For most people with COVID-19, over-the-counter pain relievers, a cough suppressant, and plenty of fluids are enough to get through the illness at home. If you’re at higher risk for severe disease, a prescription antiviral taken within the first five days of symptoms can significantly reduce your chances of hospitalization. The right approach depends on your symptoms, your age, and your underlying health.
Over-the-Counter Medications for Symptoms
COVID-19 typically brings fever, body aches, sore throat, congestion, and cough. You don’t need anything specialized for these. Standard fever reducers and pain relievers, either acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), work well. A single dose can keep your temperature down for up to 12 hours and help with body aches. Follow the dosing guidelines on the label carefully, particularly with acetaminophen, which can cause liver damage if you take too much.
For the dry cough that COVID is known for, dextromethorphan (found in Robitussin and similar products) is the most targeted option. If your cough is producing mucus, guaifenesin (Mucinex) helps thin it out so you can clear it more easily. Lozenges and cough drops also provide temporary relief, especially for sore throat. Standard decongestants and antihistamines can help with nasal congestion and runny nose, just as they would for a cold.
Hydration and Rest
Staying hydrated matters more than most people realize during a viral infection. General recommendations call for about 15 cups of fluid daily for men and 11 cups for women under normal conditions, and illness increases that need. If you’re dealing with nausea or vomiting, don’t try to gulp large amounts. Take small sips of about an ounce every three to five minutes to rehydrate without overwhelming your stomach.
Water is fine, but drinks with electrolytes or hydrating powders that combine salt and sugar can be especially helpful if you’re sweating from fever or not eating much. Broth, diluted juice, and oral rehydration solutions all count. Avoid alcohol and limit caffeine, both of which can dehydrate you further.
Prescription Antivirals for High-Risk Patients
If you’re at higher risk for severe COVID-19, prescription antiviral treatment can make a meaningful difference. The key is timing: treatment needs to start within five days of your first symptoms to be effective. The sooner you start, the better it works.
The most commonly prescribed option is nirmatrelvir/ritonavir (Paxlovid), a pill you take twice daily for five days. It’s approved for adults and for adolescents over 12 who weigh at least 88 pounds. To qualify, you need mild to moderate COVID (not severe enough to require hospitalization) and at least one risk factor for progressing to severe illness. Your doctor will also check that you don’t have severe kidney or liver disease, since the drug is processed through both organs, and will review your other medications for interactions, which are common with this drug.
Molnupiravir (Lagevrio) is another oral antiviral option. A large meta-analysis covering more than 1.6 million patients found it reduced the risk of death by 55% to 65% within 28 days. Its effect on preventing hospitalization varied by age: the strongest benefit was seen in people with a mean age of 75 or older, while younger age groups saw less clear protection against hospitalization specifically.
Paxlovid Rebound
You may have heard about “Paxlovid rebound,” where symptoms return a few days after finishing the course. This does happen, typically 3 to 7 days after the initial illness resolves. But the rebound rate is lower than many people assume. A large observational study found rebound occurred in about 6.6% of people who took Paxlovid, compared to 4.5% of people who took nothing at all. Multiple studies have found no statistically significant difference in rebound rates between treated and untreated patients, suggesting that symptom recurrence is partly just how COVID-19 behaves. Rebound episodes are generally mild.
Who Counts as High Risk
The CDC considers you eligible for treatment if you’re 50 or older, or if you have a condition that increases your risk of getting very sick. The list of qualifying conditions is broader than many people expect. It includes:
- Chronic conditions: diabetes (type 1 or 2), chronic kidney disease at any stage, chronic liver disease, heart conditions including heart failure and coronary artery disease, and chronic lung diseases like moderate-to-severe asthma or COPD
- Immune-related factors: cancer (especially if on chemotherapy), HIV, organ transplant recipients on immunosuppressive medications, or any immunocompromising condition
- Other medical factors: pregnancy, cerebrovascular disease, dementia or other neurological conditions, cystic fibrosis, sickle cell disease or thalassemia, tuberculosis
- Lifestyle and body factors: BMI of 25 or higher (which includes both overweight and obese categories), current or former smoking, physical inactivity, substance use disorders
- Vaccination status: being unvaccinated or not up to date on COVID-19 vaccines
- Mental health conditions: mood disorders including depression, and schizophrenia spectrum disorders
That BMI threshold of 25 is notably low. It means a 5’9″ person weighing 170 pounds technically qualifies. Combined with how many conditions are on this list, a large portion of adults are eligible for antiviral treatment. If you’re unsure, contact your doctor or a telehealth service as soon as symptoms start. Don’t wait to see if you get worse.
Do Vitamins and Supplements Help?
Despite widespread interest in vitamin D, zinc, and vitamin C for COVID-19, clinical trials have not shown meaningful benefits. A randomized study gave people with mild COVID-19 either high-dose vitamin C (8,000 mg/day), zinc (50 mg/day), both, or neither. People receiving the supplements had no improvement in symptoms and no faster recovery compared to those who took nothing.
Vitamin D has a more complicated picture. Some observational studies found that people with lower vitamin D levels were more likely to test positive for COVID-19, but observational data can’t prove cause and effect. A randomized controlled study of people with moderate to severe COVID-19 who received high-dose vitamin D showed no benefit. One small study in high-risk elderly patients found lower death rates at 14 days with high-dose vitamin D, but this hasn’t been replicated at scale. If you’re deficient in vitamin D, correcting that deficiency is reasonable for your overall health, but taking large doses specifically to treat COVID-19 isn’t supported by current evidence.
Warning Signs That Need Immediate Attention
Most people recover at home without complications, but certain symptoms signal that the illness is becoming dangerous. If you have a pulse oximeter, an oxygen saturation reading below 90% is a medical emergency. Other warning signs include difficulty breathing or shortness of breath at rest, persistent chest pain or pressure, confusion or inability to stay awake, and pale, gray, or bluish skin, lips, or nail beds. Any of these warrant calling emergency services immediately rather than waiting for a doctor’s appointment.