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? 

“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.” 

Start with Your Symptoms 

Not every cold medicine treats every symptom. Before you buy a medication, identify the symptoms that are bothering you most. 

Quick Guide to Cold Medicines by Symptom 

Best Cold Medicines for Nasal Congestion 

According to Dr. Hunley, two of the most effective options for nasal congestion include: 

Saline Nasal Spray 

• Helps relieve a stuffy nose by moisturizing and clearing nasal passages. 

• Typically well tolerated. 

• Drug interactions are generally not a concern. 

Pseudoephedrine 

• Often effective for more severe congestion. 

• May not be appropriate for people with high blood pressure, certain thyroid conditions or those taking some antidepressants. 

• Talk with your doctor or pharmacist before use. 

• Sold behind the counter and typically requires identification for purchase. 

Hunley notes that saline nasal spray is often underused despite being an effective option for congestion, and she recommends discussing pseudoephedrine use with a healthcare professional if you have underlying health conditions. 

Best Treatments for a Runny Nose 

If your symptom is a runny nose, an over-the-counter antihistamine may be helpful during the first days of a cold.  

Antihistamines  

• Typically used to treat allergy symptoms such as a 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 

Many cold medicines come in a daytime and nighttime formula it is important to be sure you are taking the correct formula at the correct time of day to avoid unwanted drowsiness. Daytime cold medicines are typically formulated to relieve symptoms while helping you stay alert, while nighttime formulas may contain ingredients that promote drowsiness and help with rest. Always check the ingredients to choose the product that best fits your needs. 

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. 

For a productive cough: Guaifenesin 

• Helps loosen mucus and congestion so it can be cleared from the airways. 

• Works best when taken with plenty of water. 

• Often recommended when you’re coughing up mucus or drainage. 

For a dry cough: Dextromethorphan 

• Helps suppress a dry, persistent cough. 

• Can be especially helpful if coughing is making it difficult to rest or sleep. 

• Best suited for coughs that are irritating but not producing mucus. 

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 Treatments for a Sore Throat 

Throat sprays and lozenges 

• May provide temporary relief by numbing the throat. 

• Can be less effective if the medication doesn’t reach the back of the throat where soreness is often concentrated. 

Acetaminophen 

• Hunley says many people find acetaminophen to be an effective option for relieving sore throat pain. 

Multi-Symptom Cold Products 

Many cold medicines combine several ingredients into one product. 

While these medications may be convenient, experts recommend selecting products that treat only the symptoms you’re experiencing. Taking unnecessary ingredients can increase the risk of side effects without providing additional benefit. 

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 are often marketed as cold remedies, but Hunley says research shows they provide little benefit for most people. Zinc may cause side effects such as nausea or a bad taste, while vitamin C appears to offer only marginal benefits when taken consistently over time, not after symptoms begin.  

Natural Cold Remedies 

While many of us are quick to run to the pharmacy for cold medications, many natural remedies can provide relief. These natural remedies are especially helpful for young children because the U.S. Food and Drug Administration 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.