Key takeaways:
There are many over-the-counter (OTC) cold and flu medicines available. You can find many ingredients on their own and in combination products for multi-symptom relief.
Acetaminophen (Tylenol), dextromethorphan (Delsym), and phenylephrine (Sudafed PE) are commonly found in combination cold and flu products. These ingredients target symptoms such as fever, cough, and congestion. However, phenylephrine may not actually be effective for a stuffy nose.
Check product ingredients before making your purchase. This can help you avoid doubling up on medications and treating symptoms you don’t have.
The best OTC cold and flu medicine for you can depend on your symptoms, age, and health conditions. Your pharmacist can help you navigate your options.
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If you find yourself feeling feverish and coming down with a cough, congestion, or a runny nose, you might reach for a quick, over-the-counter (OTC) fix. But with so many products to choose from in the cold and flu aisle, it’s easy to feel overwhelmed.
OTC cold and flu medicines won’t cure your infection. But they can help make your symptoms more manageable until you’re feeling better. So, what’s the best OTC cold and flu medicine?
What are the best OTC cold and flu medicines?
The best OTC cold and flu medicine for you is one that targets your specific symptoms. And it shouldn’t interfere with other medications you’re taking or health conditions that you have.
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Marketing aside, there are just a handful of active ingredients found in cold and flu medicines. But which ones should you take? We break it down by symptoms in the table and subsequent sections below.
| Symptom | Active ingredients and onset | Good to know |
|---|---|---|
| Fever and aches |
|
|
| Cough |
|
|
| Congestion |
*Note: Oral phenylephrine has been found to be ineffective for congestion. The nasal spray form was not included in this finding. |
|
| Runny nose |
|
|
Fever and aches
There are two OTC options to help bring down your fever: acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil). Both can provide relief for headaches and achy muscles, too.
Aspirin is also an NSAID option, but it should be avoided by people under age 19. That’s because it’s linked to a dangerous condition called Reye’s syndrome.
These medications are available on their own for fever and minor aches. You can also find them in a variety of combination products for multi-symptom relief. Both acetaminophen and ibuprofen have dosage instructions for children based on their body weight. Multiple dosage forms are available for each medication, including capsules and tablets, liquids, and suppositories.
Acetaminophen takes about 15 to 60 minutes to kick in, depending on the product. Ibuprofen can take about 20 minutes to 2 hours, with the liquid-filled gel capsules working the fastest. You also have the option to alternate products. This means if acetaminophen doesn’t provide relief, for example, you can take a dose of ibuprofen a few hours later. Aspirin takes about 15 minutes to start working.
Keep in mind that taking too much Tylenol can result in liver damage. If you’re taking a few different products for your symptoms, check to make sure you’re not doubling up. The same is true with NSAIDs like ibuprofen, which can cause kidney damage and stomach ulcers if you take too much.
Best cough medicine: There are many over-the-counter and prescription cough medications to choose from. Here, experts help you compare your treatment options.
How to sleep with a cold: Is your cold making it difficult to get a good night’s rest? Learn more about ways to get sleep while you’re sick.
Sudafed vs. Sudafed PE: You may reach for decongestants like Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine) for a stuffy nose. Here’s how they compare.
Tylenol and NSAIDs aren’t safe for everyone. If you have other health conditions, or if you’re taking other medications, check with a healthcare professional first.
Cough
Dextromethorphan (Delsym) and guaifenesin (Mucinex) are common go-to remedies for cough. There isn’t much evidence that they work, but some people find relief from taking them.
Dextromethorphan is a cough suppressant. It’s thought to work by blocking your cough reflex. This may be helpful for a dry, hacking cough that doesn’t produce mucus. Dextromethorphan usually starts working within 15 to 30 minutes of taking it.
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Guaifenesin is an expectorant. If you have a wet cough, it’s supposed to loosen up and thin the mucus in your airways. This can help you cough the mucus up easier. But drinking water can have a similar effect. Guaifenesin can start kicking in within 30 minutes.
Both dextromethorphan and guaifenesin are available on their own and in combination products. Sometimes you can find them together, as with Mucinex DM.
Keep in mind that OTC cough medications can have serious side effects in young children under age 4. So, it’s best to check with their pediatrician about your options. Medication-free alternatives, such as honey (after 12 months old) or a cool-mist humidifier, may be a good place to start.
Sinus congestion
There are a few options for a stuffy nose. First, you can find non-prescription oral and nasal decongestants:
Oral options: Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE)
Nasal options: Oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine)
Decongestant nasal sprays typically kick in the fastest — within 2 to 10 minutes. But you shouldn’t use them for more than 3 days. If you do, your symptoms could come back worse and be tougher to treat.
Pseudoephedrine works better out of the two oral options. It typically starts working within 30 minutes. But you’ll have to get it from behind the pharmacy counter. It can also cause sleeping problems if you take it in the evening. Oral phenylephrine is commonly found in combination products, but it has been found to be ineffective. So even though it’s still on pharmacy shelves, it may not help your symptoms.
Keep in mind that decongestants can make certain health conditions, such as high blood pressure, worse. Check with a healthcare professional before taking one.
Runny nose
Antihistamines may be helpful for drying up your sinuses if you have a runny nose. One option is azelastine (Astepro Allergy), an OTC antihistamine nasal spray that starts working within 15 to 30 minutes. Azelastine may help clear out your sinuses if your congestion is caused by allergies.
Older oral antihistamines, such as diphenhydramine (Benadryl) and doxylamine (Unisom), may provide some relief and start working in a similar amount of time. But they can cause side effects, such as drowsiness and dry mouth. Nondrowsy antihistamines, such as loratadine (Claritin), won’t help your symptoms.
Certain oral antihistamines may not be safe for older adults. Some of these medications can have risks in young children, too. Check with a healthcare professional before taking one.
Take our quiz: OTC cold and cough medicines
Which cold and flu medicines are best for nighttime?
When you’re feeling sick and trying to go to sleep, the last thing you want is something that will keep you awake. But certain ingredients in cold and flu medicines may do just that.
As a general rule, avoid taking daytime cold and flu medications at night. They may include ingredients that are stimulating and can interfere with your sleep. Examples include decongestants such as pseudoephedrine and phenylephrine.
“Nighttime” products, on the other hand, may contain ingredients that make you sleepy. If you’re having difficulty sleeping, this can be a welcome side effect. Examples include antihistamines such as diphenhydramine and doxylamine. Dextromethorphan can also make you drowsy. Keep in mind some products contain alcohol, which may not be ideal for certain people.
Your pharmacist can be a good resource if you’re unsure when to take a specific product.
Tips for picking the best cold and flu medication
We’ve covered some of the basics to help you navigate the best OTC cold and flu medicine options. But there are a few more things you should know before making your purchase.
1. Many OTC cold and flu medications have the same or similar ingredients
As mentioned earlier, there are just a handful of ingredients found in OTC cold and flu medications. This may be surprising given how many different products are found on pharmacy shelves. What’s more, many products are the same or very similar to each other.
For example, Mucinex Fast-Max Cold, Flu, & Sore Throat contains the exact same active ingredients as Mucinex Fast-Max Cold & Flu (All-in-One). If you judge the product on the label alone, you might pick one over the other based on how it’s named. Taking different products with the same ingredient could result in you taking too much of that particular medication.
When selecting a product, try to pay less attention to the marketing. Look at the OTC medication label instead. It’ll list the active ingredients, amounts, and symptoms the product is intended to treat. This can help you avoid duplicating ingredients. And you may even find a better deal for the same combination of medications.
2. Generics and store brands can help save you money
Generic medication names like dextromethorphan and diphenhydramine aren’t always commonly known. You may be more familiar with their branded products — Delsym and Benadryl. But when you buy the brand, you’re really just paying for the name.
Generics work just as well as their brand-name counterparts. Store-brand (also called private-label) versions are also a great option. And they can save you some money, too.
If you’re not familiar with the generic names, ask your pharmacist. They can help you select the right product to meet your needs.
3. You may be taking more medication than necessary
It’s best to avoid throwing the kitchen sink at your cold or flu symptoms. Especially with OTC combination products, you may end up taking more medication than you actually need.
For example, you may keep a combination product like NyQuil Cold and Flu on hand for when you get sick. It contains acetaminophen, as well as medications for cough and runny nose. But if you don’t have a fever or aches, you’ll end up taking acetaminophen — even though you don’t need it.
Combination products can be convenient. But taking medications you don’t need can increase the risk of side effects, interactions, and more. Be sure to check product ingredients first.
4. Know when to consult with a doctor about cold and flu medicine
It’s also important to know when you should skip OTC cold and flu medicines altogether. In some cases, you’re better off speaking to your primary care provider or another healthcare professional. You may need prescription cold and flu medications. You may also need more targeted treatments, such as flu antivirals, that aren’t available OTC.
Talk to a healthcare professional about your symptoms if:
You’re age 65 or older and think you have the flu
You have a chronic health condition, such as diabetes, high blood pressure, or asthma
You’re pregnant
You have a weakened immune system
You take medications that weaken the immune system, such as prednisone
You’ve been taking OTC cold and flu medicines for 1 week and don’t feel any better
Your symptoms initially improve and then worsen again
You have more severe cold or flu symptoms, such as a fever of 103℉ or higher
Frequently asked questions
You shouldn’t combine cold and flu medicines that contain the same ingredients or ingredients that belong to the same drug class together. For example, you shouldn’t take diphenhydramine and chlorpheniramine together since they’re both antihistamines. This is also the case for taking multiple NSAIDs, such as ibuprofen and naproxen (Aleve, Naprosyn).
Which cold medications work the fastest depends on which symptoms you’re treating. For congestion, decongestant nasal sprays work the fastest. For a fever, there isn’t a significant difference between acetaminophen, ibuprofen, and aspirin. And for a runny nose, nasal spray antihistamines, such as azelastine, usually start working faster than oral antihistamines.
You shouldn’t combine cold and flu medicines that contain the same ingredients or ingredients that belong to the same drug class together. For example, you shouldn’t take diphenhydramine and chlorpheniramine together since they’re both antihistamines. This is also the case for taking multiple NSAIDs, such as ibuprofen and naproxen (Aleve, Naprosyn).
Which cold medications work the fastest depends on which symptoms you’re treating. For congestion, decongestant nasal sprays work the fastest. For a fever, there isn’t a significant difference between acetaminophen, ibuprofen, and aspirin. And for a runny nose, nasal spray antihistamines, such as azelastine, usually start working faster than oral antihistamines.
The bottom line
If you’re dealing with cold and flu symptoms, over-the-counter (OTC) remedies may help provide some relief. Depending on your symptoms, fever reducers, cough suppressants, and decongestants are common options you may consider. You can find them on their own and in combination products.
Check a product’s ingredients before making your purchase. This can help you avoid taking medications you don’t need. You may also want to consider generics and store brands over brand-name products to help you save money. Your pharmacist can help you navigate your options.
Why trust our experts?
References
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RB Health (US). (2024). Maximum strength Mucinex fast-max cold and flu - acetaminophen, dextromethorphan hydrobromide, guaifenesin, and phenylephrine hydrochloride capsule, liquid filled [package insert]. DailyMed.
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Truman State University. (n.d.). Aspirin.
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