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, an important note: Cold medicines do not cure your cold, nor do they shorten its duration. Cold medicines exist to ease your symptoms and help you feel a little better while you wait for your immune system to fight off the virus.
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. Take the time to show your ID to the pharmacist if you want the good stuff.
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 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.)
Most other cold medicines don’t work very well (or at all)
Phenylephrine is the decongestant that replaced pseudoephedrine in over-the-counter products. (It’s what’s in Sudafed PE. Don’t be fooled.) It doesn’t seem to work very well, and according to some studies, it doesn’t work at all. (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?”) And while phenylephrine is intended specifically for nasal congestion, the evidence isn’t much better for medicines that are supposed to ease your cough.
Dextromethorphan, considered a cough suppressant, doesn’t have much evidence suggesting 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.
By the way, children under 4 years of age should not use any of the cough or cold medicines we’ve mentioned so far, according to the FDA. Fortunately, home remedies like drinking fluids and getting their snot sucked out with a bulb syringe are safe and tend to bring relief.
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 that we mentioned above 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.
Stock your medicine cabinet with the stuff that works:
Original Sudafed for congestion (prescription-only if you’re buying from Amazon, or go to your local pharmacy to get it in person)
Regular (or extra strength) Tylenol for fevers and pain
Honey if you really want a cough syrup
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.
An important caveat on honey, by the way: honey is not considered safe to give to babies under 1 year old. There’s a small risk of botulism, and babies are particularly susceptible. Honey isn’t going to help that much, so it’s not worth the risk.
Homeopathic cold medicines are useless
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 if 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.