The cold medicine aisle can be baffling, even for those of us in the know. The shelves teem with so many products, mostly combinations of unpronounceable ingredients with different purposes (and different side effects!). Many patients give up on the whole endeavor, especially those people who have been warned off of OTC because of interactions with prescription medicines or undesirable side effects. But these same folks may be suffering needlessly through their cold when safe, effective help is out there.

Understanding OTC Cold Medicines

The key to using OTC cold medicines is to understand the ingredients, and use only what you need and can tolerate. Combination medicines can be more convenient, but sometimes an a la carte approach is better, especially if there is a class of medication you are trying to avoid. Here is a simple breakdown of the ingredients in “cold medicines,” what they do and their potential side effects so that you can choose the right medication to relieve your symptoms. Bottom line: READ THE FINE PRINT.

ANTIHISTAMINES: Generally a very safe class, these medications were originally designed to interfere with allergic reactions, but have the nifty effect of also DRYING UP NASAL SECRETIONS regardless of the cause. Good old BENADRYL (and its cousins) work great, but make many people drowsy, which is great at bedtime but during the day it is better to go with the non-sedating one listed below. The elderly should also stick with the less-sedating meds.

Sedating antihistamines: diphenhydramine (Benadryl), dimenhydrinate (Dramamine), doxylamine (in Nyquil), meclizine (Bonine), hydroxizine (VIstaril), chlorpheniramine (Chlor-trimaton)
Nonsedating antihistamines: loratidine (Claritin), fexofenadine (Allegra)
Mildly- sedating antihistamines (affect some people and not others): cetirizine (Zytrec)


DECONGESTANTS: This class of medications causes constriction of the blood vessels in the nose, reducing swelling and making more room for air to flow. They are NOT RECOMMENDED for people with high blood pressure. These medications can also cause unpleasant side effects such as insomnia, palpitations, loss of appetite, “jitteriness” or anxiety. A sedating antihistamine taken at the same time can offset the insomnia effect for many folks. Brands with a “D” after time often include these ingredients (such as “Allegra D”):

EXAMPLES: phenylephrine (Sudafed PE), pseudephedrine (Sudafed)


COUGH SUPPRESSANTS: These medications are related to morphine and codeine without the central effects on pain and mood. Like the narcotics (such as codeine), the OTC cough suppressant depresses the cough reflex. Side effects are rare but can include constipation. Brands with a “DM” after them often include this ingredient (such as “Mucinex DM”).

EXAMPLE: dextromethorphan


MUCOLYTICS: Also very safe medication, they used to be given to breastfeeding mothers to increase their milk supply. This medication thins mucous, making it more liquid and easier for the body to deal with.

EXAMPLE: guaifenisen (Mucinex)


ANALGESICS: Don’t forget to take something for pain! Colds often come with low-grade headache, sore throat and nasal pain that we may try to ignore. These meds also block the inflammatory mediators that cause fever and generally make us feel gross. Avoid NSAIDS if you are on blood thinners, avoid all if you take Coumadin.

Non-NSAID: acetaminophen (Tylenol)
NSAID: ibuprofen (Advil and Motrin), naproxen (Aleve)


NASAL SPRAYS: Saline (plain salt water) nasal sprays and irrigations are safe and can really help with the management of dry nose and also with mucous management. Irrigations can also clear the nose of bacteria that contribute to sinusitis and are recommended as long as the nose is not too stuffy to allow for the flow of saline. DECONGESTANT NASAL SPRAYS SHOULD BE USED WITH EXTREME CAUTION. It is easy for the nose to “become dependent” on them and continue to be stuffy even after the cold has passed. They can be very useful, for instance, to allow sinus drainage and a good cleansing irrigation, but I recommend use for a day or two at most.

Here is a good assortment to have around: loratidine, Benadryl, Sudafed, Mucinex DM or Robitussen DM, and Tylenol or ibuprofen. Just about all cold meds are some combination of these. I also like NyQuil which contains pretty much everything with a little alcohol added.

Remember, cold medicines will not shorten the duration of your cold. (Neither will antibiotics) But they can help you weather the viral infection with less discomfort and loss of productivity. You should be better in 7-10 days; if you are not, a visit to the primary care physician or otolaryngologist is in order as you may have developed a bacterial infection.