Overwhelmed in the cold remedy aisle? BYU researchers help choose medicine that works

You’re standing in a store aisle looking at a shelf that’s as packed with cold remedies as your throat is filled with phlegm. It hurts. Your sinuses are stuffed and you have a cough that comes and goes — sometimes violently.

It’s cold season and you caught one, which means it’s not the best time to try to decide which of the dozens of cold remedies in front of you will genuinely provide some relief.

A trio of Brigham Young University researchers are pretty sure they can help. They’ve been studying ingredients in cold medicines and looking at dozens of studies to see what’s effective and what isn’t. Their research was just published in JNP, the Journal of Nurse Practitioners.

It’s all about the recipe, or rather, the ingredient list, according to Katreena Merrill, a registered nurse with a doctoral degree who is a professor in BYU’s College of Nursing, and Beth Luthy, who has a doctorate-level nursing degree and is a professor and associate dean in the college. Those two and nurse practitioner Elizabeth Edwards, who was a graduate student at the time of the research, co-wrote the study.

The researchers relied on the U.S. News and World Report 2023 pharmacist survey to identify the most highly recommended over-the-counter cold medications, reviewing 388 articles written about the active ingredients and effectiveness in cold symptom relief. Then they looked at 26 articles to see the strength and quality of the evidence for antitussives, decongestants and antihistamines — all commonly used to treat symptoms of a cold.

“This is such an important topic. The cold medication aisle at the store can be overwhelming for the patient,” Luthy told the Deseret News. “There are brand names, generic names and different combinations of medications. If the patient isn’t paying close attention to what is on the label they could inadvertently take too much of a medication or take a medication that could make another one of the patient’s conditions worse.”

Luthy sees another challenge, as well. “Then there is the problem of knowing which medications work the best for each specific symptom. The fact that this article specifies which medications are best for cough and nasal symptoms is really helpful for consumers, especially this time of year.”

Checking the ingredients

So what do you choose?

For coughs, you need something containing dextromethorphan, which is a cough suppressant in multiple popular nonprescription drugs. The second option is guaifenesin — but there’s much less research evidence to back up its effectiveness, Merrill said.

Sore throats are usually caused by postnasal drip, so medicine that gets rid of congestion or a runny nose often helps a sore throat.

Sinuses are a bit trickier. Are they congested? Runny? For packed sinuses, something with pseudoephedrine is ideal, but it’s probably behind the pharmacy counter and you’ll have to ask for it and provide some identification since it’s an ingredient that can be used to make methamphetamine. It’s sold without a prescription, but precautions are being taken to help spot people who may be buying too much of it, which could be associated with criminal activity.

A runny nose benefits more from an antihistamine, a type of drug that is also used to counter allergies. For nighttime, the researchers say studies suggest a product containing diphenhydramine, chlorpheniramine maleate, or doxylamine succinate, since they also make people a bit drowsy. In the daytime, look for antihistamines that don’t make you sleepy.

Merrill said to pick the symptom that’s bothering you the most and go for that ingredient first. But if you have multiple symptoms, seek out the medicine that has effective ingredients for each of them. Merrill noted, however, that their research didn’t look at combination products, just single active ingredients.

More to think about

Brigham Young University published a Q & A with Merrill that looks at the difference between generic and brand-name over-the-counter medicines and that offers advice for deciding what to do.

She told the Deseret News that one of the first steps in treating a cold is recognizing colds are caused by a virus, not bacteria, so antibiotics are worthless. That’s also true of flu, COVID-19 and respiratory syncytial virus, so none of the respiratory illnesses circulating right now benefit from pressing a doctor for an antibiotic prescription. Merrill said people can be quite demanding when they’re miserable and want to feel better. But it doesn’t help and it empowers bacteria, which can grow stronger and resistant to antibiotics. That’s a concerning medical fact worldwide.

Merrill also noted that many OTC medicines use the same active — and hopefully effective — ingredient, but possibly in different amounts. Paying attention to the ingredient panel on the product is vital.

It’s also very important, Merrill said, to make sure you don’t overdo acetaminophen or ibuprofen by taking it separately if it’s also an ingredient in cold medication, which is common. Acetaminophen — Tylenol — is a particularly common ingredient, but too much of it can lead to liver damage and serious health consequences. Too much ibuprofen can cause kidney damage.

The advice on OTC medications for colds, Merrill said, is meant for those who are adults, not pregnant and not elderly. She said people need to remember that children are not small adults who can simply take a small portion of medicines formulated for adults. They need medicine formulated for their age group.

Because name-brand medicines can be expensive, “I go to generic drugs and see if I can’t find the same ingredient,” Merrill said. But she acknowledges that when you don’t feel good, that’s sometimes hard to do.

The researchers didn’t look at the effectiveness of home remedies or nondrug options. But she doesn’t discount them, she said. “Medications don’t mean that old tried-and-true stuff doesn’t work. When it comes to symptom management, if you feel better and it’s not harmful, that’s fine.”