Early Flu Treatment May Be Critical

While not ideal, starting antivirals more than two days after the onset of flu symptoms can still be beneficial, especially if you’re at high risk for serious complications, says Elena Govorkova, M.D., laboratory director in the Department of Infectious Diseases at St. Jude Children’s Research Hospital in Memphis, Tennessee.

In recent years, the CDC estimates that between 70 to 85 percent of seasonal flu-related deaths have occurred in people 65 years and older, and between 50 to 70 percent of seasonal flu-related hospitalizations have occurred among individuals in this age group. 

One of the oldest antivirals on the market is the pill or liquid suspension oseltamivir (Tamiflu), which is also available as an equally effective, and often cheaper, generic medicine. Clinical trials have proven that this drug works to relieve flu symptoms, and is well absorbed as well as “pretty well tolerated,” says Tosh. As with any antiviral, Govorkova notes, it’s important to finish all the prescribed medicine instead of stopping once you feel better.

Other antivirals on the market include zanamivir (Relenza), which is taken by an inhaler device. It is not recommended for people with breathing problems such as chronic obstructive pulmonary disease (COPD) or asthma. The antiviral peramivir (Rapivab) is given intravenously and is used for hospitalized patients. 

One of the newest antivirals on the market is baloxavir marboxil (Xofluza), which can be taken as a single dose (as opposed to Tamiflu, which is taken over several days). However, given its side effects, this medication is not recommended for those with other illnesses, or those who are severely immunocompromised. Govorkova notes that this antiviral should not be taken with oral supplements such as iron, magnesium, selenium or zinc, because those will decrease the effectiveness of the medication. It should also not be taken with laxatives and antacids. 

As for whether we’ll see shortages of antivirals as flu season gets going, experts say it’s possible. “We still have to be judicious in how we give out Tamiflu,” Tosh says.

Over-the-counter RX options

For uncomplicated cases of the flu, Peter Ellis, M.D., associate professor of internal medicine at the Yale University School of Medicine, says patients can rely on over-the-counter nonsteroidal anti-inflammatories — such as Advil, Motrin and Aleve — to relieve muscle aches and lower fever. However, these medicines should be used only in the short term since they can harm the stomach and kidneys, sometimes causing internal bleeding. Tylenol, he notes, is safer.

If your fever doesn’t improve in two to three days, or you get a deepening and worsening cough, you should call your health care provider immediately. Flu is a common cause of pneumonia, especially in the elderly. 

Nasal sprays — like ipratropium bromide (Atrovent) — can help relieve nasal congestion, Ellis notes. Other sprays, such as Afrin or Neosynephrine, shouldn’t be used for more than two to three days, however, as they can cause rebound congestion.

For cough and congestion, doctors say a combination decongestant and antihistamine found in Alka-Seltzer Plus Cold & Flu can also help. However, expectorants, such as Mucinex, “don’t cause harm, but they don’t do much,” Ellis notes. 

Why you need rest — and fluids

Beyond medications, the standard advice to get enough rest still applies. Being up and around too much “will probably impair your ability to fight [the flu],” Ellis says.

And, yes, be sure to get enough fluids. Not only do you want to fend off dehydration, you also “need [enough] circulating blood volume to treat infection,” says Ellis, who believes a good bowl of chicken soup can’t hurt, because fever causes you to lose water as well as salt. 

Finally, doctors recommend staying away from herbs such as elderberry and echinacea, because they have not been shown to help fight the flu and may contain contaminants. Vitamin C and zinc have also not been proven to treat the flu.