Most people with the flu recover using over-the-counter medications to manage fever, aches, cough, and congestion. Prescription antivirals are available and work best when started within 48 hours of your first symptoms. The right combination depends on your specific symptoms, your age, and whether you’re at higher risk for complications.
Over-the-Counter Options by Symptom
No single pill treats every flu symptom. Most people do best by matching their medication to whatever is bothering them most, rather than reaching for a multi-symptom product that may include ingredients they don’t need.
For fever and body aches, acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are the two main choices. Both lower fever and relieve the muscle soreness that makes the flu feel so miserable. You can use either one alone, or combination tablets that contain both are available for adults and children 12 and older. One important rule: never give aspirin to children or teenagers with the flu. Aspirin during a viral illness is linked to Reye’s syndrome, a rare but potentially fatal condition that causes swelling in the liver and brain.
For cough, dextromethorphan (the “DM” on many cough medicine labels) is the most widely used cough suppressant. It works throughout your body to quiet the cough reflex. Topical options like menthol or camphor chest rubs and lozenges can also help by soothing the throat and airways directly. If your cough is producing mucus, a cough suppressant may not be ideal since coughing helps clear your lungs. An expectorant like guaifenesin can thin mucus and make it easier to cough up.
For nasal congestion, pseudoephedrine (Sudafed, kept behind the pharmacy counter) is the more effective oral decongestant. Nasal sprays containing oxymetazoline (Afrin) work faster and more directly but shouldn’t be used for more than three consecutive days, as they can cause rebound congestion that’s worse than what you started with. Oral phenylephrine, found in many products on the shelf, has come under scrutiny for limited effectiveness at standard doses.
Prescription Antivirals
Unlike over-the-counter medicines that only manage symptoms, prescription antivirals actually fight the flu virus itself. There are four FDA-approved options currently recommended by the CDC, and all must be started within two days of symptom onset to be effective.
Oseltamivir (Tamiflu) is the most commonly prescribed. It’s a pill or liquid taken twice daily for five days and is approved for anyone 14 days and older. It works by blocking a key enzyme the virus needs to spread from cell to cell in your body.
Baloxavir (Xofluza) has a significant convenience advantage: it’s a single pill, taken once. That’s the entire treatment. It’s approved for people 5 and older and works through a different mechanism, interrupting the virus’s ability to copy its genetic material. Dosing is based on body weight: one 40 mg tablet for people under about 176 pounds, and one 80 mg tablet for those above that weight.
Zanamivir (Relenza) is an inhaled powder approved for ages 7 and up. Because it’s inhaled, it’s not appropriate for anyone with asthma, COPD, or other breathing problems.
Peramivir (Rapivab) is given as a single IV infusion at a healthcare facility. It’s approved for people 6 months and older and is typically reserved for situations where someone can’t take medication by mouth.
The 48-Hour Window
All four antivirals are approved for use within two days of when symptoms start. The earlier you begin treatment, the more effective it is. If you wake up with sudden onset of high fever, chills, and body aches during flu season, that’s the time to call your doctor or visit an urgent care clinic, not wait several days to see if it passes.
That said, the 48-hour window isn’t an absolute cutoff for everyone. Some evidence suggests hospitalized patients may still benefit from antiviral treatment started after 48 hours. The window matters most for otherwise healthy people with uncomplicated flu.
Who Should Prioritize Antivirals
Antivirals are most important for people at higher risk of serious flu complications. This includes adults 65 and older, children under 5 (especially under 2), pregnant women, and people with chronic conditions like asthma, heart disease, diabetes, or weakened immune systems. If you fall into any of these groups, getting a prescription quickly can be the difference between recovering at home and ending up in the hospital.
For healthy adults and older children, antivirals can shorten the illness by a day or so and reduce severity. Whether that’s worth pursuing depends on the situation, but the option exists if you act within the first 48 hours.
Flu Treatment During Pregnancy
Pregnant women are considered high priority for antiviral treatment. Oseltamivir is the preferred choice at any stage of pregnancy because it has the most safety data available. Multiple observational studies have found no increased risk of adverse outcomes for the pregnancy or baby. Treatment is also recommended for women up to two weeks postpartum, including after pregnancy loss.
Baloxavir (Xofluza) is not recommended during pregnancy or while breastfeeding because no safety or efficacy data exist for these populations. For fever and pain relief during pregnancy, acetaminophen is generally the go-to option, as ibuprofen carries risks in certain trimesters.
Staying Hydrated While You Recover
Flu causes fluid loss through fever, sweating, and sometimes vomiting or diarrhea. Adults between 18 and 64 should aim for 9 to 12 cups of fluid daily during recovery. Adults 65 and older need about 6 to 8 cups. Water is fine, but drinks with electrolytes (sports drinks, broth, oral rehydration solutions) help replace what you’re losing more effectively.
Watch for signs of dehydration: dry mouth, dizziness or weakness, dark urine, urinating less frequently, or muscle cramping. If vomiting or diarrhea lasts longer than 24 to 48 hours, or you simply can’t keep enough fluids down, that’s a signal you may need medical attention for rehydration.
What Not to Take
Aspirin is off-limits for anyone under 19 with the flu. Reye’s syndrome, though rare, can cause lasting brain damage or death. Use acetaminophen or ibuprofen for fever and pain in children and teenagers instead.
Two older antiviral drugs, amantadine and rimantadine, are still technically FDA-approved but are no longer recommended. Circulating flu strains have developed such high resistance to these medications that they’re essentially useless against current viruses.
Antibiotics do nothing against the flu. The flu is caused by a virus, and antibiotics only kill bacteria. Taking antibiotics unnecessarily contributes to resistance and can cause side effects with no benefit. The exception is if you develop a secondary bacterial infection on top of the flu, like bacterial pneumonia or a sinus infection, which your doctor would diagnose separately.