How to Choose the Best Cold Medicine, According to Medical Experts
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CHOOSING THE BEST COLD MEDICINE can be overwhelming. Drugstores are stocked with shelves and shelves full of options—including pills, liquids, and nasal sprays—that claim to treat different symptoms and contain different ingredients.
This cold season, you may have one less option, though. A U.S. Food and Drug Administration advisory panel recently said that over-the-counter oral phenylephrine is an ineffective nasal decongestant. Pharmacy chain CVS has said its removing some products with the ingredient from its shelves as a result.
Phenylephrine, which is found in many cold medicines, such as Sudafed PE and NyQuil Severe Cold, was thought to reduce swelling of nasal blood vessels, according to MedlinePlus. But doctors have been questioning its effectiveness for years.
“Oral phenylephrine isn’t very well absorbed by the body, so it doesn’t work for a lot of people,” says Stacia Woodcock, PharmD, pharmacy editor at GoodRx.
Still, if there’s a phenylephrine medication that does work for you, Woodcock says it’s fine to keep taking it, as “there’s no safety issue with the ingredient.” Also, she notes that the FDA didn’t include phenylephrine nasal sprays in its ruling, and they’re still considered effective for relieving nasal congestion.
“The FDA has not shared any new information regarding the future of these products and if the ingredient will be removed down the line. But either way, it won’t harm you to keep taking medications that contain phenylephrine,” Woodcock says.
But if products with phenylephrine don’t work for you—or you have cold symptoms beyond nasal congestion—there are some other other options out there. Here’s an overview of some of the best cold medicines, according to pharmacists and doctors, and when to see your doctor if your OTC medication isn’t working.
What’s the best cold medicine to take?
OTC cold medications are designed to treat specific symptoms, explains Jennifer Bourgeois, PharmD, a pharmacy and health expert at SingleCare. “So it's important to find the correct medicine in order to manage and relieve your symptoms.”
Here are some examples:
For times when you have a runny nose, sneezing, itchy eyes, and nasal congestion at the same time, try an antihistamine like Claritin or Zyrtec, or a steroid such as fluticasone (Flonase) or mometasone (Nasonex).
For nasal congestion and headaches, try a decongestant. Options include pseudoephedrine (Sudafed) or nasal sprays with oxymetazoline (Afrin) or phenylephrine (Neo-Synephrine).
For pain relief and to control fever, try acetaminophen (Tylenol) or ibuprofen.
For headaches, ibuprofen or Tylenol can help.
For coughs, dextromethorphan (Delsym) and guaifenesin (Mucinex) can help.
Phenylephrine nasal sprays, which aren’t included in the FDA ruling, are still considered effective for nasal congestion, Woodcock says. Just don’t use them for more than a few days in a row, or you risk rebound congestion, which causes nasal passage inflammation and can be tough to treat.
Another option is a saline nasal spray, which won’t put you at risk for rebound congestion or other side effects, says Keith Hopkins, M.D., a physician at Strive Health. Examples include Salinex or Hydrasense.
Pseudoephedrine, such as Allegra-D (which also contains an antihistamine) or Sudafed 12/24, is an alternative for phenylephrine to treat nasal congestion, Bourgeois says. Just note that you need an ID to buy it and can only purchase a certain amount at a time.
Throat lozenges, such as Halls or Ricola, can help reduce symptoms, too, Dr. Hopkins says. He recommends choosing the sugar-free options.
How to Choose a Cold Medicine
There are actually only a handful of ingredients in OTC cold medications, Woodcock says. So, it’s best to overlook the marketing claims on the packaging and read the list of ingredients.
“For example, two various medications from Mucinex will have the same exact ingredients, but one will be labeled as treating ‘cold, flu and sore throat,’ while the other will say it only treats ‘cold and flu,’” she says.
Some OTC drugs also combine different ingredients—so, you could end up taking too much of one ingredient if you’re layering up medicines, Bourgeois says.
For instance, some multi-ingredient OTC drugs may contain acetaminophen (Tylenol), so you wouldn’t want to take Tylenol by itself, too.
Cold Medicine Side Effects
Depending on the medication, some people may experience side effects such as nausea, restlessness, a rapid heart rate, rebound congestion, or increased blood pressure, Dr. Hopkins says.
If you have existing conditions such as heart disease, kidney disease, or high blood pressure, it’s best to talk to your doctor before taking cold medication, he says.
It’s also a good idea to check with your doctor or pharmacist about any potential drug interactions if you take prescription medication.
When to See a Doctor About Your Cold
OTC cold medicine can help treat many cold symptoms, but they don’t kill the viruses causing the symptoms, Woodcock says. They also don’t work for everyone.
If you’ve been taking the medications for 10 days without relief, see your doctor, Dr. Hopkins says.
“Headaches, dizziness, feeling tired all the time, and body aches are signals of the common cold as well as worsening of many chronic diseases,” he explains.
Also, if you have a prolonged fever above 102 degrees Fahrenheit, shortness of breath, or chest pain, call your doctor, Bourgeois says.
“As long as your symptoms are improving over time, there’s likely nothing to worry about,” Woodcock says. “That’s why rest and fluids are the key to a quick recovery when you’re sick.”
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