What this protocol covers
The winter cold: what actually helps, how long a decongestant can be used and who should not have one.
1. What to ask
- What symptoms do they have and for how many days?
- Do they have a fever? How high and since when?
- Do they have high blood pressure, heart disease, glaucoma, prostate or thyroid problems?
- What are they already taking? Many cold and flu remedies combine paracetamol, a decongestant and an antihistamine.
- Who is it for: an adult, a child, a pregnant woman?
2. Refer if any of these appear
- More than 10 days without improving, or getting worse after starting to improve.
- A high fever for more than 3 days.
- Severe pain in the face or forehead, or swelling around the eye.
- Difficulty breathing, severe earache or discharge from the ear.
- Babies under 3 months, or people with weakened immunity.
3. If there are no red flags
Blocked nose
- Saline nasal rinses several times a day: suitable at any age.
- In adults, a nasal decongestant (oxymetazoline, xylometazoline) for 3-5 days at most: longer causes rebound congestion.
- Oral decongestants (pseudoephedrine) only in adults with none of the contraindications in question 3.
Feeling unwell, pain or fever
- Paracetamol or ibuprofen at usual doses.
- Single-ingredient medicines rather than a combined cold remedy: you treat what is there and keep control of the dose.
What is not needed
- Antibiotics: a cold is viral.
- Vitamin C or zinc "to cure it": they do not shorten it noticeably.
4. Adjust to who will take it
- High blood pressure
- No oral decongestants (pseudoephedrine, phenylephrine) or cold remedies that contain them. Saline rinses and paracetamol.
- Pregnancy
- Saline rinses and paracetamol. Decongestants only on medical advice.
- Children
- Saline rinses. No decongestant, nasal or oral, and no cold remedy in young children without a doctor's advice.
- Older people
- With glaucoma or prostate problems, avoid decongestants and the sedating antihistamines in many cold remedies: urinary retention, confusion, falls.
What not to recommend
- A nasal decongestant for more than 5 days in a row.
- A cold remedy with paracetamol together with more paracetamol.
- Antibiotics.
- Cold remedies with a sedating antihistamine for someone who has to drive.
Pharmacy Pills · conveniodefarmacia.com
Patient sheet: common cold
To print and hand over. It carries only what the patient needs at home.
- Rinse your nose with saline several times a day.
- If you use a decongestant spray, do not use it for more than 5 days in a row.
- Do not take two medicines with paracetamol at once: check what is in cold remedies.
- See your doctor if it is no better in 10 days, if the fever lasts more than 3 days or if you find it hard to breathe.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
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Oral decongestants can raise blood pressure. Rinses and paracetamol relieve symptoms without that risk.
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More than 3-5 days of a nasal decongestant causes rebound congestion. It has to be stopped; if that is hard, a doctor should assess it.
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The colour of the mucus is not enough. What suggests a complication is the duration, worsening or a persistent fever.
Training content. It does not replace the summary of product characteristics or clinical judgement.