Key takeaways
Tamiflu, a medication used to treat the influenza virus, is not available over the counter due to concerns about potential misuse and side effects.
The best over-the-counter alternatives to Tamiflu include pain relievers and fever reducers, decongestants, cough suppressants, antihistamines, and expectorants.
Several prescription medications, such as Relenza, Xofluza, and Rapivab, are alternatives to Tamiflu.
Tamiflu (oseltamivir) is a prescription antiviral medication used to treat influenza (the flu) in people two weeks of age and older who ideally have had flu symptoms for no more than two days. Healthcare providers also prescribe the medication to reduce the chance of getting the virus in high-risk individuals exposed to the virus. Tamiflu is not currently available as an over-the-counter medicine; however, alternatives, such as pain relievers, decongestants, and cough suppressants, may offer symptom relief.
Can you get Tamiflu over the counter?
According to Morris Nejat, MD, a physician specializing in adult and pediatric allergy and immunology, and the medical director of NY Allergy and Sinus Centers in New York, there is no over-the-counter Tamiflu available. “It’s specifically indicated for influenza and only recommended in certain cases where the risks of complications outweigh the benefits,” he explains.
Another reason Tamiflu is not available over-the-counter is the need for an accurate diagnosis of influenza. “Influenza is a contagious disease I see often,” Dr. Nejat says. “I can make the diagnosis through testing or simply through clinical presentation. Then I determine the risks and benefits of taking Tamiflu versus just letting the disease run its course. I base this decision on age, any medical conditions, duration of illness, and other risk factors for adverse effects of untreated influenza versus side effects of Tamiflu.”
Other reasons you cannot get over-the-counter Tamiflu include the following:
- Narrow time frame for best effectiveness: Antiviral drugs like Tamiflu work best when used within one to two days after the onset of flu symptoms. A healthcare provider’s assessment and prescription can ensure you get the most benefits at the right time.
- Potential for misuse or overuse: If Tamiflu were sold over the counter, there’s a risk that people may misuse or overuse the drug for illnesses outside of the flu. This could not only make the medication ineffective but may also cause the development of drug-resistant influenza viruses and potentially lead to serious adverse events in children and teenagers, such as seizures, confusion, or abnormal behavior.
- Potential side effects: As Dr. Nejat mentions, there are several side effects of Tamiflu. The most common side effects are nausea, vomiting, and headache, while more serious side effects include delirium, abnormal behavior, anaphylaxis (severe allergic reaction), and arrhythmia (irregular heartbeat).
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Tamiflu OTC substitutes
While Tamiflu isn’t available over-the-counter (OTC), there are several other medications you can pick up at your local pharmacy or convenience store to relieve flu symptoms.
Below are the most common OTC Tamiflu substitutes:
Pain relievers and fever reducers
Ben Gibson, PharmD, PAHM, a licensed pharmacist, fundamental medicine specialist, and best-selling author in San Antonio, Texas, recommends the following over-the-counter pain and fever medications for influenza:
- Acetaminophen (Tylenol)
- Naproxen (Aleve)
- Ibuprofen (Advil, Motrin)
Acetaminophen, also known as paracetamol, can help alleviate mild to moderate pain associated with the flu, such as headaches and muscle aches, and reduce fever. An animal study involving mice revealed that paracetamol is a safe and effective drug for both relieving flu symptoms and reducing lung inflammation caused by the virus.
Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen can have similar effects on relieving the flu as acetaminophen. Research shows NSAIDs can reduce fever in both children and adults. However, researchers couldn’t conclude that pain relief medications could help relieve cough.
One NSAID typically not recommended for managing flu symptoms is aspirin; however, it may be helpful in certain situations. “I wouldn’t suggest aspirin because I believe the benefit would be outweighed by risk, but if one wants to use it, one may,” Dr. Gibson says. “One patient took 81 milligrams (mg) every night with a snack and claimed it reduced pain, and the person fell asleep better.”
Children should not be given aspirin. “Aspirin should be avoided, especially in children, because it can cause serious side effects like Reye’s Syndrome,” Dr. Nejat says. Reye’s syndrome is a rare but serious illness that causes swelling in the brain and liver.
Decongestants
Dr. Gibson recommends over-the-counter decongestants, such as oxymetazoline (Afrin), phenylephrine nasal spray (Neo-Synephrine, Nasal Four), and pseudoephedrine (Sudafed), to relieve nasal congestion caused by the flu. These medications should be reviewed with a healthcare provider, such as a physician or pharmacist, to ensure they do not interact with any other medications you may be taking or concurrent health conditions.
Cough suppressants
For a cough associated with influenza, cough suppressants like dextromethorphan (Robitussin DM, Delsym) can reduce the urge to cough, especially for dry or hacking coughs. These drugs help reduce sensitivity to the cough reflex, thereby reducing the frequency of coughs.
While cough suppressants are a common go-to for reducing flu symptoms, there’s limited research that supports their effectiveness against the virus. Some researchers advise against its use entirely.
Antihistamines
Antihistamines are medications that help relieve allergy symptoms by blocking the effects of histamines, chemicals released by the body during allergic reactions. This type of medication may alleviate certain flu symptoms, such as a runny nose, congestion, swelling, sneezing, and itchy, watery eyes.
Dr. Gibson lists the following as antihistamines that can be used to manage flu symptoms:
- Fexofenadine (Allegra, Mucinex)
- Azelastine (Astepro Allergy)
- Diphenhydramine (Benadryl)
- Cetirizine (Zyrtec)
- Loratadine (Claritin, Alavert)
Older adults and people taking medications that cause dizziness, balance issues, or drowsiness should use caution when taking antihistamines.
Expectorant
Guaifenesin (Mucinex) is a common expectorant medication that can help thin and loosen mucus from flu-related chest congestion, allowing you to cough more effectively.
Research shows that guaifenesin is a safe and effective expectorant for treating mucus-related symptoms in upper respiratory conditions, such as those caused by the influenza virus, in patients.
Natural remedies
In addition to prescription and over-the-counter medications, there are a few natural remedies that may help with the treatment of influenza.
Here are the most common remedies to relieve flu symptoms:
- Drink plenty of fluids: Drinking water, juice, broth, or warm lemon water with honey can reduce congestion, thin mucus, and keep you hydrated.
- Get plenty of rest: Resting can help speed up recovery.
- Try a saltwater gargle: Adding ¼ to ½ teaspoon of salt to an eight-ounce glass of warm water can help relieve a sore throat.
- Drink warm liquids: Tea, soup, and warm apple juice can help ease stuffiness while increasing the flow of mucus to relieve some discomfort from the influenza virus.
- Add cool moisture to the air: Using a cool-mist vaporizer or humidifier can add moisture to your home.
Prescription Tamiflu alternatives
If you visit your healthcare provider and are diagnosed with the flu, depending on the duration and the severity of your symptoms, they may prescribe one of the following alternative medications if Tamiflu is not the right fit for you:
- Relenza (zanamivir): An oral inhalation antiviral medication that treats and helps prevent influenza types A and B, and prophylaxis.
- Xofluza (baloxavir marboxil): Antiviral drug that treats the flu in patients who’ve had flu symptoms for 48 hours or less.
- Rapivab (peramivir) ): Antiviral medication that treats acute, uncomplicated influenza in patients who’ve been symptomatic for ideally no more than two days; as this medication is only available intravenously, it is generally reserved for those unable to take oral or inhalation alternatives
“Sometimes people are prescribed albuterol (ProAir HFA, Proventil HFA, Ventolin HFA) for breathing,” Dr. Gibson says. “That is much more common than theophylline, which has a narrow therapeutic index before its toxicity outweighs its benefits.
If you have questions or concerns about Tamiflu or other medications for treating the flu, please consult your healthcare provider.
- Tamiflu: Consumer questions and answers, U.S. Food and Drug Administration (2017)
- Self-care for the flu, Mayo Clinic (2024)
- Paracetamol reduces influenza-induced immunopathology in a mouse model of infection without compromising virus clearance or the generation of protective immunity, BMJ Journals (2011)
- Nonsteroidal anti-inflammatory drugs in acute viral respiratory tract infections: An updated systematic review, Pharmacology Research & Perspectives (2022)
- Reye’s syndrome, Mayo Clinic (2024)
- Colds and flu – Treating with medication, University of Michigan (n.d.)
- Systematic review of randomised controlled trials of over-the-counter cough medicines for acute cough in adults, The BMJ (2002)
- Options for relieving cold, flu and COVID-19 symptoms, Mayo Clinic (2022)
- Expectorant, Cleveland Clinic (2021)
- Role of guaifenesin in the management of chronic bronchitis and upper respiratory tract infections, Multidisciplinary Respiratory Medicine (2017)
- Cold remedies: What works, what doesn’t, what can’t hurt, Mayo Clinic (2024)
- Ben Gibson, PharmD, PAHM
- Morris Nejat, MD of NY Allergy and Sinus Centers