For flu-like symptoms, over-the-counter pain relievers, decongestants, and cough medicines can manage most discomfort while your body fights off the infection. If you suspect actual influenza, prescription antivirals can shorten your illness, but only if started within 48 hours of your first symptoms. Here’s a breakdown of what works, what to reach for, and when something stronger is needed.
Pain Relievers and Fever Reducers
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are the two go-to options for the fever, headache, and body aches that come with flu-like illness. They work differently: acetaminophen lowers fever and dulls pain, while ibuprofen does both of those things and also reduces inflammation. For the deep muscle soreness that often accompanies the flu, ibuprofen’s anti-inflammatory effect can feel noticeably better. Either one is fine for fever, and some people alternate between the two to keep symptoms controlled around the clock.
One critical rule: never give aspirin to children or teenagers with a viral illness. Aspirin use during flu or chickenpox is linked to Reye’s syndrome, a rare but serious condition that causes swelling in the liver and brain. This applies to any product containing aspirin, which sometimes appears on labels as acetylsalicylic acid or salicylate.
Cough and Congestion Relief
The right cough medicine depends on the type of cough you have. If you’re coughing up mucus, an expectorant containing guaifenesin (the active ingredient in Mucinex) is the better choice. It works by adding water to the mucus in your airways, making it thinner and easier to cough up. It comes in tablets, dissolving granules, and liquid form. Don’t use it for a dry cough, since there’s no mucus to clear.
For a dry, hacking cough that keeps you up at night, dextromethorphan (found in brands like Delsym and Robitussin DM) is the standard OTC cough suppressant. That said, the evidence for it is underwhelming. A randomized trial in children with upper respiratory infections found that dextromethorphan performed no better than no treatment at all for cough frequency, severity, or sleep quality. Buckwheat honey, by contrast, reduced cough frequency more than doing nothing. For children over age two, a teaspoon or two of honey before bed may be as effective as anything on the pharmacy shelf. (Never give honey to children under one year old due to botulism risk.)
For a stuffy nose, decongestants containing pseudoephedrine (Sudafed) or phenylephrine shrink swollen nasal passages so you can breathe. Pseudoephedrine is kept behind the pharmacy counter in most states, so you’ll need to ask for it. Many multi-symptom cold and flu products bundle a pain reliever, a cough suppressant, and a decongestant into one pill. If you go that route, check the active ingredients carefully so you don’t accidentally double up on acetaminophen by taking Tylenol separately.
Prescription Antivirals
If your symptoms point to actual influenza rather than a general cold or other virus, prescription antivirals can cut your illness shorter. The key is timing: they work best when started as close to symptom onset as possible, ideally within 48 hours. After that window, the benefit drops significantly.
Four antivirals are currently approved for flu treatment. The most commonly prescribed is oseltamivir (Tamiflu), a pill or liquid taken twice daily for five days. Baloxavir (Xofluza) is a single-dose pill, which makes it the most convenient option. Zanamivir (Relenza) is an inhaled powder, and peramivir (Rapivab) is given as a one-time IV dose, typically in a medical setting. Your doctor will choose based on your age, health conditions, and how quickly you caught it.
Antivirals are especially important for people at higher risk of flu complications: adults 65 and older, young children, pregnant women, and anyone with chronic conditions like asthma, diabetes, or heart disease. If you fall into one of these groups and develop sudden fever with body aches and respiratory symptoms, getting evaluated quickly matters.
Staying Hydrated
Fever, sweating, reduced appetite, and sometimes vomiting or diarrhea all pull fluid out of your body faster than usual. Even small fluid losses can make it harder for your body to regulate its temperature, which can make a fever feel worse and drag out your recovery. There’s no magic number for how much to drink while sick, but baseline recommendations for healthy adults are about 9 cups (2.25 liters) per day for women and 12 cups (3 liters) for men. When you’re running a fever, you likely need more.
Water is the obvious choice, but broth, herbal tea, diluted juice, and electrolyte drinks all count. Warm liquids can also soothe a sore throat and help loosen congestion. If you’re struggling to keep fluids down, small frequent sips work better than trying to drink a full glass at once.
Zinc and Other Supplements
Zinc lozenges are a popular early intervention for respiratory illness, but the research is mixed. Some studies show zinc shortens cold symptoms by a few days, while others show no benefit at all. There’s no strong, consistent evidence that it makes a meaningful difference for flu specifically. If you want to try it, zinc gluconate lozenges started within the first 24 hours of symptoms are the most studied form. It’s unlikely to hurt, but don’t count on it as a primary treatment.
Warning Signs That Need Medical Attention
Most flu-like illness resolves on its own within a week or two, but certain symptoms signal something more dangerous. In adults, seek immediate care for difficulty breathing or shortness of breath, persistent chest or abdominal pain, confusion or difficulty staying alert, not urinating, severe weakness or unsteadiness, or seizures. A fever or cough that improves and then comes back worse is a particular red flag, as it can indicate a secondary bacterial infection like pneumonia.
In children, watch for fast or labored breathing, bluish lips or face, ribs visibly pulling in with each breath, refusal to walk due to muscle pain, signs of dehydration (no urine for eight hours, dry mouth, no tears), or fever above 104°F that doesn’t respond to medication. Any fever in an infant under 12 weeks old warrants immediate evaluation regardless of other symptoms.