Most people with COVID-19 recover at home using over-the-counter medications for fever, pain, and cough. If you’re at higher risk for severe illness, a prescription antiviral like Paxlovid can reduce your chances of hospitalization, but it needs to be started within five days of your first symptoms. Here’s a breakdown of every option available, from prescription treatments to what’s already in your medicine cabinet.
Prescription Antivirals
Paxlovid (nirmatrelvir/ritonavir) is the most widely prescribed antiviral for COVID-19. It’s approved for adults and authorized for patients 12 and older who weigh at least 88 pounds. To qualify, you need at least one risk factor for severe disease. Your doctor makes that call based on your medical history, but the biggest risk factors include being over 65, being immunocompromised, having multiple chronic conditions, or not being up to date on COVID vaccinations. The treatment is a twice-daily pill regimen for five days.
Timing matters more than anything with antivirals. Paxlovid must be started as soon as possible and within five days of symptom onset. If you think you qualify, get tested and contact your doctor early rather than waiting to see if you feel worse.
Molnupiravir (Lagevrio) is a second-line option for adults who can’t take Paxlovid. It’s indicated for people who don’t need supplemental oxygen but are at increased risk for hospitalization or death. Your doctor may turn to it when Paxlovid isn’t suitable for you.
Drug Interactions With Paxlovid
Paxlovid interacts with a long list of common medications, which is one of the main reasons some people can’t take it. One of its components boosts drug levels in your bloodstream, and that can push other medications to dangerously high concentrations. Certain cholesterol-lowering statins (simvastatin is contraindicated outright, while atorvastatin and rosuvastatin may need to be temporarily stopped), the blood thinner rivaroxaban, several heart rhythm medications, immunosuppressants like tacrolimus and cyclosporine, and even some corticosteroids like dexamethasone and prednisone all interact significantly. If you take warfarin, your blood clotting levels need close monitoring during treatment. The same goes for common blood pressure medications like amlodipine and diltiazem, which may need dose adjustments.
Bring a complete list of your medications to your doctor or pharmacist before starting Paxlovid. This isn’t a formality. Some of these interactions can cause life-threatening complications.
Over-the-Counter Medications for Symptoms
If you’re managing COVID at home, over-the-counter drugs won’t shorten the illness, but they can make you significantly more comfortable. Here’s what works for the most common symptoms:
- Fever, headache, and body aches: Acetaminophen (Tylenol) at 500 mg every four hours or 1,000 mg every six hours, up to a maximum of 3,000 mg in 24 hours. Ibuprofen (Advil, Motrin) at 200 to 400 mg every four to six hours also works, with a maximum of 1,200 mg per day for over-the-counter use.
- Cough: Dextromethorphan, labeled as “DM” on most cough medicines, suppresses the cough reflex in your brain. If your cough is producing mucus and you want to clear it out rather than suppress it, guaifenesin (the active ingredient in Mucinex and Robitussin) loosens and thins mucus in your airways.
- Sore throat and chest congestion: Honey, either on its own or mixed into chamomile tea with lemon, can help relieve cough and loosen chest congestion. This is a simple remedy that genuinely works for mild symptoms.
If you’re using a liquid cough medicine, use the dosing cup that comes with the bottle. Household spoons are unreliable and can lead to over- or underdosing.
Hydration and Rest
Fever burns through fluids faster than you might expect. Sweating, reduced appetite, and simply breathing harder all contribute to dehydration, which makes fatigue and headaches worse. Aim for at least 64 to 70 ounces of water per day. If you’ve been running a fever, a half-and-half mix of water and an electrolyte sports drink (like Gatorade or Powerade) helps replace the sodium and potassium you’re losing through sweat.
Avoid alcohol and caffeinated drinks, both of which pull water out of your system. Be especially cautious with anything labeled as an “energy drink,” since these are often loaded with caffeine even when they’re marketed as hydrating.
Supplements: What the Evidence Shows
Vitamin D, zinc, and vitamin C are the three supplements people reach for most often during COVID. The evidence for all three is underwhelming. The NIH has reviewed the available clinical trial data and found that none of them meaningfully shortens the illness or reduces the risk of hospitalization.
Some observational studies have linked low vitamin D levels and low zinc levels to worse outcomes, but that’s a correlation, not proof that taking supplements fixes the problem. Randomized clinical trials testing high-dose vitamin D have generally not shown reductions in hospitalization, ICU admission, or death. The same pattern holds for zinc: a randomized trial called COVID A to Z found no benefit for symptom duration. For vitamin C, large trials found no improvement in survival or organ function in hospitalized patients, and there’s not enough data to support using it for milder cases either.
None of these supplements are harmful at standard doses, but they shouldn’t replace actual treatment if you’re eligible for antivirals.
COVID Rebound
Some people feel better for a few days and then experience a return of symptoms. This is called COVID rebound, and it happens whether or not you took antivirals. A large observational study found rebound rates of about 6.6% in people who took Paxlovid, 4.8% in those who took molnupiravir, and 4.5% in people who received no treatment at all. The differences were not statistically significant, meaning rebound is a feature of the virus itself, not a side effect of medication.
Rebound typically shows up 3 to 7 days after you start feeling better. In studies tracking viral levels, the median time to rebound was about 9 days after diagnosis, and symptoms generally resolved for good around day 16. If you experience rebound, it tends to be milder than the initial illness.
Warning Signs That Need Immediate Attention
Most COVID cases resolve on their own, but certain symptoms signal that your body isn’t coping well. If you have a pulse oximeter at home, an oxygen reading that stays at or below 92% means you need emergency help immediately. A resting heart rate at or above 120 beats per minute, or a breathing rate above 30 breaths per minute, are equally urgent.
Without a pulse oximeter, watch for these physical signs: difficulty breathing, blue-tinged lips or face, chest pain or pressure, confusion, skin that’s cold and clammy or unusually pale, fainting, very little urine output, or coughing up blood. Any of these warrant calling emergency services right away. Let them know you have COVID so they can prepare.