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Cold Symptoms

Symptoms of a cold overlap heavily with the flu (and also with COVID-19), so it can be helpful to distinguish. In general, cold symptoms are usually milder than flu symptoms: 

• Fever (temperature higher than 100.4 degrees F) and chills caused by a cold is rare. 
• Body aches are generally slight. 
• Fatigue is fairly common but usually less pronounced compared with flu. 
• Sneezing, cough, stuffy nose, and sore throat are all common cold symptoms. 

A temperature higher than 100.4 degrees F is an indicator that a trip to urgent care or your doctor may be beneficial. You should seek care immediately if your fever is accompanied by a rash, vomiting, or diarrhea. 

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Choose Cold Medicine For Adults Based on Symptoms

Because there is a large variety of over-the-counter remedies for cold symptoms, it can be easy to feel lost. Many of these options are combination products and may deliver medications you don’t necessarily need. Treating your specific symptoms can help you choose products that don’t include any extras that may not provide any additional benefit.

Pain

Tylenol (acetaminophen) is helpful for pain like body aches and sore throat and also helps manage fever. This is a common component in many combination products. 

NSAIDs like Advil (ibuprofen) are also helpful for pain and offer some benefit for managing fever. NSAIDs should not be used by individuals taking other over-the-counter or prescribed NSAIDs or blood thinners. Discussing use with your doctor before use is also essential if you’ve had a stomach ulcer. 

Runny nose or sneezing

Antihistamines like Zyrtec (cetirizine) and Claritin (loratadine) are longer-acting and can be taken once daily. These are unlikely to cause drowsiness. 

Antihistamines like Benadryl (diphenhydramine), doxylamine, and chlorpheniramine are generally stronger but shorter-acting. These last for about four to six hours and can cause significant drowsiness. These are common components in combination products marketed for night-time relief, partially because they can also be used as sleep aids. These are often in products carrying a “PM” moniker. 

Nasal sprays like Flonase (fluticasone) or Afrin (oxymetazoline) also help with runny nose and sneezing. Flonase is a topical steroid that can be used periodically for any length of time. Afrin is an antihistamine and should be used for no longer than two to three days when managing cold symptoms due to the potential for rebound symptoms with longer use. 

Cough

In general, the only medication you’ll find over-the-counter labeled for cough is dextromethorphan (often included on labels as “DM,” i.e. Robitussin DM). Dextromethorphan is in many combination products and is often paired with guaifenesin, an expectorant. Expectorants help loosen mucus so you can clear it from your system. Clearing this mucus is good, and coughing helps you do this. Reserving a cough suppressant for a particularly disruptive cough is best (coughing is making it difficult to sleep, for instance).  

Cough drops containing higher doses of menthol may be more effective for loosening mucus and suppressing cough. Products like Fisherman’s Friend have particularly high levels of menthol. This produces a strong minty smell and flavor, creating a potential downside depending on individual tastes. Individuals managing diabetes should be particularly mindful of the sugar content in cough drops. 

Nasal Congestion

The most common nasal decongestants are pseudoephedrine and phenylephrine, which are available either alone or in various combination products. These are usually included in products intended for morning use, or that carry an “AM” moniker. This is because these products are stimulants and can cause jitteriness and difficulty sleeping. 

An FDA advisory committee recently raised concerns about phenylephrine specifically, stating the medication is ineffective. The FDA will evaluate the input of the advisory panel, along with public comments. This has the potential to result in the removal of phenylephrine from store shelves.

Nasal sprays like Flonase (fluticasone) or Afrin (oxymetazoline) are particularly useful alternatives for individuals managing high blood pressure. Afrin should only be used for two to three days at a time to limit the risks of rebound congestion. 

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Precautions

Cold Medicine While Breastfeeding or Pregnant

Choosing a breastfeeding or pregnancy-safe cold medicine should ultimately be done with your doctor’s consultation. Using Tylenol and antihistamines during pregnancy is generally considered safe. Using cold medicine while breastfeeding can cause infants to become exposed to these medications. Tylenol and Benadryl are safe while breastfeeding, although there are some reports of increased infant agitation with Benadryl use.

Cold Medicine for High Blood Pressure Patients

A commonly asked question is, “What cold medicine can I take with high blood pressure?” Products marketed specifically for nasal decongestion or sinus pressure, like pseudoephedrine and phenylephrine are stimulants. These can raise blood pressure, making them a poor choice for individuals managing hypertension. Products like Coricidin HBP are marketed specifically for patients with high blood pressure because they avoid including stimulants.

Combination Products

Reading the labels on over-the-counter medications is important because many products contain multiple ingredients. This can cause some individuals to double up on ingredients like acetaminophen inadvertently. This also raises the risk of drug interactions and unnecessary side effects. Combination products can be appropriate, but it’s helpful to choose an option that covers symptoms that you actually have rather than simply seeking to cover all the bases. 

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Natural Cold Remedies

Zinc

Using zinc to prevent and treat the common cold has been touted as a potential solution for years. The primary proposed mechanism is immune system support, although some have argued for a potential direct impact on viral replication. While zinc is generally considered safe, studies have yielded mixed efficacy results. Additional research would be valuable, particularly for identifying the best dose, timing, and form (i.e. nasal sprays vs. lozenges).

Vitamin C

Many products containing vitamin C have been marketed for immune system support, but does vitamin C help prevent colds? A review of the research indicates:

• Generalized vitamin C supplementation does not prevent the common cold for most people. 
• Taking vitamin C regularly may decrease the duration of symptoms by about 10% (i.e. 9 days sick instead of 10 days). 
• Starting vitamin C supplementation after symptoms begin will not reduce the duration of symptoms. 

Interestingly, the individuals who did experience lower rates of common cold were specifically taking vitamin C for several weeks prior to strenuous physical activity. 
Vitamin C is also often combined with other vitamins. In the case of products like Emergen-C, some additional benefits may be seen due to lower levels of fatigue and the potential for improved concentration associated with B vitamins.

Elderberry

Black elderberry has been used in a variety of forms, like elderberry tea or supplements like Sambucol syrup and gummies. A systematic review suggests that while Elderberry is likely safe, it does not appear to be reliably effective for preventing or treating viral respiratory illnesses like the common cold.

References

1. Centers for Disease Control and Prevention. “Cold Versus Flu.” September 2022. Accessed October 17, 2023.
2. National Library of Medicine. “Acetaminophen.” September 2023. Accessed October 20, 2023.
3. National Library of Medicine. “Diphenhydramine.” September 2021. Accessed October 20, 2023.
4. Glowacka, Krystyna; Wiela-Hojenska. “Pseudoephedrine—Benefits and Risks.” International Journal of Molecular Sciences, May 2021. Accessed October 20, 2023.
5. Wieland, L. Susan; et al. “Zinc for prevention and treatment of the common cold.” Cochrane Database of Systematic Reviews, September 2021. Accessed October 20, 2023.
6. National Library of Medicine. “Common colds: Does vitamin C keep you healthy?” October 2020. Accessed October 20, 2023.
7. Wieland, L. Susan; et al. “Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review.” BMC Complementary Medicine and Therapies, April 2021. Accessed October 20, 2023.

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