Navigating the Cold and Flu Aisle

When struggling with cold or flu symptoms, you may depend on over-the-counter medications for relief. However, figuring out which option is right for you can be overwhelming.

To help you understand the basics, internal medicine doctor Maria de Miguel, MD, draws on her expertise in general medicine and her experience treating patients to explain the various types of cold and flu medicines and how they can help you feel better.

We’re often told that cold and flu medicines aren’t a cure. So, what exactly do they do?

A cold and the flu are caused by viruses, and it’s true, we don’t have cures for them like we can use antibiotics to kill bacteria. Most adults will get one to two bouts of a cold and/or flu per year, which can cause multiple symptoms such as sore throat, headache, cough, congestion, runny nose, and fatigue. A cold may cause a mild fever, and the flu can cause a higher fever and body aches.

Over-the-counter cold and flu medicines can lessen these symptoms while your body’s immune system works to clear the virus. The idea is to help you feel (and possibly function) better, even though the virus is still present in your body.

Could you explain the different types of cold/flu medicines?

Certainly. Analgesics, most commonly acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, treat pain symptoms like headache, sore throat, and body aches. They can also lower fever.

Cough is one of the most bothersome symptoms of a cold or flu. Antitussive medications, like the generic drug dextromethorphan, attempt to calm coughing, but in general, they are not very effective. Mucolytics or expectorants (such as the generic drug guaifenesin) can help break up or thin mucous to make it easier to cough up. Antihistamines (including generic names doxylamine, diphenhydramine, and chlorpheniramine) help to dry up runny nose and sinus congestion, which can also help with sneezing and sometimes mitigate cough.

Decongestants, which clear the sinuses, can be taken in oral form (like the generic pseudoephedrine) or as a nasal spray (such as oxymetazoline).

These medicines can be helpful, temporarily reducing the discomfort of symptoms while the immune system does its job.

If someone has more than one symptom, should they take more than one medicine? Or does taking a single, multi-symptom medicine make more sense?

Taking different medicines for different symptoms is okay, but multi-symptom medicines make managing several symptoms easier with a single dose. Combination antihistamine, decongestant, and analgesic medicines have been shown to more effectively reduce symptoms than using individual medicines on their own.

However, it’s important to note that antihistamines can have side effects like dry mouth and drowsiness (in the PM formulations). In addition, decongestants (like pseudoephedrine) can cause insomnia. Using single-symptom medicines can help you avoid unnecessary side effects.

Could you elaborate on multi-symptom cold/flu medicines? Are there some precautions to keep in mind?

First, it’s important to take multi-symptom medicines as they are directed on the label. It’s also important not to combine single-symptom medicines like acetaminophen with a multi-symptom medicine that has acetaminophen in it. This can lead to an overdose of that medicine, which can be dangerous.

Then, there are cases where patients have particular vulnerabilities. For example, people with high blood pressure should avoid oral decongestants like pseudoephedrine. And people with kidney disease, stomach ulcers, or high blood pressure should avoid NSAIDs like ibuprofen.

Do you have an opinion on using generic cold/flu medicines versus name-brands?

Absolutely! Generic medicines are fine. Why not save some money?

Other than treating the symptoms, what are other ways to help the body fight a cold or flu virus?

The best thing to do to help your body fight a cold or flu virus is to get enough rest. Sleep is critical for the immune system to do its job well.

Also, keeping yourself hydrated is very important. Even if you don’t feel like drinking much, this will help your body get the phlegm out and will replace your body’s lost fluids. With my patients, I recommend drinking a half-and-half mixture of a sports drink such as Gatorade and water. This delivers plenty of water and electrolytes while reducing the sugar load.

Do cold/flu symptoms ever warrant calling a healthcare provider? When?

Yes, there are some situations when it is important to call a healthcare provider. Sometimes, it’s hard for an individual to tell if they have a bacterial infection instead of a cold or the flu. A sore throat with painful swallowing and a high fever that doesn’t have a cough or runny nose, for example, could be strep throat, which must be treated with antibiotics.

For the elderly, people with significant lung disease or other serious illnesses, or those with a weakened immune system, the flu can be very serious and may need treatment with a prescription medicine to help prevent hospitalization. A doctor can test for the flu in the office and provide the prescription to help lessen the chance of a serious course of flu.

What are the best ways to avoid getting a cold or the flu in the first place?

Vaccines are the most important way to avoid diseases caused by viruses. We have vaccines for the flu virus and COVID-19, which are recommended for everyone. These vaccines can help protect you and your loved ones from the flu and COVID-19, which can both be very serious.

Cold and flu viruses are passed through droplets from coughing and sneezing. Washing hands frequently is always a good practice, but especially during cold/flu season or when you or a close contact has symptoms. People with symptoms of sneezing or coughing should avoid being around others, should wear a mask, or, at the very least, should cover their mouths with the bend in their arm.