Over-The-Counter Cold and Flu Medications

There is a wide variety of over-the-counter (OTC) cold and flu medications out there. In part, this has to do with the wide variety of symptoms you may be looking to improve. Decongestants, for example, can help improve stuffiness, analgesics can reduce pain and fever, and other types of medications can help you ease other concerns.

Taking stock of exactly which cold and flu symptoms are bothering you is the first step in figuring out which type of OTC medication is right for you. One may be sufficient. At other times, a multi-symptom medication may be a better choice.

Cold/Flu Symptom Ingredient to Look For Drug Type
Body aches acetaminophen, aspirin, ibuprofen, naproxen Analgesic
Cough (dry) dextromethorphan Antitussive
Cough (wet/productive) guaifenesin Expectorant
Fever acetaminophen, aspirin, ibuprofen, naproxen Analgesic
Headache acetaminophen, aspirin, ibuprofen, naproxen Analgesic
Runny nose/sneezing/stuffiness cetirizine, chlorpheniramine, desloratadine, diphenhydramine, fexofenadine, hydroxyzine, levocetrizine, loratadine Antihistamine
Stuffiness oxymetazoline, phenylephrine, pseudoephedrine Decongestant

Decongestants

Congestion, a hallmark symptom of colds and flu, is caused by dilated blood vessels in the nasal and airway membranes. Over-the-counter decongestants work to narrow those blood vessels, decreasing swelling and inflammation, and allowing air to flow and mucus to drain. 

Decongestants can be taken orally or in a nasal spray. Oral decongestants include Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine). 

Pseudoephedrine comes in regular and extended-release tablets and liquid, and in combination cold and allergy medications. Although it is an over-the-counter medicine, pseudoephedrine is controlled and kept behind the pharmacy counter. Quantities are limited and you may need to show ID to make a purchase. 

Phenylephrine is not controlled and can be found in the cold and flu medicine aisle in the pharmacy or grocery store. Available as a tablet, liquid, and quick dissolve strip, it is also found in combination cold medicines. 

Nasal sprays contain oxymetazoline and deliver relief directly to the nasal passages. Decongestant nasal sprays sold over the counter include:

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

Analgelsics

For fever, headaches, and body aches that come with a cold or the flu, over-the-counter medications known as analgesics can help. Common analgesics include: 

  • Tylenol (acetaminophen) 
  • Advil (ibuprofen) 
  • Aleve (naproxen) 
  • Asprin

Overall, analgesics relieve pain and reduce fever, though some do this more effectively than others. Aspirin and acetaminophen are generally better at treating fevers and headaches, while ibuprofen and naproxen may be better at reducing pain. 

For fevers above 102 degrees F, it is often recommended to alternate between taking acetaminophen and ibuprofen every three hours, especially if the fever continues to rebound as the medication wears off. 

Some precautions should be taken with analgesics. Taking too much acetaminophen can cause liver damage, sometimes serious enough to require a liver transplant or cause death. Do not take more than 4,000 milligrams (mg) of acetaminophen per day.

Be cautious when taking multiple medications to treat a cold or flu. Avoid taking more than one product that contains acetaminophen at a time. 

Children under the age of 18 should not take aspirin unless specifically instructed to do so by their health care provider. Taking aspirin or medicines that contain salicylates when a child has a cold or other virus puts them at an increased risk of developing Reye's syndrome. 

Cough Medicine

Treating a cough from a cold or flu can be tricky. You first want to evaluate your cough to determine the type of cough medicine that you need. A dry cough may benefit from taking an antitussive cough suppressant, while a wet and productive cough typically requires an expectorant. The time of day matters as well.

Antitussives help to quiet a cough and can be used at night when coughing is keeping you awake. The generic drug dextromethorphan is the common cough suppressant found in many over-the-counter cough medicines including:

  • Delsym
  • Robitussin DM
  • Mucinex DM
  • Tussin DM

Quieting a cough may not be your best option during the day, however. Coughing works to clear mucous from the lungs, which can lead to pneumonia or other lung infections if not moved out. Taking an expectorant during the day can help loosen chest congestion and thin mucous, allowing it to drain. This medication will not stop your cough, but it will make it easier to cough up phlegm and clear the lungs. 

Guaifenesin is the only expectorant approved by the U.S. Food and Drug Administration (FDA). It's available as a generic drug and in multiple brand-name products, including:

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

Over-the-counter cold medicine is not recommended for children under the age of 4. Children between the ages of 4 and 6 should only take cough medicine under a doctor’s supervision.

Antihistamines

For nasal symptoms including a stuffy or runny nose and sneezing, many people turn to antihistamines. Antihistamines are commonly used to treat allergic rhinitis. They work by blocking the receptor for histamine, a chemical released in response to an allergen. 

Common antihistamines include: 

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

Antihistamines work well to relieve congestion related to an allergic response, but their effect on the common cold is questionable.

A 2015 Cochrane review of 18 randomized controlled trials with more than 4,000 subjects found that antihistamines may help relieve congestion better than a placebo in the first two days of a cold, but not on day three or later. 

Some antihistamines have side effects, such as drowsiness, dizziness, dry mouth, irritability, and constipation.

People with glaucoma, enlarged prostate, epilepsy, overactive thyroid, heart disease, high blood pressure, or diabetes should talk to their doctor or pharmacist before taking antihistamines. 

Multi-Symptom Treatments

Multi-symptom formulas typically include a combination of analgesics, decongestants, antihistamines, expectorants, and/or cough suppressants. These are often helpful when you have a cold or flu because they treat many different symptoms in one dose.

Multi-drug medications should be used with caution, however. Always read the ingredients list to ensure the formula only includes medications that treat the symptoms you have. Avoid taking additional medications at the same time to prevent accidental overdose and interactions.

For example, if a medicine contains acetaminophen, do not also take Tylenol, Midol, or Excedrin, drugs that also contain acetaminophen. You also should not take a multi-symptom reliever that contains dextromethorphan or guaifenesin along with cough syrup, which also contains those ingredients.

A Word From Verywell

Some turn to natural remedies to help with cold and flu symptoms as well. Know that some supplements can interact with other medications you may be on—including those sold over the counter. Speak to your doctor or pharmacist before using an OTC cold or flu product alongside any supplement.

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