Fever and Pain Relief for Colds and Flu

Written by WebMD Editorial Contributors

Medically Reviewed by Jennifer Robinson, MD on November 04, 2021

• Pain Relief Basics: NSAIDs and Acetaminophen
• The Risks of Taking NSAIDs for Pain Relief
• Risks of Using Acetaminophen for Pain Relief
• The Risks of Combination Medicines
• Safe Pain Relief for Adults
• Safe Pain Relief for Children
• Acetaminophen or an NSAID: Which Is Best?
• More

If you’re looking for relief from the symptoms of a cold, fever, or the flu, you’ll find many over-the-counter (OTC) options at your local pharmacy.

The pain and fever-reducing ingredients often found in these medicines — acetaminophen, ibuprofen, naproxen sodium, and aspirin — are safe for most adults if taken correctly. But in the throes of fever or the flu, you may not think as clearly about safety.

To be prepared, read this primer on OTC pain relievers, so when illness strikes, you’ll know how they work to reduce fever, aches, and pains and how to use them safely.

Two common groups of pain relievers are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Most OTC pain relief drugs contain one or the other.

These medications don’t make illnesses go away, but they can relieve some symptoms so you suffer less while the cold, flu, or fever works its way through your system.

NSAIDs. This group of drugs relieves pain and fever by tamping down on the substances in your body that cause the feeling of pain, and they help control body temperature.

Drugs in the NSAID category include:

• Ibuprofen, the active ingredient in Advil and Motrin
• Aspirin, found in Bayer or St. Joseph
• Naproxen sodium, found in Aleve

Acetaminophen. This is an active ingredient in Tylenol and many other prescription and non-prescription medications. Acetaminophen seems to work on the parts of the brain that perceive pain and control body temperature.

NSAIDs are safe for most people when taken at the right dose for a short period. However, they can increase risk for serious stomach bleeding. NSAIDs may also increase the chance for heart attack and stroke.

Ask a doctor before using NSAIDS if:

• You have a history of stomach problems such as heartburn
• You have high blood pressure, heart disease, liver disease, or kidney disease
• You have asthma

Combining NSAIDs with more than two to three alcoholic drinks a day for women or three to four for men increases the risk for stomach bleeding. Taking NSAIDs along with blood-thinning medications can also increase the risk for bleeding, including serious stomach bleeding. Talk to your doctor if you drink alcohol or take and blood-thinning medicines before using an NSAID. Others factors that increase risk for stomach bleeding include:

• Having a previous history of stomach bleeding
• Being over age 60
• Taking steroid medications, or other NSAID medications

The most serious risk from acetaminophen is liver damage. Ignoring the dose recommended on the label can put you at risk of severe liver damage.

People who are at greater risk for liver damage from acetaminophen include people with liver disease and men who drink three or more alcoholic drinks a day (or two a day or more drinks for women).

Talk to your doctor or pharmacist if you also take the blood thinner warfarin (Coumadin), because it may increase the risk of bleeding.

It is important to read the package labeling carefully and not exceed the maximum daily dosage. Because many other OTC and prescription products contain acetaminophen as an active ingredient, make sure to look at the list of active ingredients in other medicines you are taking in order to avoid overdosing.

Because the signs and symptoms of liver damage from acetaminophen may not be immediately noticeable, if you think you may have taken too much, call 911 or poison control (800-222-1222) immediately.

OTC pain relievers are often used with other ingredients in prescription and non-prescription medications, including some for arthritis, menstrual symptoms, allergies, and sleeplessness. To avoid an overdose, it’s important not to take two medicines that contain the same pain reliever.

Mixing medicines that contain different pain relievers can also cause problems and should not be done without talking to a doctor.

Because of the risks of overdosing on a pain medication, it’s important to keep track of how much you take and how long you take it.

Follow these other drug safety tips for using OTC pain relievers:

• Read and follow the label. It should clearly state whether a medicine contains acetaminophen or NSAIDs, the risks of the active ingredient, the highest dose you can take safely, and how long you can take it.
• Wait until you need it. Leave acetaminophen and NSAIDs on the shelf until you really need them. Limiting your intake automatically reduces your risk.
• Set a cut-off date. Before taking an NSAID, set a date to stop, based on the label’s instructions for how long you should take it before seeing a doctor.
• Don’t mix medicine with alcohol. If you drink alcohol, talk with your doctor before taking NSAIDs or acetaminophen.

Drugs work differently in children than they do in adults. Take extra care when giving your child acetaminophen or ibuprofen and only use those products labeled specifically for your child’s age group. Adult medicines and doses are too strong for most kids and should not be given to children.

Beyond not giving aspirin to children and teens (ages 18 and under) due to the risk of Reye’s syndrome, follow these safety measures:

• The FDA recommends that parents not give any cough and cold medicine to children under age 2. The FDA supports the voluntary label change of drug makers to state “do not use in children under 4” for OTC cough and cold medicines.
• Talk to your pediatrician about safe OTC options for your child.
• When giving your child liquid medicine, make sure to use the appropriate measuring tool that came with the medication and not a spoon used for eating or cooking.
• There’s no need to expose your child to drugs they don’t need. Select a medicine that treats only the symptoms your child has.
• Keep all medicine out of children’s reach.

For some people, acetaminophen is the best way to reduce certain cold and flu symptoms. For others, ibuprofen does the trick. For many, both are equally effective.

How do you know which to take? Talk to your doctor or pharmacist about the other medicines you are taking and your medical history, such as problems with your heart, kidneys, stomach, or liver, or if you take anti-clotting medication or medication for high blood pressure.

Top Picks

» DO – Tylenol vs Motrin: Guidelines and Good Practices

When our children have fever or pain, we naturally want to make them feel better. Tender loving care can go a long way, but sometimes we need a little help from medications. When considering when to give medications for fever or pain and also what to give, the first thing to do is realize why we’re using the medication.

Pain

Pain is pretty self-explanatory – nobody wants their child to be in pain. Pain is not only upsetting, but it also can increase the heart rate, breathing and blood pressure (although not usually to dangerous levels) and make a child cranky or withdrawn.

One of our key jobs as parents and caregivers is to reduce suffering by trying to minimize or prevent pain. Acetaminophen (such as the Tylenol™ brand) and ibuprofen (such as Motrin™ or Advil™) are our main tools to do that.

Both are great medications for fever and pain, but ibuprofen has an added benefit of fighting inflammation, which acetaminophen does not. For this reason, ibuprofen is sometimes preferred for pain from injuries or illnesses involving inflammation.

Fever

Fever is one of the most common reasons caregivers seek medical evaluation for their children. There is much apprehension about fever: some people are afraid for their children when they have fever, having heard stories about fever causing brain damage and convulsions or even death. Couple that with the fact that children often look and act much sicker when they have fever, and it adds up to a lot of anxiety.

Caregivers often turn to acetaminophen or ibuprofen, and sometimes both, in an effort to make the fever go away. There’s a lot of confusion about which medicine to give, how much to give and when to give it.

The good news is most stories about the dangers of fever are absolutely false! Fever from infection rarely goes above 106 F. The body temperature has to go above about 107 F before there is any damage to the brain or body.

There is such a thing as febrile seizures, but they are limited to children between the ages of 6 months and 5 years. When they occur, they are usually very brief and do not cause complications. They are completely unpredictable and do not occur because the temperature goes above a certain level. They’re far scarier than they are dangerous.

A fever that doesn’t go down all the way with proper doses of fever medication or one that comes back before the next dose is due is neither an indicator of infection nor of the seriousness of the illness. The fact that you can’t completely control the fever is not something to worry about, as it means nothing about the infection that’s causing the fever. The fever will go away when the worst of the infection goes away.

The real reason to treat fever is to make your child feel better. Fever itself, regardless of the source of the infection, will increase the heart rate and breathing rate; make your child sleepy, cranky or clingy; and decrease their appetite. If you can get the fever down even a degree or two, your child will likely feel better, start eating and drinking better, and look much more like themselves. Then you’ll feel better too!

Fever Control

Both acetaminophen and ibuprofen are excellent medications for fever control.

We tend to limit ibuprofen to children older than six months. Children with kidney disease, bleeding problems or a few other chronic illnesses may not be able to take ibuprofen. If your child has a chronic disease, check with your primary care provider to see if he or she can safely take ibuprofen.

A few studies have suggested ibuprofen may be better than acetaminophen in helping to treat fevers over 102 – 103 F, while acetaminophen may be better for children who are also having stomach pain or upset, because ibuprofen can sometimes irritate the stomach. 

Some children consistently seem to respond better to one medication than the other. Each individual illness may also respond better to a particular medication. If you get a feeling that one medication is working better than the other, use that medication.

Many medical providers recommend alternating acetaminophen and ibuprofen for better fever control. Studies suggest there may be a slight improvement in fever control when using both medications; however, there is also an increased chance the child will accidentally be given an overdose of one or both medicines, especially if more than one person is giving the child medication.

With this possible safety concern about accidental overdose, there’s little benefit in using the medicines on an alternating schedule.  If you choose to alternate acetaminophen and ibuprofen, alternate them every 4 hours. For example, give acetaminophen at noon, ibuprofen at 4pm, acetaminophen at 8pm, and so on. If more than one person will be giving medications, keeping a written schedule may help reduce dosing errors.

There is absolutely no evidence that giving acetaminophen and ibuprofen at the same time helps to control the fever. This practice can also lead to significant medication overdoses thus is not safe.

Dosage

Oral dosing recommendations on the packages of medications are most often given in weight or age ranges. This can lead to under-dosing or slight over-dosing. It’s best to get a dosing chart or recommendations from your medical care provider so you can dose your child based on their current weight.

We recommend ibuprofen to be given at 10mg per kilogram of weight (about 10mg for every 2 pounds) every 6-8 hours or acetaminophen at 15mg per kilogram of weight every 4-6 hours.

Acetaminophen can also be given as a rectal suppository, but they are available in a limited selection of doses. Suppositories should not be split to modify the dose because the medication may not be suspended equally throughout the suppository, so one portion may have more medication than another. This limits the usefulness of the suppositories. It is not true that suppositories work better or faster than oral medication. Ibuprofen is not available in suppository form in the U. S.

Conclusion

To sum it all up, whether they have fever or pain, we use acetaminophen and ibuprofen to make our children feel better. With a few exceptions, both medications are safe to use when given in appropriate doses and with appropriate timing.

Ibuprofen may be better than acetaminophen for injuries or illnesses that also involve pain and inflammation or for higher fevers.

There is no need to alternate the two medications for fever. Keep it simple and use which ever medication seems to work better. Consult your primary care or urgent care provider to learn the safest and most effective doses to meet your child’s needs.

Lou Romig, MD, FAAP, FACEP, Medical Director

After Hours Pediatrics Urgent Care

Click here to read more Doctor’s Orders articles

Antipyretics at a temperature for adults on the background of influenza, colds and SARS

All antipyretics for adults and children are divided into 2 groups: non-steroidal anti-inflammatory drugs and analgesics-antipyretics (for example, paracetamol) ^3,4,6 . The mechanism of their effect on the body is different. These drugs to varying degrees have analgesic, antipyretic and anti-inflammatory properties. Means affect the center of thermoregulation in the brain, inhibiting the formation of prostaglandins – substances that cause high temperature ^3,4,6 .

Consider the most common antipyretic drugs.

Paracetamol . This is a strong antipyretic and analgesic ^3,4,6 . It has been well studied and has been used in clinical practice for a long time. Available in various dosage forms. With the right dosage, paracetamol lasts 3-6 hours.

Ibuprofen . It is an antipyretic anti-inflammatory drug ^3,4,6 . The effect of using the drug for fever may be less pronounced than that of paracetamol.

Acetylsalicylic acid . It helps with fever, and is also used to reduce pain and inflammation, and can reduce blood clotting. Unlike paracetamol, it is not suitable for the treatment of children due to the high risk of side effects ^{3. 6} .

All of these drugs with acetylsalicylic acid, ibuprofen, paracetamol and other active ingredients have contraindications, you should consult your doctor before taking. If it is not possible to bring down the high temperature in an adult or child, call a therapist or an ambulance. In this case, a specialist should prescribe specific drugs after examining the patient.

Some of the best known folk remedies for fever include the following.

Blackcurrant . In folk medicine, it is allowed to take both fresh berries and juice, and infusion of buds and leaves. The content of nutrients in decoctions and infusions is reduced due to heat treatment, so this treatment is ineffective, unlike the use of medications with paracetamol or other active substances.

Herbal preparations . Most often, the composition of antipyretic infusions and decoctions used at temperature includes linden flowers, chamomile, rose hips, plantain, coltsfoot. Whichever folk recipe you choose, keep in mind that it is based on an approximate dosage of herbal ingredients, so treatment with herbal preparations is rarely effective.

Honey . To relieve fever and relieve other symptoms of a cold, it is used both in its usual form and with tea. Honey is an allergenic product, in addition, in hot water, its beneficial properties are practically lost (active substances are destroyed under the influence of high temperatures).

Lemon . Drink fresh, juice mixed with water or warm tea with lemon. However, the actual content of vitamin C in lemon and other citrus fruits does not satisfy the daily requirement of the body fighting a cold.

Remember that home remedies for fever have not been proven to be clinically effective!

How to bring down the temperature of a child at home and without drugs

An elevated body temperature in a child is a clear sign of a disease, and the range of diseases can be wide: from SARS to chicken pox or tonsillitis. Maria Chakhnashvili, a pediatrician at the Semeynaya clinic chain, told Gazeta.Ru in which cases the temperature in a child needs to be brought down and what to do if it does not decrease.

How to bring down a high temperature in a child at home?

An increase in body temperature is a natural protective reaction of the human body. The immune system begins active synthesis of various protective substances only at temperatures above 38.5°C. That is, when the body temperature rises above 38.5 ° C, the immune system tries to start working, there is no need to turn it off. If the temperature drops, then recovery may be delayed.

The fact is that viruses and bacteria that cannot survive at high (above 39°C) body temperature, at a comfortable 36.6°C or 37.5°C, they reproduce perfectly.

It must be remembered that antipyretic therapy does not shorten the duration of the disease, does not reduce the risk of complications, and is required mainly to alleviate the discomfort of the child.

If you still need to bring down the temperature, you can use two drugs approved for children – paracetamol and ibuprofen. They have many trade names and forms of release (candles, syrup, tablets), but these are the active ingredients.

close

100%

A single dose of ibuprofen is prescribed at the rate of 10 mg per 1 kg of weight, paracetamol – at the rate of 10-15 mg per 1 kg. You should not be guided by the instructions, which indicate the dosage by age, since one child per year can weigh 8 kg, and the other 12 kg.

It must be remembered that the drugs act after 40 minutes and only in the absence of dehydration. If the temperature does not drop, and you are sure that you have correctly calculated the dose of the antipyretic, give the child more fluids.

How to quickly reduce the temperature without medication?

It is necessary to bring down the temperature in children, but not every one. Parents should focus not on the numbers on the thermometer after measuring the temperature in the armpit, but on the well-being, behavior and appearance of the child.

If the child’s skin is pink, he is active and fights off attempts to take the temperature, cries loudly, drinks well, you can do without drugs. In this case, you only need to ventilate the room, do not wrap up, do not try to feed and do not turn on the heater.

It is recommended to drink plenty of water: 100-120 ml per 1 kg of body weight per day. That is, for a preschooler weighing 20 kg, this is about two liters of liquid, water or fruit drink.

What to do if the antipyretic does not bring down the temperature of the child?

Do not bring down a child’s temperature by rubbing with alcohol or vinegar. Rubbing only creates the illusion of a decrease in temperature: upon contact with a cold liquid, a spasm of skin vessels occurs, the skin temperature decreases, and the temperature of internal organs, on the contrary, rises. That is, rubbing aggravates the condition of the child.

In addition, when alcohol or vinegar evaporates from the surface of the body, a child can inhale their vapors, which can cause poisoning in a child.

close

100%

But there are conditions in which self-medication will not help:

– body temperature above 40.