Most people with COVID recover at home using over-the-counter medications to manage symptoms like fever, body aches, and congestion. If you’re at higher risk for severe illness, prescription antivirals can reduce your chances of hospitalization, but they need to be started within the first five days of symptoms. What you should take depends on your risk level, your other medications, and how quickly you act.
Over-the-Counter Medications for Symptom Relief
COVID doesn’t have a cure you can buy at the pharmacy, but you can treat the symptoms that make you miserable. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are the two main options for fever, headaches, and body aches. Stick to the dosing instructions on the label. Higher doses of acetaminophen can damage your liver, and ibuprofen should be taken with food. If you have kidney disease or a history of stomach ulcers, ibuprofen may not be a good choice for you.
For coughs, you might be tempted to grab a cough suppressant off the shelf, but most OTC cough medications have not proven effective for COVID-related coughs. Honey in warm water or tea can soothe a sore throat and may do as much good as anything in the cough aisle. Nasal saline sprays or rinses can help with congestion.
Hydration Matters More Than You Think
Fever-induced sweating drains fluids and electrolytes faster than you might realize. Aim for at least 64 to 70 ounces of water per day. If you’ve been running a fever or sweating heavily, try mixing water half-and-half with an electrolyte sports drink like Gatorade or Powerade, or use a powdered electrolyte packet. Avoid alcohol and caffeinated drinks, which promote dehydration. Be especially cautious with anything labeled “energy drink,” as these typically contain large amounts of caffeine even when they claim to promote hydration.
Prescription Antivirals: Who Qualifies
Prescription antivirals are not for everyone. They’re recommended for people with mild or moderate COVID who have at least one risk factor for severe illness. Risk factors include being over 65 (with risk climbing significantly past 75), having multiple chronic medical conditions, being immunocompromised or on immunosuppressive medications like chemotherapy, and not being up to date on COVID vaccinations.
The first-choice treatment is Paxlovid, a pill taken twice daily for five days. It needs to be started as soon as possible and within five days of your first symptoms. The sooner you start, the better it works, so if you think you qualify, contact your doctor or a telehealth provider the same day you test positive.
Paxlovid has a serious limitation: it interacts with a long list of other medications. One of its ingredients blocks an enzyme your liver uses to process many common drugs, which can cause dangerous spikes in those drugs’ levels. Blood thinners, certain heart medications, cholesterol drugs, and some psychiatric medications can all interact. Your prescriber will need to review every medication you take before writing the prescription. Some medications can be paused for the five-day course; others make Paxlovid a no-go.
Alternatives to Paxlovid
If Paxlovid isn’t an option because of drug interactions or other reasons, remdesivir is the second choice. It’s given as an IV infusion over three days and must be started within seven days of symptom onset. This means visiting an infusion center, which is less convenient but still effective.
The third option is molnupiravir (Lagevrio), another oral antiviral used when neither Paxlovid nor remdesivir is appropriate. It must also be started within five days. In a large real-world analysis, molnupiravir reduced hospital admissions by about 38% and deaths by roughly 52% in adults 65 and older compared to no antiviral treatment.
What About Symptom Rebound?
You may have heard that Paxlovid causes symptoms to come back after treatment ends. Rebound does happen, but it’s not unique to the drug. Studies show rebound rates of roughly 5% to 14% in people who take Paxlovid, depending on how rebound is defined. The catch is that people who take no antiviral at all also experience rebound at rates between about 2% and 9%. One large retrospective study found no statistically significant difference: 6.6% rebound with Paxlovid versus 4.5% without treatment. So while rebound is real, it’s partly a feature of COVID itself, not just the medication.
If your symptoms do return after finishing antivirals, they’re typically mild and resolve on their own. You don’t need a second course of treatment.
Vitamins and Supplements
Vitamin C, vitamin D, and zinc have all been widely discussed as COVID treatments, but the evidence hasn’t backed up the hype. The NIH COVID-19 Treatment Guidelines do not recommend vitamin C for hospitalized patients and say there isn’t enough evidence to recommend it for non-hospitalized patients either. The same is true for vitamin D: not enough evidence to recommend it for preventing or treating COVID. For zinc, the NIH actually recommends against taking doses above the standard daily allowance for COVID prevention and says the evidence for treatment is similarly insufficient.
None of this means these nutrients are bad for you. Maintaining adequate vitamin D and zinc levels supports your immune system in general. But megadosing them once you’re already sick is unlikely to change your COVID outcome in any meaningful way.
Metformin and Long COVID Risk
One treatment that has shown a surprising benefit is metformin, a cheap, widely available diabetes drug. In a phase 3 clinical trial published in The Lancet Infectious Diseases, outpatient treatment with metformin reduced the incidence of long COVID by about 41% compared to placebo. By day 300 of follow-up, 6.3% of the metformin group had developed long COVID versus 10.4% in the placebo group. When metformin was started within three days of symptom onset, the benefit was even larger, cutting long COVID risk by roughly 63%.
This is not yet a standard recommendation, and metformin is a prescription medication. But if you’re concerned about long COVID and have risk factors, it’s worth discussing with your doctor, especially in the first few days after symptoms start.
Warning Signs That Need Immediate Attention
Most COVID infections are manageable at home, but some require emergency care. If you have a pulse oximeter, monitor your oxygen level. A reading of 90% or below is a medical emergency: call 911 or get to an emergency room. The tricky part is that low oxygen doesn’t always feel dramatic. You might just feel unusually tired, or you might feel nothing at all, which is why checking with a pulse oximeter matters.
Other warning signs include difficulty breathing, persistent chest pain or pressure, confusion, inability to stay awake, and pale or bluish lips or skin. These symptoms warrant an immediate call to emergency services regardless of what your oxygen reading says.