Cough and cold medications are often available over the counter. Ingredients will vary by product and some common active ingredients may include dextromethorphan and acetaminophen.
It is important to be aware of what is in any over-the-counter (OTC) drug to stay safe and to get the best treatment for symptoms.
Fast facts on cough and cold medications:
- A wide array of over-the-counter medication is available for coughs and colds.
- Combined treatments target more than one symptom at a time.
- It is important to know which ingredients do what, to avoid making symptoms worse.
- Some medications can interact or have adverse effects, so it is important to take safety precautions and read the instructions carefully.
One study has suggested that fewer than 40% of consumers are familiar with the most common active ingredients in cough, cold, and flu remedies, and only 43% ask the pharmacist for help.
A cold or seasonal flu can have a wide range of symptoms, so it is important to treat the right ones. For example, a person with a runny nose and sore throat should not use medications that include an ingredient to control coughs. A cough helps remove mucus from the throat.
Consumers must make sure they choose medications that treat only the symptoms that they have and avoid taking medications they do not need. Understanding the different active ingredients and which symptoms they treat can help find the most suitable OTC treatment.
Consumers should be aware of the major active ingredient categories related to cold symptom relief. The main ones are:
Analgesics: These include acetaminophen and the non-steroidal anti-inflammatory drugs (NSAIDs) aspirin, ibuprofen, and naproxen sodium.
Decongestants: These are for nose and chest congestion. Pseudoephedrine and phenylephrine are examples.
Expectorants: These loosen or thin the mucus in the chest, making it easier to cough it up. One example is guaifenesin. Drinking extra fluids can also help.
Antihistamines: These are also used in medication for allergies, which may have similar symptoms to a cold. They include chlorpheniramine maleate, diphenhydramine, and doxylamine succinate.
Cough suppressants: These block the cough reflex, making coughing less likely. One example is dextromethorphan.
Cough suppressants should not be used if the cough is caused by smoking, emphysema, asthma, pneumonia, or chronic bronchitis, because coughing helps to clear the lungs.
Antihistamines or decongestants can also dry the throat, making the mucus thicker and harder to move, resulting in a more severe cough.
Combination medicines: These contain more than one of these ingredients, and they treat more than one symptom.
Changes to cough and cold medications
In the United States (U.S.), all OTC cold products that are not sold behind the pharmacy counter have recently been reformulated with phenylephrine. Products that are sold from behind the pharmacy counter still contain pseudoephedrine.
To buy these, the person will need to present a valid ID, and their recent purchase history will be reviewed online through MethCheck, a database. The amount of each product that a person can buy within a certain time is restricted, because of the risk of abuse of these medications.
Examples of medications sold from behind the counter are Aleve Cold and Sinus, Motrin Cold and Sinus, Sudafed, and Sudafed 12 hour.
Treatments are available in a range of forms, including syrups, powders, pills, capsules, and sprays.
Consumers can often choose from brand-name medications or store-brand products. These contain the same ingredients, but store-brand products are usually cheaper.
Cough suppressants
Cough suppressants help to control a persistent cough. Expectorants make a cough more productive.
Robitussin cough and cold is one brand example of a cough suppressant. The active ingredients are dextromethorphan, guaifenesin, and phenylephrine. Robitussin cough and cold is also an expectorant and a nasal decongestant. As a store brand product, it may be called Tussin.
Nasal decongestants
Nasal decongestants help clear nasal passages and make breathing easier. They do not cause drowsiness. Phenylephrine is an active ingredient that treats a stuffy nose and sinus problems.
Sudafed and Sudafed PE are well-known brand products that treat nasal congestion. Sudafed contains pseudoephedrine, and Sudafed PE contains phenylephrine.
Nasal decongestants come as capsules, tablets, liquids, or as a nasal spray.
Combination medicines
OTC combination medicines can treat a multi-symptom cold with a wide range of symptoms, such as nasal congestion, cough, sore throat, aches, and fever. They contain active ingredients to treat specific symptom combinations.
NyQuil or DayQuil are brand medications containing acetaminophen and dextromethorphan. Nyquil adds doxylamine succinate to help you sleep, DayQuil adds phenylephrine as a decongestant.
Triaminic Cold and Cough contains the active ingredients phenylephrine and diphenhydramine. It can relieve congestion, a runny nose, and a cough.
Theraflu Nighttime Severe Cold and Cough contains the active ingredients acetaminophen, phenylephrine, and diphenhydramine. Store brand products include Flu Severe Cold and Congestion.
Alka-Seltzer Plus Cold Effervescent Tablets contains the active ingredient aspirin, chlorpheniramine maleate, and phenylephrine. Store brand products include Plus Cold.
Like all medications, OTC drugs can have side effects.
These are not usually severe, but prolonged use or overuse can have a negative impact on older people, children, those with other health problems, and those taking other medications.
A 2016 study found that:
- 45 percent of patients do not think about their prescription medicines when choosing an OTC cough or cold treatment
- 58 percent do not consider their existing health conditions
- 65 percent do not think about other OTC drugs they are taking
- 73 percent of people over 60 years do not think about whether the drug is suitable for their age
- 20 percent do not see any of these as important factors
Not considering these factors can put a person at risk
OTC remedies can interact with other drugs. People who are taking monoamine oxidase inhibitors (MAOIs) or selective serotonin uptake inhibitors (SSRIs) for depression should not use cough and cold preparations.
Here are some safety tips for using OTC cough and cold remedies:
- Read the label carefully to know how much to take and how often.
- Check any warnings about drowsiness, driving, and alcohol intake.
- Check the drug facts sheet to find the age at which a drug can be used.
- Do not exceed the recommended dose.
- Only use a medication that matches the symptoms you are treating.
- Contact a doctor if symptoms worsen or do not improve after 2 days, or if a cough lasts longer than 2 weeks, or keeps coming back.
- Talk to a health care provider first if you are pregnant or breastfeeding or if you are taking other prescription medications.
- Never give a combination medication to a child under 4 years.
- Avoid duplication of ingredients if you use more than one product.
- Use combination medications only for the symptoms listed on the drug fact sheet.
Some cough and cold remedies contain codeine or dextromethorphan, a weak narcotic. In normal doses it is safe to use, but can be addictive if it is misused.
What about children?
Products containing dextromethorphan should not be given to children under 4 years of age.
Robitussin DM can be used in children over the age of 2 years, but it should only be used under pediatrician’s supervision until the age of 6 years.
OTC medications do not need a prescription, but excessive use can lead to complications. An overdose can be fatal. Remember to keep all medicines away from children.
Store or brand medication: Which is better?
Store-brand or generic medication can be much cheaper than the advertised brands. They are easy to find, as most stores place both versions together.
Generic and brand OTC medicines are equally safe, as they must both meet the standards established by the Food and Drug Administration (FDA).
A pharmacist can help customers choose a suitable remedy for their symptoms. They can recommend products that contain the appropriate active ingredients.
Alternative options for treating a cough or cold include:
- getting plenty of rest and fluids
- gargling with warm salt water
- using a chest rub
- using a vaporizer with a few drops of peppermint or eucalyptus oil
Essential oils must not be swallowed as they can be toxic.