The Best (and Worst) Cold Medicines, According to Experts

There are dozens of over-the-counter cold and flu medications to choose from, but what works? Learn which cold remedies actually get results.

Photo: Anna Bizon/Getty Images

The average American adult gets two to three colds a year, according to the Centers for Disease Control and Prevention (CDC), with each lasting about seven to 10 miserable days.

So it's no surprise that we spend hundreds of millions of dollars on over-the-counter cold and flu remedies annually, according to the Consumer Healthcare Products Association.

Turns out that by and large, we're wasting our money. Evidence suggests that few head cold remedies—herbal, over-the-counter, or homeopathic—are likely to influence the course of a cold or the flu. That said, some do work.

Here, a complete list of cold and flu remedies—both over-the-counter and all-natural—to help you kick the sniffles, or skip them altogether.

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Does it work? Maybe. Some evidence suggests that zinc lozenges (like Zicam and Cold-Eeze) may shorten the duration of the common cold.

A review published in 2015 in Cochrane Database of Systematic Reviews looked at 16 studies of zinc used during colds and found that if started within 24-hours of symptoms, zinc lozenges or zinc syrup reduced the duration—but not the severity—of cold symptoms. However, the authors cautioned that no firm conclusions could be made since the studies varied in how they were organized.

Most studies are small and don't provide "robust" evidence of benefit, said Joy P. Alonzo, PharmD, assistant professor of pharmacy practice at Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy. "I don't recommend it," Alonzo said.

And there may be a drawback to some forms of zinc: In 2009, taking zinc nasal products was linked to a permanent loss of taste and smell in some people. The Food and Drug Administration (FDA) warned consumers not to use three zinc-based nasal products, but that warning didn't extend to oral products, like zinc tablets or lozenges.

However, zinc lozenges can cause temporary side effects, such as a bad taste in your mouth and nausea, according to the 2015 review.

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Taking echinacea might slightly reduce your chances of catching a cold, according to the National Center for Complementary and Integrative Health (NCCIH), but the herb has not been shown to help once you have a common cold.

So much depends on the treatment's preparation—juice, root-and-herb, or tincture—which can vary widely. In addition, a lab study published in 2019 in the journal Scientific Reports suggests that the potential effects of echinachea on immune cells may vary based on the bacterial composition within the plant and the soil in which it was grown.

What's more, echinacea is closely related to ragweed. Allergic reactions to oral echinacea—like rashes and gastrointestinal problems—are uncommon. But if you have ragweed-triggered seasonal allergies, you may be more likely to develop symptoms with echinacea, according to the Allergy and Asthma Network.

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Do they work? Yes. A review published in 2019 in American Family Physician found that over-the-counter decongestants were effective for cold symptoms in adults.

Decongestants target stuffy sinuses by shrinking the blood vessels that stop up the nose.

Studies suggest that decongestants help with congestion, according to another review published in 2018 in the journal BMJ. However, the review authors cautioned that the research on decongestants is limited and the studies are small.

Choose a product that contains pseudoephedrine (like Sudafed). You'll have to ask for it at the pharmacy counter—in 2005, the FDA put limits on how much an individual can purchase because pseudoephedrine is commonly used to make methamphetamine, a highly addictive stimulant.

"The quick rule of thumb is if you can buy it without showing an ID, don't bother. It's not going to work," said Ally Dering-Anderson, PharmD, clinical assistant professor of pharmacy practice at the University of Nebraska Medical Center.

Pseudoephedrine may slighly increase blood pressure, so those with high blood pressure may want to consider spray-based decongestants such as Afrin 12 Hour. This won't stray into your bloodstream, said Alonzo.

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Vitamin C

Vitamin C in mega-doses comes brightly packaged as Emergen-C and Airborne, but there's no concrete evidence that large doses of C can reduce the duration or severity of colds.

Vitamin C is water soluble, so anything over the recommended dietary allowance—which is 90 milligrams a day for men and 75 for women, according to the National Institutes of Health (NIH) —will be eliminated from the body when you urinate.

The better approach: Fill up on whole foods loaded with vitamin C, which are also loaded with other important nutrients to keep your body strong and healthy.

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Expectorants, such as Mucinex, thin the nasty mucus draining down the back of your throat, which helps you cough it up and out.

These products can help, but the best expectorant may be as near as your kitchen sink. "All you need to do is drink more water," said Dering-Anderson. If you find water too bland for your tastes, try lemonade or tea, Dering-Anderson said.

You can also turn on the hot water in the shower and breathe it in or try a cool-mist humidifier.

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This homeopathic remedy claims to fight multiple symptoms of a head cold including "hacking cough" or "rattling/tickling cough." According to Alonzo, there's no data that show either way whether Defend works.

In fact, the NCCIH states that there's little to no evidence that any homeopathic products work. Homeopathic products are not as tightly regulated as drugs.

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Do they work? Sometimes. At the start of a cold, antihistamines may provide temporary relief. They can also be helpful if your runny nose and scratchy throat are actually due to allergies.

A review published in 2015 in Cochrane Systematic Reviews found that antihistamines helped lessen the severity of overall cold symptoms for the first two days. After day two, they didn't offer a benefit, according to the review.

Often used to treat allergies, common brand names include Claritin, Zyrtec, and Benadryl. Claritin and Zyrtec aren't likely to make you drowsy. Benadryl will, but that can be a good thing when you need to get some rest, said Dering-Anderson.

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Does it work? Maybe. Another natural remedy for a head cold, Sambucol consists of extracts from the black elderberry plant.

One study of 312 air travelers published in 2016 in the journal Nutrients reported that elderberry extract reduced both days of a cold and severity of symptoms compared to a placebo. The researchers relied on participants' own reports of how they were feeling and called for more research.

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Pain Relievers

A pain reliever may be the first thing you reach for when you come down with a cold, and with good reason. "Pain relievers for coughs and cold can be very effective," said Alonzo. They can also help with fever.

Tylenol (acetaminophen) can relieve pain and reduce a fever. Nonsteroidal anti-inflammatory meds (NSAIDs) like Advil or Motrin (ibuprofen) or Aleve (naproxen) can relive pain and fever and have the advantage of also reducing tissue inflammation.

However, NSAIDS may increase the risk of heart attacks or stroke and can lead to gastrointestinal sides effects, such as ulcers and bleeding, according to National Library of Medicine's resource MedlinePlus.

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Theraflu is basically a dose of acetaminophen along with several other anti-cold ingredients and has a warning about the risk of liver damage if you take more than the recommended dose or mix with alcohol or other acetaminophen-containing products.

Better bet: Take ibuprofen or acetaminophen alone and brew yourself a cup of tea or soup, said Dering-Anderson. You'll get the warm, soothing fluids without the extra drugs.

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Cough Suppressants

A hacking cough is one of the most disabling symptoms of cold or flu, and suppressants containing dextromethorphan (abbreviated as "DM") may be able to help a little bit.

But keep in mind that a cough can be part of the natural healing process. "It's your lungs saying to your brain, 'We've got to get this stuff out of here,'" said Dering-Anderson. "You can't turn off a cough and expect to get better."

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Combination Products

Do they work? Yes, but… Combination products claim to treat all the nagging symptoms of colds and flu: pain, cough, sniffles, runny nose, you name it. The chemical cocktail may get the job done, but that doesn't mean you should use them—especially ones that contain acetaminophen.

If you're taking other products with acetaminophen, it's just too easy to go overboard and run the risk of liver damage, said Dering-Anderson.

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This homeopathic remedy is made from heart and liver extract from the moscovy duck, which is native to Mexico, Central America, and South America.

A 2012 review of studies on almost 50 years of research on oscillococcinum published in Cochrane Database of Systematic Reviews found "insufficient good evidence" that "oscillo," as it's affectionately called, has any effect on the treatment or prevention of the flu.

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Brewer's Yeast

Does it work? Maybe. The same stuff used to ferment beer is sold in a supplement form under the name EpiCor.

In a study published in 2010 in The Journal of Alternative and Complementary Medicine, researchers from the University of Michigan and the company that makes the supplement found that people who took 500 milligrams of EpiCor daily for 12 weeks had fewer colds than those taking a placebo.

For those who did fall ill, the supplement had no effect on duration or severity.

Brewer's yeast contains B vitamins, including vitamin B6—a vitamin that's involved in immune function, according to the NIH.

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Ginger Tea

Does it work? No. There's no research that shows ginger or ginger tea having any concrete effect on flu symptoms or being a common cold remedy, said Alonzo. That said, sipping a steaming cup of tea or any other hot liquid may help you feel more comfortable.

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Eucalyptus Oil

The strong smell of eucalyptus oil may be why many people turn to this when they're congested and miserable. But the extract can actually be dangerous, said Alonzo. "If you put it on your nose and breathe it in and get it into your lungs, you're setting yourself up for chemical pneumonia," Alonzo warned. Nor should it be rubbed on your chest.

Instead, you could put a couple of drops on your shower floor and then turn on the hot water. This may provide some overall relief. "The fragrance is soothing," Alonzo said.

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Extracts from this plant are touted not only for colds and respiratory tract problems, but also for eye infections, ulcers, hay fever, and digestive upset such as constipation or diarrhea. The problem? There's no evidence that it actually works for any of these indications, according to the NCCIH.

Goldenseal also has a high risk of drug interactions since it interferes with two metabolic enzymes that your body uses to break down and absorb many prescription medications, per the NCCIH. Interactions include metformin used to treat type 2 diabetes; cyclosporine, an immune-suppressing drug used by transplant patients; digoxin, which is used to treat heart rhythm problems; and other drugs metabolized by the liver.

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Does it work? Maybe. There is some—though not a lot—of evidence that this herb may shorten the duration of colds if taken consistently.

A review of studies looking at ginseng for the prevention of colds published in 2011 in the journal Evidence-Based Complementary and Alternative Medicine found that ginseng shorted the duration of colds and respirartory infections by about six days on average when taken daily as a preventative for eight to 14 weeks.

The review did not find any evidence that ginseng could actually reduce the number of colds or their severity.

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Pelargonium Sidoides

Extracts from this South African plant are approved to treat bronchitis in Germany, but haven't been approved by the FDA in the U.S.

Preliminary research suggessts that Pelargonium sidoides might offer some symptom relief for the common cold, bronchitis, and sinus infections, according to a 2014 review published in Cochrane Database of Systematic Reviews. However, the review authors noted that the quality of studies was low.

In addition, a lab study published in 2019 in the journal PLoS One suggested that Pelargonium sidoides may block certain proteins that help rhinoviruses (common cold) thrive while also assisting defense proteins that help fight viruses.

Does it work? Maybe. More research is needed.

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Vitamin D

As soon as one study proclaims that vitamin D lowers the risk of upper respiratory infections, another study turns up to refute the claim. What we do know is that vitamin D is essential for bone health and your immune system needs it in order to fight viruses and bacteria, according to the NIH.

Vitamin D is found in fish, eggs, fortified food, and natural sunlight. A balanced diet may be the best protection for your overall health.

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Okay, but What Types of Cold Medicine Can You Take While Pregnant?

Most medicines taken during pregnancy cross the placenta and reach the fetus, so it's important to know which ones are safe, and which should be avoided—and what some natural remedies are instead.

The American Pregnancy Association recommended getting plenty of rest (during the day and night), drinking lots of fluids and trying some natural remedies.

For instance, to reduce congestion, place a humidifier in your room, elevate your head during rest time, or try nasal strips, per the American Pregnancy Association. To soothe a sore throat, gargle with warm salt water, drink warm tea, or suck on ice chips.

As far as OTC medications go, the American Pregnancy Association advised keeping the number to a minimum during pregnancy. Among the safest options for pregnant people are:

  • Acetaminophen (i.e. Tylenol) can work for fevers, headaches, and body aches.
  • Most cough drops are generally considered safe to help ease a cough.
  • Anesthetic throat lozenges can relieve a sore throat.

Cold medicines that you may need to avoid, however, include:

  • Some pain relievers and fever reducers, such as aspirin, ibuprofen (e.g. Advil) and naproxen (e.g. Aleve)
  • Afrin and other non-steroidal nasal decongestant sprays containing oxymetazoline
  • OTC herbal remedies like echinacea

To be on the safe side, always get your cold meds approved by your pharmacist or healthcare provider. Many healthcare providers advise staying away from all medicines (whether prescribed or OTC) during the first trimester.

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