People’s Pharmacy: When should you treat a fever?

Q. You’ve written that fever can boost the immune response, but a high fever should be treated. What is considered high? How should it be treated? I understand it is not good to treat every fever, but at what elevated reading should one take something?

A. There is no hard and fast rule about fever that holds in every circumstance. In a baby under 3 or 4 months old, parents should check in with the pediatrician for even a mild fever (a bit over 100 degrees).

For older children and adults, other symptoms might be more significant. If a child is playing, eating and drinking normally, even a fever as high as 102 might not need treatment. The American Academy of Pediatrics states: “It should be emphasized that fever is not an illness but is, in fact, a physiologic mechanism that has beneficial effects in fighting infection” (Pediatrics, March 1, 2011).

According to the Mayo Clinic, you should check with the doctor if a toddler is irritable, lethargic and uncomfortable or if the temperature goes over 102. The experts there use 102 as the cutoff even for adults. If the fever lasts for days (even if it is not as high as 102) or the person feels ill, a doctor should be consulted.

For treating a fever, acetaminophen (APAP, Tylenol), ibuprofen (Advil, Motrin IB) or naproxen (Aleve) can work. Adults can take aspirin, but children should not receive it.

Q. My doctor started me on atorvastatin in 2006 because my cholesterol was hovering around 200. I am a data analyst and by the end of the second week, nothing on my computer screen made any sense. For example, I couldn’t hold a thought about programming long enough to trace a formula back to source data.

I couldn’t work, so I couldn’t possibly stay on the statin. I don’t think I had any of the other side effects, but I was so distressed about all of a sudden becoming “stupid,” I might not have noticed. My cholesterol did go down, but I coped better when it was higher. It only took a couple of days before I started to come out of the brain fog.

A. Whether cognitive impairment is a side effect of statins is a very controversial question. An analysis in “Nature Reviews Cardiology” (December 2018) concluded the evidence overall “does not indicate an association between statin use and cognitive dysfunction.”

According to the official prescribing information, though, “There have been rare postmarketing reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use.”

To learn more about statin side effects in general and cognitive problems in particular, you may read our book “Top Screwups.” It is available at peoplespharmacy.com.

Q. You wrote about valacyclovir for cold sores, and I’m glad you did. My dermatologist prescribed it about 10 years ago, and the drug changed my life. I’d suffered with horrid cold sores since I was a little girl.

Now I keep two valacyclovir pills in my purse. That way, I have them handy at the first “tingle,” which I’ve learned to recognize. If I take them immediately, I have zero cold sore. It’s a miracle drug for me.

A. Thank you for sharing your experience. Valacyclovir (Valtrex) and similar antiviral drugs can be highly effective against herpes simplex infections.