The Pitt Prescription | How to handle flu season

The Pitt Prescription is a biweekly blog where student pharmacist and senior staff writer Elizabeth Donnelly provides tips on how to stay healthy in college. This edition was reviewed by Karen Pater, PharmD., CDCES, BCACP.

By Elizabeth Donnelly, Senior Staff Writer

With everyone constantly talking about COVID-19 and its related conditions, there is much less conversation surrounding the typical yearly illnesses that arise with the onset of cold weather. Flu season is quickly approaching, with experts saying this year could see a potentially early and severe flu season because of a lack of population immunity since March 2020.

Experts hypothesize that mask-wearing and increased hygiene, combined with social distancing, all have played a role in slowing the pandemic, but also in preventing several other communicable diseases, like seasonal colds and the flu. During the 2019-20 flu season, the CDC reported an estimated 38 million people infected and 22,000 related deaths. But looking at the 2020-21 flu season, the CDC is reporting unusually low flu activity in the United States, despite high levels of testing. Although exact numbers have yet to be confirmed, in terms of hospitalizations, the rate of flu related hospitalizations in the 2020-21 season is the lowest ever recorded since this data started being collected in 2005.

Since the flu season was so minimal last year due to COVID-19 precautions put in place, this year could see a more severe season because our immune systems are not as used to the flu viruses as they have been in the past. As COVID-19 mitigation measures like masking and social distancing begin to relax and more places reopen to full capacity, this may result in an increase in flu activity for the upcoming 2021-22 season.

The best care with regards to the flu is prevention. The CDC recommends everyone, regardless of age or past medical history, get a flu shot on a yearly basis. Flu season typically starts in October and could last through May, but the most severe months typically fall in the wintertime and are December, January and February. Pitt is offering flu shot clinics on campus a few times throughout October.

There are several myths surrounding the flu shot in general, but they are just misinformation and should be treated as such. Flu shots are safe and healthy measures that can significantly help stop the spread of the flu virus while keeping everyone healthy. The reason prevention is so important is because there aren’t really many treatment options once someone does contract the flu.

There are some antiviral medications that may be prescribed to patients who are diagnosed with the flu early enough — within the first 48 hours of onset — but typically most people will not receive any sort of prescription medication to help them get over their flu-caused illness. Antivirals are usually reserved for people who are at a high risk for complications related to the flu, but for the general population, the only medications available are those that are sold over-the-counter at local pharmacies.

There are no OTC antiviral medications, so the only thing you can do is use OTC medications to treat the symptoms associated with flu infection. Flu usually has a sudden onset and its symptoms consist of a fever, chills, cough, sore throat, congestion, muscle and/or body aches and fatigue.

Here are some over-the-counter self-care recommendations for flu and flu symptoms:

Fever and muscle aches

Acetaminophen or ibuprofen may assist with lowering fevers and relieving pain. 

Acetaminophen comes in several different dosage formulations. A typical recommended dosing of acetaminophen (Tylenol ES) is taking two 500mg tablets every 8 hours as needed for pain and fever relief, not to exceed six 500mg tablets (3000mg) total each day.

Ibuprofen (Advil, Motrin) is only marketed as one dosage formulation: 200mg. The recommended dosing of ibuprofen is taking two 200mg tablets every 6 hours as needed for pain and fever relief, not to exceed six 200mg tablets (1200mg) total each day.

Cough and sore throat

Medicated lozenges with menthol or benzocaine may soothe sore throats while cough suppressants like dextromethorphan may assist with dry or hacking coughs.

Medicated lozenges with menthol and/or benzocaine (like Cepacol) can typically be used every two hours, but each product has its own instructions on the package that are the most accurate, so be sure to take them as directed.

Dextromethorphan can be found in several products, but many common ones are liquid 12-hour long formulations like Delsym 12 Hour. A typical recommended dosing of dextromethorphan is 60mg every 12 hours as needed for a non-productive dry cough, not to exceed 120mg total each day. For the liquid formulation of Delsym 12 Hour, there are 30mg per each 5mL, so the recommendation is adults take 10mL every 12 hours, not to exceed 20mL in a 24 hour period.

Congestion

Pseudoephedrine is an oral decongestant that may assist with congestion, but another option includes nasal saline rinses and sprays.

Pseudoephedrine like Sudafed comes in several dosage forms as well. A typical recommended dosing of pseudoephedrine is taking two 30mg tablets every six hours as needed for congestion relief, not to exceed eight 30mg tablets total each day.

Nasal saline sprays like Ayr Saline Nasal Mist can be used alternatively and should be sprayed once or twice into each nostril as often as needed to assist with congestion. Products like NetiPots can also be used to rinse the sinuses to assist with congestion and they may be used one to two times per day. The saline rinse for these pots is typically composed of lukewarm distilled/filtered water — not tap water — and kosher salt.

Many OTC medications that are advertised as flu remedies often have multiple active ingredients within them. For example, the NyQuil Severe Flu product contains acetaminophen, dextromethorphan, doxylamine succinate and phenylephrine. These are all active drug ingredients that could potentially cause someone to double dose on accident, so make sure you read all the active ingredients in any products you take.

It is important to note that while taking OTC medications may help improve your symptoms, you are still contagious and should be keeping your distance from others. Additionally, there are non-medication actions that can be taken to alleviate some symptoms. Make sure to get plenty of rest and to drink a lot of fluids, especially if you have been vomiting.

As always, if you have any questions or need help finding the best medication for your symptoms, your local pharmacist would be more than happy to assist you with these needs.

Elizabeth writes primarily about self-care and pharmacological topics. For questions, comments or concerns, you can reach her at [email protected].

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