Prescription for Common Cold with Runny Nose

Important note: The common cold is caused by viruses (rhinovirus, coronavirus, etc.). Antibiotics are NOT indicated and must NOT be prescribed for uncomplicated viral rhinitis. Treatment is entirely symptomatic.

1. Decongestants (for nasal congestion + rhinorrhea)

Oral decongestant

• Pseudoephedrine 60 mg orally every 4-6 hours (max 240 mg/day)
  • OR Phenylephrine 10 mg orally every 4-6 hours
  • Avoid in hypertension, ischemic heart disease, hyperthyroidism

Topical (intranasal) decongestant - SHORT COURSE ONLY

• Oxymetazoline 0.05% nasal spray - 2 sprays each nostril BD (twice daily)
  • STOP after 3 days maximum - prolonged use causes rebound congestion (rhinitis medicamentosa)

2. For Rhinorrhea (runny nose specifically)

• Ipratropium bromide 0.06% nasal spray - 2 sprays per nostril 2-3 times daily
  • FDA-approved specifically for rhinorrhea in the common cold
  • Reduces runny nose with minimal effect on congestion
  • Tolerable side effect profile (mild nasal dryness)

3. Antihistamines (first-generation preferred for cold)

• Chlorpheniramine (Chlorphenamine) 4 mg orally every 4-6 hours
  • OR Diphenhydramine 25-50 mg every 6-8 hours
  • Note: Non-sedating antihistamines (cetirizine, fexofenadine) are NOT effective for cold symptoms - per Scott-Brown's Otorhinolaryngology, there is no evidence they reduce common cold symptoms

4. Analgesic / Antipyretic (for fever, headache, sore throat)

• Paracetamol (Acetaminophen) 500-1000 mg orally every 6-8 hours (max 4 g/day)
  • OR Ibuprofen 400 mg orally every 8 hours with food (avoid if GI issues or renal impairment)

5. Nasal Saline Irrigation

• Isotonic saline nasal spray/irrigation (e.g., NaCl 0.9%) - 2 sprays each nostril 3-4 times daily
  • Thins and washes away thick secretions - safe for all ages, no contraindications
  • Highly recommended as first-line adjunct

6. Evidence-Based Adjuncts

Sample Prescription (Adult)

Rx
1. Tab. Paracetamol 500 mg — 1 tab orally TDS (3x/day) × 5 days
2. Tab. Chlorpheniramine 4 mg — 1 tab orally BD (2x/day) × 5 days
3. Tab. Pseudoephedrine 60 mg — 1 tab orally TDS × 3 days
4. Ipratropium bromide 0.06% nasal spray — 2 sprays/nostril TDS × 5 days
5. Saline nasal spray — 2 sprays/nostril QID (4x/day) PRN
6. Zinc lozenges 10 mg — dissolve 1 lozenge every 2 hrs while awake (max 6/day) × 5 days

Advice:
- Rest and adequate hydration (8-10 glasses of water/day)
- Avoid antibiotic use — this is a viral infection
- Return if: fever >38.5°C persisting >3 days, green/yellow discharge >10 days,
  ear pain, facial pain/pressure, or worsening symptoms

Special Populations

Red Flags - When to Investigate / Refer

• Symptoms persisting beyond 10-14 days (may indicate bacterial sinusitis)
• High fever (>39°C), severe facial pain/pressure, periorbital swelling
• Ear pain or hearing loss (otitis media)
• Neck stiffness, severe headache (rule out meningitis)
• Unilateral nasal symptoms (rule out foreign body, tumor)