Rhinovirus (RV) Infection (Common Cold) Medication

Updated: Jul 30, 2019
  • Author: Joseph Adrian L Buensalido, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Medication

Medication Summary

Drugs used in symptomatic treatment of rhinovirus (RV) infection include nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines, and anticholinergic nasal solutions. These agents have no preventive activity and appear to have no impact on complications. The combined effect of NSAIDs and antihistamines often relieves nasal obstruction; therefore, decongestion therapy is rarely needed. Oral decongestants (pseudoephedrine) and topical decongestants (oxymetazoline and phenylephrine) are commonly used for symptomatic relief.

First-generation antihistamines reduce rhinorrhea by 25-35%, as do topical anticholinergics and ipratropium bromide. Second-generation or nonsedating antihistamines appear to have no effect on common cold symptoms. Corticosteroids may actually increase viral replication and have no impact on cold symptoms.

In adults, evidence shows that zinc decreases the duration of symptoms and severity.

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Antihistamines, 1st Generation

Class Summary

Antihistamines relieve runny nose, watery eyes, or other allergylike symptoms. They act by competitive inhibition of histamine at the H1 receptor. This mediates wheal-and-flare reactions, bronchial constriction, mucous secretions, smooth muscle contraction, edema, hypotension, central nervous system (CNS) depression, and cardiac arrhythmias. First-generation antihistamines are generally more sedating and have stronger anticholinergic side effects (eg, blurred vision, urinary retention) than second-generation antihistamines do. Still, the first-generation antihistamines are recommended over second-generation antihistamines because the latter appear to have no effect on common cold symptoms.

Diphenhydramine (Aler-Cap, Q-Dryl, Benadryl)

Diphenhydramine is an oral H1-blocker used in the treatment of allergic conjunctivitis and rhinitis, angioedema, pruritus, and urticaria. It causes occasional drowsiness and is suitable for use on a day-to-day basis.

Chlorpheniramine (Chlor-Trimeton, Aller-Chlor, Allergy Relief)

Chlorpheniramine competes with histamine for H1-receptor sites on effector cells in blood vessels and the respiratory tract.

Brompheniramine (Respa-BR, J-Tan PD)

Brompheniramine is an oral H1-blocker used in the treatment of allergic conjunctivitis and rhinitis, angioedema, pruritus, and urticaria. It is available in various formulations, including long-acting preparations, chewable, suspension, and prescription infant drops. It does not tend to cause drowsiness and is suitable for use on a day-to-day basis.

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Antihistamines, 2nd Generation

Class Summary

Antihistamines relieve runny nose, watery eyes, or other allergy like symptoms. They act by competitive inhibition of histamine at the H1 receptor. Second-generation antihistamines are also known as nonsedating antihistamines. Although they are not void of sedative properties in all individuals, they are often better tolerated and have less anticholinergic effects. Second-generation antihistamines appear to have no effect on common cold symptoms, and so are not the antihistamines of choice for the common cold.

Cetirizine (Zyrtec)

Cetirizine is a H1-receptor antagonist and is also available as an over-the-counter (OTC) product.

Desloratadine (Clarinex)

Desloratadine is a long acting oral H1-receptor antagonist used for seasonal and perennial allergies and chronic idiopathic urticaria.

Fexofenadine (Allegra)

Fexofenadine is a selective peripheral H1-receptor antagonist known to inhibit bronchospasms and nasal congestion due to allergic rhinitis.

Levocetirizine (Xyzal)

Levocetirizine is an oral H1-receptor antagonist used for relief of symptoms associated with allergic rhinitis and uncomplicated urticaria.

Loratadine (Claritin)

Loratadine is an oral H1-receptor antagonist that temporarily relieves symptoms due to hay fever or other respiratory allergies.

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Anticholinergics, Respiratory

Class Summary

Anticholinergic agents have antisecretory properties and, when applied locally, inhibit secretions from the serous and seromucous glands lining the nasal mucosa.

Ipratropium intranasal (Atrovent)

Ipratropium is chemically related to atropine. It comes in 2 strengths of nasal spray: (1) 0.03%, for treatment of rhinorrhea associated with allergic and nonallergic perennial rhinitis, and (2) 0.06%, for treatment of rhinorrhea associated with the common cold.

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Nonsteroidal Anti-inflammatory Drugs

Class Summary

Analgesic and antipyretic agents are used for relief of pain, discomfort, or fever. They inhibit central synthesis and release of prostaglandins that mediate effect of endogenous pyrogens in hypothalamus; thus, they promote return of set-point temperature to within the reference range. Other mechanisms also may exist (eg, inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions).

Naproxen (Aleve, EC Naprosyn, Anaprox, Anaprox DS, Naprosyn)

Naproxen is used for relief of mild to moderate pain and reduction of fever; it inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

Ibuprofen (Advil, Motrin IB)

Ibuprofen is used for relief of mild to moderate pain and reduction of fever; it inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis. Ibuprofen is one of the few NSAIDs indicated for reduction of fever.

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Analgesics, Other

Class Summary

Acetaminophen is commonly used for analgesia or fever reduction. It may be used in alternation with NSAIDs.

Acetaminophen (Tylenol)

Acetaminophen reduces fever by directly acting on hypothalamic heat-regulating centers, thereby increasing dissipation of body heat via vasodilation and sweating.

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Decongestants, Systemic

Class Summary

Decongestants relieve congestion of nasal passages or sinuses.

Pseudoephedrine (Sudafed, Oranyl)

Pseudoephedrine stimulates vasoconstriction by directly activating alpha-adrenergic receptors of respiratory mucosa. It also induces bronchial relaxation and increases heart rate and contractility by stimulating beta-adrenergic receptors.

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Decongestants, Intranasal

Class Summary

Nonsystemic decongestants may be used temporarily to relieve congestion without causing systemic effects. Use for more than 3 days may result in rebound congestion.

Phenylephrine nasal (Neo-Synephrine Nasal, 4-Way Fast Acting)

Phenylephrine is a strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity; it produces vasoconstriction of arterioles, which decreases congestion.

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Antitussives

Class Summary

Antitussive agents act centrally or peripherally (or both) on the cough reflex. Centrally acting agents increase the threshold of the cough center in brain to incoming stimuli, whereas peripherally acting agents decrease the sensitivity of receptors in the respiratory tract.

Dextromethorphan (Robitussin, Delsym, Creo-Terpin, Nycoff)

Dextromethorphan is an antitussive-expectorant that is supplied as a single entity or in various combinations in cough and cold preparations.

Codeine

Codeine is used for symptomatic relief of cough. It is helpful for alleviating the pain of the intercostal muscle strain associated with cough. Codeine binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways and altering perception of and response to pain.

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Vitamins, Water-Soluble

Class Summary

Vitamin C may decrease the severity and duration of colds (large doses are not recommended for children).

Ascorbic acid (Cenolate, Vita-C, Acerola)

The effect of ascorbic acid on cold severity and duration is still controversial. Vitamin C comes in various formulations.

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Trace Elements/Metals

Zinc

The exact mechanism of the antiviral effect of zinc remains uncertain, although in vitro studies have demonstrated that zinc can inhibit viral replication and has activity against respiratory viruses including rhinovirus and respiratory syncytial virus.

Multiple zinc preparations are available; 75 mg of elemental zinc per day should be used to treat the common cold in adult patients so that the benefits of reduction of symptom duration and severity can be achieved. Zinc acetate is composed of 30% elemental zinc; zinc gluconate, 14.3%; zinc sulfate, 23%; and zinc oxide, 80%.

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