How to Pick an Over-the-Counter Cold Remedy

When you have a cold, it can be hard to sort through the dizzying array of over-the-counter cold medications.

But many cold medications contain just a few types of drugs. The key is to check the list of ingredients and match the right drug to your symptoms.“Assess what’s bothering you the most, and then target the medication that’s appropriate for the symptom,” says William J. Hueston, MD, professor in the Department of Family Medicine at the Medical University of South Carolina in Charleston. “Make sure you understand what the medicine is for before you buy it.”Here’s a guide to over-the-counter cold medications for adults (not kids!).

NSAIDs

What they are:
Nonsteroidal anti-inflammatory drugs (NSAIDs) fight inflammation and reduce fevers, so they are a good choice if you have a sore throat, headache, muscle aches, or fever. They include ibuprofen (Advil), aspirin, naproxen and (Aleve), among others. Many combination cold medications include an NSAID.

Reasons to avoid:
If you’re already taking some form of NSAID for blood clots, rheumatoid arthritis, or another condition, you should talk to your doctor before taking NSAIDs for cold relief. NSAIDs can upset your stomach, so they’re not the best choice if you have acid reflux or gastric ulcers, or are taking another medication that affects the stomach. NSAIDs also can be asthma triggers in between 10 to 20% of people with asthma.

Acetaminophen

What it is:
Acetaminophen, the active ingredient in Tylenol, is also found in many cold medications. It’s a good choice if you have a fever or aches and pains. “Tylenol can often be less upsetting to the stomach than NSAIDs,” Dr. Hueston says. You can also take acetaminophen safely with a decongestant or cough medication.

Reasons to avoid:
People who consume an excessive amount of alcohol or who have liver problems such as hepatitis or cirrhosis should not take acetaminophen. Don’t take more than the recommended dose or combine acetaminophen-containing products because of the risk to your liver.

Antihistamines

What they are:
Antihistamines help allergy-related symptoms like runny nose, sneezing, watery eyes, and itching. There are many different kinds, including diphenhydramine (Benadryl), brompheniramine (Dimetapp), and loratadine (Claritin). If you have a cold, the drugs’ side effects may help you sleep, but they aren’t the best choice for cold symptoms, Dr. Hueston says. “Even when you take combination medicines, antihistamine is not the ingredient that’s helping you.”

Reasons to avoid:
Drowsiness and sedation caused by some antihistamines (Benadryl, Dimetapp) can interfere with work, driving, and other daily activities.

Decongestants

What they are:
Decongestants help if you have a stuffy nose. There are many types, including pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE). You may have to ask the pharmacist for products with pseudoephedrine because they can be used illegally to make methamphetamine. “You can still go to the pharmacy and pick up a box, but it’s somewhat restrictive because you have to sign for it at the counter,” says Dr. Hueston.

Reasons to avoid:
Some people experience fast heartbeats and/or shakes from these drugs. “This reaction is due to the way they metabolize the decongestant,” Dr. Hueston says. Decongestants also can raise blood pressure, so avoid them if you have severe hypertension.

Expectorants

What they are:
These drugs, sometimes called mucolytics, relieve congestion by loosening mucus trapped in the lungs. Unlike cough suppressants or decongestants, these drugs thin mucus to make it easier to cough it out. The most common active ingredient is called guaifenesin (Mucinex, Robitussin Chest Congestion).

Reasons to avoid:
Side effects can include headache, nausea, or vomiting.

Cough suppressants

What they are:
These medications, also known as antitussives, can suppress coughing if they contain dextromethorphan or codeine, Dr. Hueston says. Codeine, which is also a narcotic, is only recommended for those with severe cough. Codeine is stronger and may require a prescription or need to be signed for at the pharmacy. Dextromethorphan is a more common ingredient and found in products with “DM” in the name.

Reasons to avoid:
People who need to be alert on the job or at school, or are prone to constipation, should avoid taking codeine. Dextromethorphan has similar side effects (drowsiness and constipation), but they’re much less severe because it is less potent.

Nasal decongestants

What they are:
Nasal sprays deliver decongestants such as oxymetazolin (Afrin, Nasin, and others) directly to the nose, which helps clear sinus congestion quickly and effectively.

Reasons to avoid:
Overusing a nasal decongestant (more than five days straight) can lead to dependency, a situation in which you may have a stuffy nose even if you don’t use the spray, Dr. Hueston says. Only use as directed. People with high blood pressure might have to avoid using nasal spray decongestants because they can make the condition worse.

Dangerous combinations

If you use several different over-the-counter remedies, you may accidentally take more than the recommended dose of a drug or class of drug.

“Watch out when taking two of the same medications,” Dr. Hueston says. “Don’t take two different decongestants, for example, and if you take a combination or multi-symptom medicine, you probably shouldn’t take anything else.”

Dr. Hueston recommends sticking with “one medication for one symptom.”

Zinc

What it is:
Zinc is a natural remedy with convincing evidence that it works to relieve sore throat, says Dr. Hueston, who recommends zinc lozenges for patients with a sore throat.

Reasons to avoid:
The main drawbacks to zinc are that it can irritate your mouth and upset your stomach. In one study, one out of five test subjects treated with zinc complained about nausea. And research suggests that taking too much zinc can actually impair your immune system. Zinc nasal products such as gels and sprays have been removed from the market because they have been known to permanently damage the sense of smell in some cases.

Source: How to Pick an Over-the-Counter Cold Remedy

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