When you’re feeling awful because of a cold, you just want something to fix you—if not to cure you, at least to help you temporarily feel better. Unfortunately a lot of remedies are placebos, but some things in the drugstore work better than others.
Before we talk about which medicines are best, here’s an important note to consider: Cold medicines do not cure your cold, nor do they shorten its duration. If you’re reading this because you want to know how to get rid of a cold fast, or what a doctor would prescribe you to get rid of a cold—sorry. Colds are caused by viruses, and there’s no medication that will kill them off the way that antibiotics can kill off bacteria. The point of cold medicines is to help you be a little less miserable while you wait for your immune system to fight it off.
Ignore brand names on cold medicines
The companies that make cold medicines rely on our stuffy-headed memories. If you bought Sudafed (or Mucinex, or Dayquil) the last time you had a cold, they hope you’ll buy the same thing this time, while makers of store brands are hoping you buy something the same color and figure it’s good enough. But the brand name tells you next to nothing about what’s 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 that the same brand will sell the same thing under two different names. My favorite example of this is the labyrinth of Mucinex products: Their Maximum Strength Fast-Max Severe Congestion and Cough has the same dosage and ingredients as their Maximum Strength Sinus-Max Pressure, Pain, & Cough. Meanwhile, Maximum Strength Sinus-Max Severe Congestion & Pain—which sounds like it should be very similar to the other Sinus-Max product—takes out a cough-related ingredient and swaps in some acetaminophen (that’s Tylenol). You are never going to have much luck navigating the cough and cold aisle on brand names and symptoms alone.
So where to go instead? Well, for quick relief of congestion, you’ll need the good stuff they keep behind the counter.
Pseudoephedrine (original Sudafed) is the good stuff
If you have a stuffy nose, pseudoephedrine is the real deal. In the old days, you could find it on the 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. It’s still an over the counter medication, but you’ll need to take the time to show your ID to the pharmacist if you want to buy some.
Studies have shown pseudoephedrine to be effective at clearing nasal congestion. When you feel like your nose is “stuffed” with dried or gooey mucus, that’s not literally true. Blood vessels in the lining of your nose and sinuses swell up, and that’s what narrows the air passages. Pseudoephedrine makes those blood vessels constrict, reducing the swelling and opening your 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 isn’t worth buying
Phenylephrine is the decongestant that replaced pseudoephedrine in over-the-counter products. Phenylephrine, the “PE” ingredient, has been known for years to be useless at treating cold symptoms when taken by mouth. This led two pharmacists to write a paper in 2022 entitled “Why Is Oral Phenylephrine on the Market After Compelling Evidence of Its Ineffectiveness as a Decongestant?”) Finally, as of November 2024, the FDA agreed that phenylephrine products will (eventually) be removed from store shelves.
Phenylephrine is what’s in Sudafed PE. This is another case of brand names leading you astray—regular Sudafed is the good stuff, but Sudafed PE has the ineffective ingredient. Don’t be fooled—anything with a PE in the name won’t work.
Most cough medicines don’t work, either
But that’s not the only cold medicine that probably does little to nothing for your cold. The “active” ingredients in cough medicines are probably useless too. Dextromethorphan is considered a cough suppressant, though there’s not much evidence to suggest it actually does its job. Nor does guaifenesin, an “expectorant” that’s intended to thin out mucus to make it easier to cough up. A Cochrane review concluded that there’s not enough evidence to say whether these or any other over-the-counter cough medicines actually work.
Tylenol and ibuprofen can help with fevers and pain
There is one more category of over-the-counter medicines that may actually help you feel better when you have a cold, although they’re probably not what you’re thinking of when you think of cold medicines.
Acetaminophen (regular Tylenol) and ibuprofen (Motrin or Advil) are known as pain relievers and fever reducers. They do work for these jobs, and they are considered safe to use even in young children. That said, the American Academy of Pediatrics warns that you should always contact your pediatrician for a fever in a baby less than 3 months old, and not give medication unless directed, since fevers at that age can be life threatening and need to be evaluated in a healthcare setting.
If you’re used to looking at brand names, please make sure you turn the package around and make sure it contains what you’re expecting on the ingredients list. Regular Tylenol is just acetaminophen, but the company also makes a Tylenol Cold and Flu that contains all three of the ingredients mentioned above that do not work for colds or coughs. Advil makes a similar product. These aren’t the ones you want.
Another important note: Tylenol, or acetaminophen, is in a lot of cold medicines as part of a mixture of ingredients. It’s also potentially toxic if you take more than the recommended amount. If you’re combining medications, make sure you’re not double-dosing on this ingredient.
The best cough syrup is honey
So you have a decongestant that works (pseudoephedrine), and something to bring your fever and headache under control (acetaminophen or ibuprofen). Is there anything we can do about that nasty cough? There is, but you’ll want to leave the pharmacy aisles and head over to the grocery shelves.
Honey isn’t going to cure your cold, but it seems to soothe sore throats and relieve coughing, at least a little bit. Studies often show it works better than over-the-counter cough syrups. (Is this because honey is great or because cough syrups kind of suck? Possibly the latter, to be honest.) But don’t bother with honey-based cough syrups—yes, these are a thing—just grab some actual honey and mix it into some hot water or tea. That’s cheaper and easier.
Pretty much every “children’s” cold medicine is garbage. After all, the ones with decongestants and antihistamines aren’t considered safe for kids under 4. But since you’re in the medicine aisle anyway, “natural” brands are there to fill that gap with concoctions of vitamins, honey, and herbal supplements. These don’t really do anything, either, but somehow they cost like eight bucks a bottle.
But it gets worse. In both the kids’ and adults’ sections, you’ll find homeopathic remedies, which are pretty much scams and should be illegal. Watch out for anything that says “homeopathic” or that has ingredients measured in “X” or “C” instead of a real unit like milligrams. These aren’t simply natural supplements, as the labels sometimes suggest, and homeopathy is not another word for home remedy. Homeopathic “drugs” are beneficiaries of a bizarre loophole in FDA and FTC policy that allows them to be marketed as drugs while claiming to work by magic. I wish I were making this up, but I’m not. Save your money.
This articles is written by : Nermeen Nabil Khear Abdelmalak
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