorized for hospitalized COVID-19 patients or those receiving oxygen therapy.
Should You Take Otc Medications Before Getting The Vaccine
Taking OTC pain medications ahead of your shot to try and decrease symptoms is not recommended by the CDC, because it’s not clear how that could affect the vaccine’s effectiveness.
The concern is that pre-treating with pain medications that reduce fevers and inflammation could dampen your immune system’s response to the vaccine.
That’s because your immune system responds to vaccines through a process called “controlled inflammation,” Dr. Colleen Kelley, an associate professor of medicine at Emory University School of Medicine, told USA Today in January.
Covid messenger RNA vaccines work by giving cells genetic material that tells them how to make a non-infectious piece of the virus. The immune system then creates antibodies against it which is controlled inflammation and can remember how to trigger an immune response if exposed to the virus in the future.
But OTC pain-relieving medications “reduce the production of inflammatory mediators,” Kelley said. That’s why it’s important to wait until after you’ve gotten the vaccine to take pain medication.
Research on children has shown that those who take acetaminophen before getting vaccines have a lower immune response than those who didn’t. And a recent study out of Yale found that giving mice nonsteroidal anti-inflammatory drugs before being exposed to SARS-CoV-2 led to fewer protective antibodies from the virus.
Will An Antibiotic Cure Me Of The Flu
No, antibiotics are used to treat bacterial infections and do not work on viral infections like the flu. This is another common myth about the flu and possible flu medicine used to treat it.
You might hear people say that they took an antibiotic and it cured them of the flu. Since the flu usually lasts about 5 to 7 days, it might seem that an antibiotic may have helped cure the flu. However, it is likely that the flu just resolved on its own.
Research studies of antiviral flu medicine shows that it can lessen symptoms of the flu and shorten the amount of time youre sick. If you think you may need a flu medicine to help with the flu, you should talk about it with your healthcare provider.
OTC flu medicines, as mentioned above, can help with symptoms but usually do not shorten the flus course.