How to Choose the Best Cold Medicine

You’ve experienced the symptoms. You’re going about your daily activities, and notice you’re getting a scratchy throat, or that you’re feeling a bit “achy.” Pretty soon you have nasal congestion or a runny nose. You might be sneezing. Maybe you have a cough or a headache as well, or you feel a bit feverish. Looks like you have a cold. How do you choose the best cold medicine for your symptoms?

More than 200 respiratory viruses can cause colds, according to the Centers for Disease Control and Prevention. Rhinoviruses are the most frequent cause of colds in the U.S. Most cause mild symptoms that don’t need medical attention, but they can also cause severe illness, especially if you have a weakened immune system.

There is no vaccine, treatment or medicine to prevent or cure illnesses caused by rhinoviruses. But there are many products available without a prescription (over-the-counter) that offer symptom relief. The choices can be confusing – decongestants, antihistamines, cough suppressants, expectorants, analgesics, etc. How do you choose the best product for your needs?

“It’s always important to consider the symptoms you have and the medications you take on a regular basis,” says Dani Hunley, Pharm.D., a pharmacist for Covenant Health. “While you want to treat the symptoms, you must be mindful of the potential for drug interactions. It’s always best to speak with a pharmacist when you are selecting an over-the counter product.”

Best Cold Medicines for Stuffy Noses

“There are two products that typically work best for a stuffy nose or congestion,” Hunley says. “Saline nasal spray is highly underused, but it’s effective for relieving a stuffy nose. Saline nasal sprays are typically well-tolerated, and drug interactions are not a concern.

“For a more severe stuffy nose, pseudoephedrine products are quite effective. It’s important to discuss pseudoephedrine use with your physician if you have high blood pressure, certain thyroid conditions, and if you take certain medications for depression. You’ll want to consult with your doctor or pharmacist before using this type of product,” she cautions.

While a prescription is not required, the Food and Drug Administration notes that pseudoephedrine is sold “behind the counter,” in limited quantities, and the purchaser typically must show an ID.  

Best Cold Medicines for Runny Noses

If your symptom is a runny nose, an over-the-counter antihistamine may be helpful during the first days of a cold. Antihistamines typically are used to treat allergy symptoms such as runny nose and itchy, watery eyes. They work by blocking a component called histamine that causes an allergy response, so they are generally most helpful when taken with other cold medications.

If you are taking antihistamines, be aware that first-generation antihistamines (anticholinergic drugs) may be more effective for colds, but also have the potential for excessive drowsiness and may be a risk factor for dementia with long-term use.  

Daytime vs. Nighttime Cold Medicines

Cold medicines designed for daytime use may include ingredients that are stimulating, such as a decongestant, while nighttime medications may include medications that cause drowsiness, like some antihistamines. For restful nighttime sleep, check ingredients in the medicine you have chosen to make sure they won’t keep you awake.

Best Cold Medicine for Fever and Aches

“Typically, we recommend an analgesic such as acetaminophen for fever and reserve anti-inflammatory medications like ibuprofen for conditions that are inflammatory in nature. These conditions are often characterized by redness, swelling, pain or warmth. Anti-inflammatories can also be used for fevers that have not responded to acetaminophen,” Hunley says. “Speak with your physician about any medical conditions that may cause your typical ‘go-to’ therapy to be one product over another, such as kidney or liver disease.” If your fever is not responding adequately to these medications, seek medical attention.

Best Cold Medicine for a Cough

“The type of cough medicine to choose depends on whether you want the cough to be ‘productive’ and move drainage and congestion out, or whether you need to suppress a dry, ‘hacky’ cough that is bothersome and not necessarily productive,” Hunley says.

She says that products containing guaifenesin are best for productive cough. These products need to be taken with plenty of water to maximize their efficacy. Cough suppressants such as dextromethorphan are helpful for dry coughs, especially if the cough is affecting your ability to sleep or rest. Again, be sure to check with your doctor or pharmacist to make sure there are no concerns about drug interactions between these medications and the medicines you take on a regular basis.

Best Cold Medicine for a Sore Throat

“There are several throat sprays and lozenges that lessen the pain of a sore throat by numbing the area,” Hunley says, “However, these are not always effective. It’s difficult to get the medication to the back of the throat, or people discontinue use when their mouth also becomes numb from these products. She says most people will find acetaminophen to be an effective medication for sore throat pain.

Multi-Symptom Cold Products

“The biggest concern with multi-symptom products is taking a medication you do not need because you don’t have every symptom the product treats,” Hunley says. “Additionally, you may be duplicating ingredients without realizing it. For example, many multi-symptom products contain acetaminophen. You would need to be careful to avoid taking acetaminophen separately for a headache or fever until the appropriate time interval has passed.” If you are using a multi-symptom product, be sure to read all the ingredients carefully to avoid taking too much of a medication.

Regardless of which product you choose – whether it is a medicine to address a single symptom or a multi-symptom product – always read the product labeling CAREFULLY and follow dosing instructions on the packaging. Consult your doctor or pharmacist with any questions and concerns about potential drug interactions.

Less-Effective Cold Remedies

Recently, randomized studies and reports by the FDA and the American Pharmacists Association have shown that phenylephrine, which is included as a nasal decongestant in many cold and flu medications, is not effective at relieving nasal stuffiness. While it is still considered a generally safe medication, alternatives may be needed to help with decongestion.

Zinc and vitamin C supplements are often promoted as being effective for reducing cold symptoms and duration. However, Hunley says many studies show little-to-no impact from either of these products.

“Zinc doses required for even a small potential impact are often accompanied by unpleasant side effects like bad taste or nausea,” she says. “And the potential benefits of vitamin C on cold symptoms and duration come from consistent daily supplementation, not from taking vitamin C at the onset of cold symptoms. Even with daily supplementation, the impact on the severity and duration of cold symptoms is marginal.”

Natural Cold Remedies

While many of us are quick to run to the pharmacy for cold medications, there are many natural remedies that can provide relief. These natural remedies are especially helpful for young children. The American Academy of Family Physicians warns that cold and cough medicines should NOT be given to children younger than age 4.

Helpful natural symptom relievers can include: 

• drinking plenty of fluids.
• getting extra rest.
• gargling with warm salt water to ease a sore throat.
• using honey to soothe a sore throat or suppress a cough. It can be used alone or combined with lemon or cinnamon in warm water or tea. NOTE: Do not give honey to children under 1 year of age.
• breathing in steam or using a vaporizer or humidifier to help relieve congestion.

When to Seek Medical Attention

According to the CDC, most adults recover from a cold in about 7-10 days. Colds in children can last up to two weeks. The cough from a chest cold, which affects the lower airways and lungs, can last for up to three weeks. Most of the time, people recover from colds with no aftereffects. 

You may need medical attention if you do not improve, or if you notice these symptoms:

• Fever or other symptoms that last longer than 10 days without improvement, or that go away and then return
• Wheezing, shortness of breath or fast breathing
• Dehydration
• A cough with foul-smelling or blood-streaked phlegm
• Severe sinus pain or headache
• Severe sore throat

If your cold is not getting better, Covenant Health’s network of primary care physicians and urgent care centers can help. Visit CovenantHealth.com to learn more about our healthcare services and to find a doctor or clinic near you.