The wave of respiratory viruses continues to skyrocket, flu cases have doubled in a week. Since January 1 alone, Primary Care Centers have diagnosed 15,000 new infections, almost 2,000 a day, very high figures. That is why almost everyone has gone through or is going through one of the three predominant viruses these days – flu, covid or RSV, respiratory syncytial virus – or has someone around them who is having the symptoms.
In the midst of "virus soup", as it is popularly said, doubt often arises in self-medication as to which drug is the most appropriate. If I have covid or flu (both common), what medication should I use first? Is paracetamol or ibuprofen better? Is one better than the other if I have certain symptoms? In what cases can they be alternated to combat the intense discomfort of the first days of symptoms or high fever?
There is a premise that is the basis of self-medication in case of flu. "The priority drug, the first option, should always be paracetamol," says Mònica Solanes, family doctor at CAP 11 de Setembre in Lleida and second vice president of CAMFiC (Catalan Society of Family and Community Medicine) on RAC1.cat. . “It has fewer side effects than ibuprofen or any anti-inflammatory. It is very difficult for someone to be hurt or allergic to paracetamol.” As the doctor points out, this indication – like all those in this article – is based on general aspects, and that in the case of specific pathologies or unusual situations, the doctor should always be consulted.
Regarding dosage, the doctor recommends taking one gram every 8 hours. While it is true that one-gram paracetamol is not sold freely (without a prescription) in pharmacies, patients can take one tablet and a part of another 650-milligram tablet, which they can purchase freely. “If the symptoms are not pronounced, the tablets can be taken only when peaks of discomfort appear. Now, in the first days of the flu, with a high temperature and a lot of discomfort throughout the body, a regimen of one gram every 6 or 8 hours is indicated,” says Solanes.
For Viki Mazo, family doctor at CAP Barceloneta, it is not important to remember that “higher doses of paracetamol or ibuprofen are not always necessary. With 650 mg paracetamol the symptoms can be controlled.”
If the first option is always paracetamol, with flu and covid... When is it recommended to take ibuprofen? "When the patient still has severe pain, it can be alternated with 600 milligrams of ibuprofen every 8 hours," Solanes recommends. The younger the patient, the more safely this guideline can be given; On the contrary, in people over 65 years of age, or with other pathologies, self-administered use of any anti-inflammatory is not recommended.
There are no flu or covid symptoms that specifically require taking an analgesic or anti-inflammatory drug, according to the doctor, but “it is true that we prescribe ibuprofen when we see inflammation, and it is more effective. Especially if they are young patients that we have seen in consultation, we can indicate this drug.”
As health professionals point out, you have to be careful with anti-inflammatories. "The three most prominent side effects of ibuprofen affect hypertension, ulcer or stomach discomfort, and kidney function," says Solanes.
“During treatment with anti-inflammatories, there have been cases of gastrointestinal bleeding and ulcers, and, in extreme cases, perforations. Obviously, all side effects do not occur with the same frequency,” they report from the Medicine Information Center of the Barcelona College of Pharmacists.
Is it necessary to take a stomach protector before taking ibuprofen? “It is being seen that too much is being prescribed. The need to take the protector is relative: every time we take ibuprofen, a protector is not necessary, but it may be appropriate if the patient has some underlying gastrointestinal discomfort or illness, or also if it is a long treatment. It would always be advisable to have a medical prescription,” they point out from the Medicine Information Center of the College of Pharmacists of Barcelona.
If it is a person over 65 years old, one must be especially careful when taking anti-inflammatories (Ibuprofen, Enantyum, Voltaren...), "since with age the probability of having other health problems such as hypertension and hypertension increases. lower kidney function, two pathologies closely related to the side effect of these drugs,” Solanes emphasizes.
It is also necessary to take into account the cardiovascular risk of ibuprofen. “The Medicines Agency, in April 2015, already issued an informative note that warned that above all we must be careful with people who have cardiovascular risk (heart failure, established ischemic heart disease, peripheral arterial disease or cerebrovascular disease) and with administration of high doses of the medication,” reports the Drug Information Center of the College of Pharmacists of Barcelona.
People who are taking oral anticoagulants (such as Sintrom) should also be especially careful. “Anti-inflammatories can increase the effects of anticoagulants; Therefore, it must be monitored. These are patients who should already be very controlled and any extra medication should be monitored very well,” they add from the Center.
“Influenza medications are medications with different active ingredients, such as analgesics, antihistamines and anticongestants. They can have a combination of these three components. They are freely available and do not require a prescription. These drugs act primarily on nasal congestion and sneezing, but as they are combinations, the side effects greatly increase, especially when taken orally (pills),” says Mazo.
Anticongestants, remember, are contraindicated in cases of hypertension, hyperthyroidism and cardiovascular disease. "It is important to remember this because they are freely available, and they can cause problems." Both Mazo and Solanes do not rely on these products in their clinical practice, “better analgesics or anti-inflammatories,” they expressly express.
Although many people claim that cough syrups work for them, there is no scientific evidence to support this. “Patients go to the pharmacy or come for a consultation asking for it, but there are no studies that support its effects,” says Solanes, who emphasizes that if a cough product is purchased, it is important that it is not to stop the cough (it is necessary prescription), but only to soften it, a purpose that has fewer contraindications.
For Mazo, it depends on the components that each syrup has and each patient. “You have to see if the benefit is worth it, because there are many side effects. Flu symptoms cause a heavy irritative cough, but the prescription of the syrup is individualized.”
Both doctors remember the importance of hydration in flu or covid cases, especially relevant advice for children and older patients.
