The Best Cold Medicines Aren’t Sold in the Cough and Cold Aisle.
When you feel terrible about a cold, you just want something to cure you—if not cure you, then at least make you feel temporarily better. Unfortunately, many medications are placebos , but some over-the-counter medications work better than others.
Before we talk about which medications are best, there is an important note to take into account: cold medications do not cure a cold or shorten its duration. If you’re reading this because you want to know how to get rid of a cold or what the doctor prescribed for you to get rid of a cold – sorry. Colds are caused by viruses, and there is no medicine that will kill them the way antibiotics kill bacteria . The purpose of cold medicine is to help you feel a little less miserable while you wait for your immune system to get the better of it.
Ignore brand name cold medicines.
Cold medicine companies rely on our dull memories. If you bought Sudafed (or Mucinex or Dyquil) the last time you had a cold, they hope you’ll buy the same thing this time, while store brand manufacturers hope you’ll buy something in the same color and think it’s good enough. But the brand name says almost nothing about what is actually inside the package.
Each of the major cold medicine brands sells a variety of products with completely different ingredients. Sometimes there are so many of them that the same brand sells the same item under two different names. My favorite example of this is the Mucinex maze of products: their maximum strength Fast-Max Severe Congestion and Cough has the same dosage and ingredients as their maximum strength Sinus-Max Pressure, Pain and Cough . Meanwhile, Sinus-Max Severe Congestion & Pain Maximum Strength , which sounds like it should be very similar to another Sinus-Max product, removes an ingredient associated with coughs and replaces it with some acetaminophen (that’s Tylenol). You will never successfully navigate the cough and cold aisle based on brand names and symptoms alone.
So where should you go instead? Well, for quick traffic relief, you’ll need the good stuff they keep behind the counter.
Pseudoephedrine (original Sudafed) is a good thing.
If you have a stuffy nose, pseudoephedrine is what you need. Previously, it could be found on store shelves. Sudafed was one brand name. (Sudafed, pseudoephedrine, get it?) But pseudoephedrine can be converted into methamphetamine , so a 2006 law restricted its sale. This is still an over-the-counter drug, but you will need to take the time to show the pharmacist your ID if you want to buy it.
Studies have shown that pseudoephedrine is effective in relieving nasal congestion. When you feel like your nose is “stuffed” with dried or sticky mucus, that’s not entirely true. The blood vessels in the nasal mucosa and sinuses swell, narrowing the airways . Pseudoephedrine constricts these blood vessels, reducing swelling and opening the airways so you can breathe easier.
(Pseudoephedrine also constricts blood vessels in other parts of the body, which is why it can increase blood pressure in some people and why it is sometimes used off-label for priapism , also known as prolonged erections.)
Anything with “PE” in the name is not worth buying.
Phenylephrine is a decongestant that has replaced pseudoephedrine in over-the-counter products. Phenylephrine, an ingredient in “PE,” has been known for many years to be unhelpful in treating cold symptoms when taken orally. This prompted two pharmacists to write an article in 2022 entitled “Why was oral phenylephrine brought to market after strong evidence of its ineffectiveness as a decongestant?”).
Phenylephrine is what is found in Sudafed PE . This is another case where brands mislead you: Regular Sudafed is good, but Sudafed PE has an ineffective ingredient. Don’t be fooled: anything with PE in the name won’t work.
Most cough medicines don’t work either.
But this isn’t the only cold medicine that probably does little to help your cold. The “active” ingredients in cough medicines are probably useless too. Dextromethorphan is considered a cough suppressant, although there is not enough evidence that it actually does its job. Guaifenesin, an “expectorant” designed to thin mucus and make coughing easier, also does not work. A Cochrane review concluded that there is not enough evidence to say whether these or any other over-the-counter cough medicines actually work.
By the way, according to the FDA, children under 4 years old should not use the cough or cold medications we’ve mentioned so far. Fortunately, home remedies such as drinking fluids and suctioning out snot with a syringe are safe and usually provide real relief.
Tylenol and ibuprofen may help with fever and pain
There is another category of over-the-counter medications that can actually help you feel better about your cold, although they are probably not what you think of when you think of cold medications.
Acetaminophen (regular Tylenol) and ibuprofen (Motrin or Advil) are known pain relievers and fever reducers. They are suitable for these purposes and are considered safe for use even by young children. However, the American Academy of Pediatrics warns that you should always contact your pediatrician about fever in a baby under 3 months of age and not give medications unless directed, as fever at this age can be life-threatening and should be evaluated at a health care facility.
If you’re used to looking at brand names, be sure to turn the package over and make sure it contains what you expect in the ingredient list. Regular Tylenol is just acetaminophen, but the company also makes Tylenol Cold and Flu , which contains all three ingredients mentioned above that do not help with colds or coughs. Advil makes a similar product . These are not the ones you need.
Another important note: Tylenol, or acetaminophen, is found in many cold medications as a mixture of ingredients. It is also potentially toxic if you take more than the recommended dose. If you are combining medications, make sure you do not take a double dose of this ingredient.
The best cough syrup is honey
So you have a decongestant that works (pseudoephedrine) and something to help control your fever and headache (acetaminophen or ibuprofen). Is there anything I can do about this nasty cough? There are, but you’ll want to leave the pharmacy aisles and head to the grocery shelves.
Honey won’t cure a cold, but it does seem to soothe a sore throat and relieve a cough, at least a little. Studies often show that it works better than over-the-counter cough syrups. (Is it because honey is great, or because cough syrups suck? Probably the latter, to be honest.) But don’t worry about honey-based cough syrups—yes, they’re a thing—just take some real honey and mix it with hot water or tea. It’s cheaper and easier.
By the way, an important warning about honey: honey is not considered safe for children under 1 year of age . There is a small risk of botulism, and infants are especially susceptible to it. Honey won’t help much , so it’s not worth the risk.
Children’s cold medicines are almost all scams
Almost every “children’s” cold medicine is garbage. Finally, products with decongestants and antihistamines are not considered safe for children under 4 years of age . But since you’re in the drug aisle anyway, “natural” brands are ready to fill that gap with a mixture of vitamins, honey, and herbal supplements. They don’t do anything either , but for some reason they cost about eight bucks a bottle.
But it gets worse. In both the children’s and adults’ sections you will find homeopathic remedies that are largely a scam and should be illegal . Be wary of anything that says “homeopathic” or that has ingredients measured in “X” or “C” rather than in actual units such as milligrams. These are not just natural supplements, as labels sometimes suggest, and homeopathy is not another word for a home remedy. Homeopathic “cures” are the beneficiaries of a bizarre loophole in FDA and FTC policy that allows them to be sold as drugs by claiming to work magic . I wish I could make this up, but I don’t. Save your money.