Over-The-Counter Cold and Flu Medications

You have a lot of choices when it comes to over-the-counter (OTC) cold and flu medications. In part, that's because colds and influenza cause a lot of different symptoms.

When choosing a medication, look at your symptoms. A single drug targeting a particular symptom may be fine. Or you may want a multi-symptom medication.

This article walks you through the various drugs and what symptoms they treat so you can make the right choice.

woman looking at medication in store aisle
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Cold/Flu Symptom Ingredient to Look For Drug Type
Body aches Acetaminophen Aspirin Ibuprofen Naproxen Analgesic
Cough (dry) Dextromethorphan Antitussive
Cough (wet or productive) Guaifenesin Expectorant
Fever Acetaminophen Aspirin Ibuprofen Naproxen Analgesic
Headache Acetaminophen Aspirin Ibuprofen Naproxen Analgesic
Runny nose, sneezing, congestion Cetirizine Chlorpheniramine Desloratadine Diphenhydramine
Fexofenadine Hydroxyzine Levocetirizine Loratadine
Antihistamine
Congestion Oxymetazoline
Phenylephrine
Pseudoephedrine
Decongestant

Decongestants

Congestion is a hallmark symptom of colds and flu. It's caused by swollen blood vessels in the nasal passages and airways.

Over-the-counter (OTC) decongestants narrow these blood vessels and decrease inflammation. That means air can flow and mucus can drain. 

Decongestants come as pills, tablets, liquid, and nasal spray. Oral decongestants include:

  • Sudafed (pseudoephedrine): It's available in regular and extended-release tablets and liquid, and also in combination products. It's OTC but kept behind the pharmacy counter. Quantities are limited and you may need to show ID to buy it. 
  • Sudafed PE (phenylephrine): It's available as a tablet, liquid, and quick dissolve strip, and also in combination cold medicines. It's in the cold and flu aisle in the grocery store or drug store. 

Nasal sprays contain oxymetazoline. They deliver relief directly to the nasal passages. OTC brands include:

  • Afrin
  • Anefrin
  • Dristan
  • Mucinex
  • Vicks Sinex
  • Zicam

Analgesics

Analgesics are painkillers and fever reducers. Common OTC analgesics are: 

Aspirin and acetaminophen may work better for fevers and headaches. Ibuprofen and naproxen may be better for body aches. 

For fevers above 102 degrees, it may help to alternate between acetaminophen and ibuprofen every three hours. That's especially true if the fever comes back as the medication wears off. 

A note about acetaminophen: Taking too much acetaminophen can cause potentially fatal liver damage. Don't take more than 4,000 milligrams (mg) of acetaminophen per day. This drug is in dozens of OTC products. Read labels closely to make sure you don't take more than one product containing this drug. 

In children with a cold or other virus, aspirin or other salicylate medicines increase the risk of Reye's syndrome. Children under 18 shouldn't take aspirin unless specifically instructed to by a healthcare provider.

Cough Medicine

Treating a cough from a cold or flu is tricky. The type of cough determines the kind of medicine you need.

  • For a dry cough, choose an antitussive (cough suppressant).
  • For a wet, productive cough, choose an expectorant.

The time of day also matters. Antitussives quiet a cough so you can sleep. The generic antitussive dextromethorphan is in many OTC medicines, including:

  • Delsym
  • Robitussin DM
  • Mucinex DM
  • Tussin DM

During the day, you want your cough to clear mucus from your lungs. If the mucus isn't removed, it can lead to pneumonia or other lung infections.

An expectorant loosens chest congestion and thins mucus so it can drain. It doesn't stop a cough; it helps your cough remove mucus better.

The expectorant guaifenesin is the only expectorant approved by the Food and Drug Administration (FDA). It's in multiple brand-name products, including:

  • Robitussin Chest Congestion
  • Mucinex 
  • Tussin Chest
  • Kids-EEZE

OTC cold medicine isn't recommended for children under 4. And kids between 4 and 6 should only take cough medicine under a healthcare provider’s supervision.

Antihistamines

Many people turn to antihistamines (allergy pills) for sneezing and a stuffy or runny nose. They may not be the right choice.

Antihistamines block the chemical histamine. Your body releases that in response to an allergen, such as pollen or dust. 

Common antihistamines include:

  • Benadryl (diphenhydramine)
  • Chlor-Trimeton (chlorpheniramine)
  • Atarax, Vistaril (hydroxyzine)
  • Zyrtec (cetirizine)
  • Allegra (fexofenadine)
  • Clarinex (desloratadine) 
  • Claritin, Alavert (loratadine)
  • Xyzal (levocetirizine) 

Antihistamines relieve congestion related to allergies. But their effect on the common cold is questionable.

A review of 18 high-quality trials found antihistamines may help relieve congestion in the first two days of a cold. They're less effective on day three or later.

Some antihistamines have side effects including:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Irritability
  • Constipation

Are Antihistamines Safe for You?

Talk to your healthcare provider before taking antihistamines if you have: 

  • Glaucoma
  • Enlarged prostate
  • Epilepsy
  • Overactive thyroid
  • Heart disease
  • High blood pressure
  • Diabetes


Multi-Symptom Treatments

Multi-symptom formulas typically include a combination of:

  • Analgesics
  • Decongestants
  • Antihistamines
  • Expectorants and/or cough suppressants

These treat many different cold and flu symptoms in one dose. But they should be used with caution.

Always read the ingredients list. Make sure the product only includes drugs that treat symptoms you have.

Don't take other medications or you could risk an accidental overdose or drug interactions.

For example, if a medicine contains acetaminophen, don't also take Tylenol, Midol, or Excedrin, because they also contain acetaminophen.

Also, don't take cough syrup with multi-symptom products that contain dextromethorphan or guaifenesin. You may get a dangerous double dose of those drugs.

Summary

Knowing what cold and flu medicines do helps you choose the right one. Decongestants help clear stuffed-up nasal passages and airways. Analgesics treat pain and fever.

Cough suppressants treat dry coughs. They also quiet a cough so you can sleep. Expectorants loosen up phlegm in your lungs and help it drain. They're good during the day for wet coughs.

Antihistamines may help cold and flu symptoms somewhat. But they're better for allergies.

With multi-symptom treatments, look for one with ingredients that match your symptoms. Read labels of everything you take to avoid doubling up on a drug.

A Word From Verywell

Some people turn to natural treatments or home remedies for cold and flu symptoms. But certain supplements can interact with OTC medications.

Talk to your healthcare provider or pharmacist before using a supplement plus an OTC cold or flu product.

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13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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