Cold and Flu Remedies: Which One Is Best for You?

Tough decisions are the last thing you want to face when a cold or the flu hits you full force. Yet any veteran of the over-the-counter (OTC) medication aisle in the pharmacy knows that the choices are overwhelming.

“It’s very confusing because there are so many different products,” notes Richard Streiffer, MD, former dean of the University of Alabama College of Community Health Sciences in Tuscaloosa. “People simply have to read labels. I tell people, especially older folks, to bring your magnifying glass with you because the print is so small.”

While you’re squinting at the labels of various cold and flu medication options, pay close attention to the following information, which, per the U.S. Food and Drug Administration (FDA), must appear in this order:

• The product’s active ingredients, including the amount in each dose.
• The purpose of the product.
• The uses (indications) for the product.
• Specific warnings, including when the product should not be used under any circumstances and when it is appropriate to consult with a doctor or pharmacist. This section also describes side effects that could occur and substances or activities to avoid.
• Dosage instructions — when, how, and how often to take the product (dosages can vary widely by age).
• The product’s inactive ingredients (important information to help you avoid ingredients that may cause an allergic reaction).

Note: OTC cold medication should not be used to treat children younger than 4 years because of lack of benefit and low but significant risk of serious complications, according to the FDA.

It’s Best to Choose Cold and Flu Medication by Symptom

The key to picking the right product or products to help you feel better faster is to zero in on your symptoms. Also important: Whenever possible, stick to single-active-ingredient remedies to reduce the risk of side effects, says Nate Favini, MD, an internist and medical director of the nationwide healthcare system Forward.

“Choose a medication that’s going to directly address the symptom or symptoms that are bothering you rather than a cocktail that may include things you don’t need,” he says. For example, if the label of a cold or flu medication says that it treats fevers, coughs, and runny noses, but you have only a cough, choose a simple cough suppressant instead.

The best medicine for nagging cough:

Cough suppressants, known as antitussives, inhibit the cough reflex in the brain. The common cough suppressant dextromethorphan (DXM or DM) can be found alone in products such as Robitussin Cough Gels and CVS Health Tussin Cough Liquid Gels, or in combination with other active ingredients, as in Vicks Dayquil Cough and Delsym Adult DM Cough + Chest Congestion Relief Liquid.

Expectorants such as guaifenesin (Mucinex, Guai-Aid) work chiefly by thinning mucus so it is easier to cough up and out.

Antihistamines block histamine, a chemical the body releases that triggers runny nose and watery eyes. Antihistamines are commonly used for allergies, but also can be useful for some cold symptoms. “Coughs can be caused by postnasal drip — a trickle of mucus and other secretions that stimulates nerves in the back of the throat — in which case drying up the source with an antihistamine is the best way to treat it,” says Dr. Favini. Widely used brands include Benadryl Allergy & Cold and Actifed Cold.

The best medicine for runny nose, sneezing, and itchy, watery eyes:

Antihistamines, as noted above, are often found in combination cold and flu medication because they help treat sniffling, sneezing, itchy, and watery eyes and are the best meds for drying up a runny nose. Options include doxylamine (NyQuil, Alka-Seltzer Plus Night Time Cold Medicine), brompheniramine (Robitussin Cold & Allergy, Dimetapp Cold, Allergy Elixir), and diphenhydramine (Benadryl, Nytol). These forms of antihistamines also can help you sleep through the night because they typically cause drowsiness.

The best medicine for stuffy nose and sinus pain:

Decongestants shrink swollen blood vessels and tissues in your nose, making breathing easier. One type, pseudoephedrine (Contac Cold 12 Hour, Sudafed), is sold without a prescription, but only from behind the pharmacy counter and in limited quantities because it can be used to make the illegal drug methamphetamine (meth).

Nasal decongestant sprays containing the active ingredient oxymetazoline (Afrin, Sinex) do a good job of reducing stuffiness after just one dose, according to research. However, you shouldn’t use these sprays for more than three days in a row or your stuffy nose could get worse, according to the American Academy of Family Physicians. Preservative-free saline nasal sprays (Ayr, Flo Saline Plus), which contain a small amount of salt diluted in sterilized water to help moisturize inflamed nasal passages, tend to be safe for daily use in people of all ages.

The best medicine for fever, sore throat, and/or aches and pains:

Acetaminophen, best known by the brand name Tylenol, is primarily used as a fever reducer, although research from 2013 suggested it may also relieve cold-related aches and pains. Acetaminophen is safe for most people if taken as directed. It is found in many combination OTC products, such as Tylenol Cold + Flu Severe Caplets and Vicks Dayquil Cold & Flu Relief Liquicaps.

Because overdoing acetaminophen can cause serious harm to the liver, avoid excessive use. Prescriber guidelines note a maximum of 4,000 milligrams for an adult per 24 hours, notes Harvard Health Publishing, but if you have liver issues, you should discuss the right amount for you with your doctor.

Nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve), reduce fever as well as inflammation throughout the body. Research from 2015 found that NSAIDs can greatly lessen discomfort due to headache, ear pain, muscle pain, joint pain, and sneezing.

Note: Some cold and flu OTC products (such as Excedrin) contain both acetaminophen and an NSAID.

Numbing throat sprays and lozenges made with benzocaine (Vicks Vapocool), dyclonine (Cepacol), or phenol (Chloraseptic) work like local anesthetics to provide temporary pain relief caused by a sore throat.

If you’re still having a hard time navigating the cold medication aisle, talk to the pharmacist. With a little customized guidance about ingredients, you may be able to enjoy better symptom relief.

Additional reporting by Nuna Alberts.