The Best Cold Medicine

The best cold medicine offers relief for your worst symptom without bogging you down in side-effects. To find out which drugs do this best, we talked to doctors and pharmacists about how colds affect the body and how different drugs help. Their recommendations were unanimous: Go after the symptom that’s ailing you most, rather than seeking relief from an underpowered multi-symptom formula.

The Best Cold Medicine

Best for Fever, Aches, and Sore Throat
Advil
Advil
Generic Alternatives: Walgreens Ibuprofen Tablets, CVS Health Ibuprofen Coated Tablets
Pros
Anti-inflammatory power
Cons
Limited maximum dose

Why we chose it

Anti-inflammatory power

When a cold virus invades your body, the immune system responds by turning up the heat and bombarding the virus with chemicals in an effort to weaken it. Cells convert fatty acid to substances known as prostaglandins, which raise the body’s internal temperature and inflame the muscle and tissue around the virus. Unfortunately, they also cause most of our worst cold symptoms, starting with fever and aches.

Acetaminophen and ibuprofen both work by blocking the production of prostaglandins, but they do so in different ways. Whereas ibuprofen affects both the central and peripheral nervous systems, acetaminophen barely influences the peripheral nervous system, so it doesn’t have much anti-inflammatory power. This makes ibuprofen a better choice for symptoms like a sore throat and sinusitis (the result of inflamed tissues), though acetaminophen (Tylenol) is still effective on fever and headaches. Since they operate differently, many pharmacists actually recommend taking them in alternating doses.

Points to consider

Limited Maximum Dose

Try alternating doses.Ibuprofen and acetaminophen operate differently, so many pharmacists actually recommend taking them in alternating doses (one dose of Tylenol, then one dose of Advil) as a way to lower your total intake of each.

Ibuprofen has a maximum daily dosage of 1,200 milligrams (6 regular strength Advil), as more than that can elevate the risk of internal bleeding, compared to 4,000 milligrams for acetaminophen. That means you might hit your daily limit of ibuprofen faster. You'll find the same risks in aspirin and other “nonsteroidal anti-inflammatory drugs,” collectively known as NSAIDs. For that reason, ibuprofen also isn’t recommended for people with stomach ulcers or heart problems. But in general, as long as you stay under the maximum daily dose and remember to take it with food, you should be fine.

Runner-Up for Fever, Aches, and Sore Throat
Tylenol
Tylenol
Generic alternatives: Walgreens Regular Strength Pain Reliever Tablets, CVS Health Regular Strength Pain Relief Tablets
Pros
Larger maximum dose
Cons
Less effective for sore throats

Why we chose it

Larger maximum dose

As stated earlier, Tylenol is a better fit for those with fevers or aches. This is due to the fact that Tylenol uses acetaminophen rather than ibuprofen. It’s important to note that acetaminophen (similar to ibuprofen) can cause serious liver damage if taken in too large of a dose. The FDA requires drug manufacturers to state the maximum daily dosage as 4,000 milligrams in a 24-hour period. That would be 12 regular strength Tylenol tablets, or 8 extra strength — which is a higher limit compared ibuprofen.

While there is less risk of taking too large of a dose, it’s important to know whether you’re ingesting acetaminophen from other meds too, since it tends to make its way into a good number of over-the-counter formulations. For children, the maximum daily dosage is much less, and should be determined in consultation with a doctor.

Points to consider

Less effective for sore throats

Acetaminophen lacks the anti-inflammatory power of ibuprofen, which means it can help alleviate the pain associated with sore throats, but it won’t actually reduce the source of that pain: the inflammation of muscle and other tissue.

Best for Congestion
Sudafed
Sudafed
Generic Alternatives: Walgreens Non-Drowsy Wal-Phed D, CVS Health Non-Drowsy Nasal Decongestant
Pros
Effective decongestant
Cons
Not good for long-term use

Why we chose it

Effective decongestant

Inflammation is again the culprit when it comes to a stuffy nose and head congestion. As a cold virus sweeps in, our nasal passages swell and send mucus production into overdrive as part of the body’s natural defense response. This is what makes your head feel like it’s clogged with cotton balls and your sinuses ache, neither of which makes it easy to relax or sleep.

The two major over-the-counter decongestants are pseudoephedrine and phenylephrine, both of which shrink mucus membranes in your sinuses to limit the nasal swelling that compounds that “stuffy head” feeling. Sudafed is pseudoephedrine which is more effective than phenylephrine and is your best bet for temporary relief of a stuffy head.

Points to consider

Not good for long-term use

Sudafed is part of a class of drugs called vasoconstrictors — it constricts blood vessels to limit the nasal swelling that compounds that “stuffy head” feeling. While generally effective, that mechanism makes vasoconstrictors unsuitable for sustained daily use; the body adjusts and starts to require more and more of the drug to get the same result. Possible side effects include dehydration (the opposite of what you want to recover from a cold), as well as insomnia and dizziness.

“Pseudoephedrine is recommended for no more than 3 days, as you can get worsening rebound congestions as the body fights back against the effects of the decongestant.”

Sudafed (pseudoephedrine) has become harder to purchase over-the-counter in the U.S. due to state legislators’ worries about methamphetamine production. It’s still available “behind the counter” in most states, meaning you have to show ID, although Oregon and Mississippi require a prescription.

Best for Runny Nose and Sneezing
Benadryl Allergy Plus Congestion
Benadryl
Generic alternatives: Walgreens Wal-Dryl Allergy Relief Coated Mini Tabs, CVS Health Allergy Relief Tablets
Pros
Antihistamines
Cons
Possible Drowsiness

Why we chose it

Antihistamines

Benadryl’s active ingredient is the antihistamine Diphenhydramine. This drug block your body’s production of the “histamines” that cause nasal inflammation and itchy, watery eyes. If your nasal inflammation results in more leaky drainage than congestion, an antihistamine is the go-to treatment.

"Sedating antihistamines, such as diphenhydramine and chlorpheniramine, can sometimes impair cognition or cause fogginess the next day, so it's safest to take them at times when you don't need to drive or be especially alert."

Diana C. Graalum, PharmD, BCPSClinical Pharmacy Manager, MedSavvy

Points to consider

Possible drowsiness

Need a non-drowsy formula?Allegra 12HR is FAA qualified for pilots and air traffic controllers to use thanks to Fexofenadine — a non-drowsy antihistamine. However, we still recommend using caution when first taking it.

Like other allergy medications, drowsiness is the main side effect, and for some people it can even linger into the next day, so it’s always best to use caution if you’re scheduled to drive or do anything that requires you to be alert in the immediate future. We especially don’t recommend taking Benadryl or any antihistamines before operating vehicles. Diphenhydramine (the active ingredient in Benadryl) does cause drowsiness, but then again, sleep is probably the best cold remedy there is.

Best for Cough
Mucinex DM
Mucinex
Generic Alternatives: Walgreens Mucus Relief DM Cough Immediate-Release Tablets, CVS Health Chest Congestion Relief DM Expectorant & Cough Suppressant Tablets
Pros
Fights coughs on two fronts
Cons
Possible drowsiness

Why we chose it

Fights coughs on two fronts

Mucinex DM takes a two-pronged approach to easing your cough. Unlike most of the other OTC drugs on this list, dextromethorphan (the active ingredient in any cough suppressant with “DM” in the name), targets the brain rather than the body. It works by decreasing the brain activity that causes coughing.

By contrast, guaifenesin, the active ingredient often paired with dextromethorphan, is an expectorant that helps break up the mucus that can build in your chest with a cold. Once the mucus is loosened, it’s easier to cough up; just make sure you have some tissues handy! While guaifenesin can be effective, it’s also worth noting that the best expectorant is simply water, and guaifenesin itself works best when taken with water (like all the meds on this list).

“If you wish to suppress a cough, dextromethorphan is the over-the-counter ingredient you are looking for. Guaifenesin is a proven expectorant, but is still second to plain water.”

Diana C. Graalum, PharmD, BCPSClinical Pharmacy Manager, MedSavvy

Points to consider

Possible drowsiness

Although Mucinex DM is considered “non-sedating,” experts still suggest using caution, as some patients report dizziness, drowsiness, and difficulty concentrating. We recommend not taking Mucinex before operating any vehicles — we agree with experts that it’s always better to play it safe.

How to Find the Right Cold Medicine for You

Evaluate your symptoms

All of our experts advised taking meds only when your symptoms are really bad — like if they’re preventing you from sleeping or from getting work done. That’s because every active ingredient carries at least a tiny bit of risk, especially once you start combining medications. So if you can deal with your symptoms, the best and safest course of action is simply to rest and stay hydrated to help your body actually defeat the virus causing these symptoms.

If you have to take medication, be sure to target only the symptom(s) that is causing you the most trouble.

Avoid multi-symptom medication

Even if you are suffering from multiple symptoms, experts recommend avoiding multi-symptom medication. Whether you take capsules or liquid, multisymptom cold medicines are basically the same as taking a regular strength Tylenol (acetaminophen) with a light dose of cough suppressant and either a nasal decongestant or antihistamine (in the case of the nighttime formula). For example, DayQuil only contains a third of the cough suppressant you'd get from one Mucinex DM. So if you’re really suffering from the symptoms they target, you’re probably better off with a full dose from one of the other products on this list.

“Multi-symptom drugs should not be considered ‘magic bullets’ for treating colds; in fact, they may not be as effective due to low dosages of certain active ingredients.”

Watch for sustained release formulas

Every drug on this list carries a risk of overdose, so it’s vital that you understand not only what’s in the cold medicine you’re taking, but also how long it’s likely to remain in your system so that you don’t inadvertently overlap safe dosages — sustained release formulas can linger in your system.

“Be aware of 'sustained release' drugs (whose effective periods last longer than usual) as they can make it easier to overmedicate.”

John Beckner, RPhSenior Director of Strategic Initiatives National Community Pharmacists Association

Use caution if mixing over-the-counter meds with prescription products

If you’re taking prescription drugs, be sure to ask your pharmacist or primary care physician how they’ll interact with over-the-counter drugs, even ones as benign-seeming as acetaminophen or ibuprofen. It could be that they contain added amounts of the same ingredients in OTC drugs, (which could trigger an overdose), or that they can interact adversely with the drugs in your medicine cabinet.

Cold Medicine FAQ

Is cold medicine safe for kids?

Children under age 4 should never be given over-the-counter cold meds. A 2007 FDA meeting on the safety and effectiveness of cough and cold drug use in children revealed that there were many reports of harm in kids under age 4. Side effects of decongestants and antihistamines in particular included convulsions, rapid heart rates and in some cases, death. Given that over-the-counter cold medicine doesn’t actually cure a cold, the risks in giving it to young children just seem to outweigh any potential benefit.

Will vitamin C help cure my cold?

Despite their popularity, minerals like Vitamin C and Zinc aren’t scientifically proven to help a cold. Vitamin C is well known to support a healthy immune system, but the idea that it actually alleviates cold symptoms is a myth. Many people also swear by zinc, but there’s still no evidence that it actually shortens the duration of a cold. There is, however, some evidence that zinc nasal sprays in particular can permanently damage your sense of smell.

How do I cure a cold?

The best way to recover from a cold is with rest and hydration. While both seem obvious, hydration can be overlooked. Remembering to stay hydrated helps your body ward off the virus, and it also aids the work of your medications, speeding their absorption and diffusion into the bloodstream.

The Best Cold Medicine: Summed Up

Active Ingredients
OTC
Advil
Best for Fever, Aches, and Sore Throat
Ibuprofen
Tylenol
Runner-Up for Fever, Aches, and Sore Throat
Acetaminophen
Sudafed
Best for Congestion
Pseudoephedrine
(Behind the counter)
Benadryl Allergy Plus Congestion
Best for Runny Noses and Sneezing
Diphenhydramine
Mucinex DM
Best for Cough
Dextromethorphan, Guaifenesin