One of the most common reasons that patients come to see me for is an upper respiratory infection. These infections are often viral, at least to start out. Patients will go to the doctor for a quicker end to their symptoms. Also, they often wonder if their infection is bacterial and needs antibiotics. This can only be evaluated in person at your physician’s office. To determine whether antibiotics are needed, a doctor will look in a patient’s ears, nose, and throat. They’ll also check the lungs and sinuses as well as test for strep throat or the flu (if needed).
Whether or not an antibiotic is needed, most of the medicines used to relieve symptoms of sore throat, congestion, runny nose, and cough are available over the counter. In addition to checking for bacterial infection, patients want to know what they can take for symptomatic relief. One trip down the aisle at CVS or a local grocery store will show you tens if not hundreds of options. In this article, I will go through my favorite cold medicines for each symptom, including the benefits and drawbacks of each.
First, let’s review the steps of a cold
All colds are different but the majority follow a basic pattern. Most colds start with a sore throat. A few days later, this progresses to a runny nose and congestion. Over the next several days, the thin mucous will thicken and a cough develops. The cough is generally the last symptom to go away. Also, a fever is rare with a viral cold.
There are no hard and fast rules for how the body works. You may have a cold that skips one of the above steps or lingers on one symptom for a longer time.
Medicines to shorten a cold
Not in the mood to have a cold in the first place? Welcome to the club. In recent years, a slew of homeopathic products have come to the market that claim they can shorten the duration and severity of a cold. The active ingredients in these substances are compounds of zinc which is believed to work by competing with the cold virus for binding sites in the respiratory tract.
A good brand of zinc supplements is Zicam. The medication must be started within 24 hours of the onset of cold symptoms, likely the initial sore throat. Zicam makes several formulations. The one I like best is the oral dissolving tablets, called Rapid Melts. These essentially melt in your mouth by placing them on your tongue and sucking them. There is conflicting information on whether Zicam intranasal products (swab and gel) can cause loss of smell. Personally, I think that it is best to avoid the intranasal formulations and stick to the oral variety. The Rapid Melts do dissolve quickly which is a good thing. The longer-lasting lozenges are more likely to cause temporary taste alteration.
I have found that while Zicam does not work 100% of the time, it does give you a fighting chance to shorten the duration of a cold by a few days. It also makes the symptoms milder. When taking the medication myself, it seems to work maybe two-thirds of the time.
The dosing for Zicam Rapid Melts is very frequent which could make this medication less user-friendly. The package insert recommends a tablet every 3 hours. This may even mean taking one when getting up in the middle of the night. It seems that the more one spaces the dosing, the less likely that Zicam is to be effective. Also, if Zicam is stopped before the cold symptoms remit, the benefits may be lost. Overall, Zicam Rapid Melts can be a good product that gives one a chance to shorten a cold duration but requires dedication in dosing.
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Medicines for the sore throat and runny/stuffy nose
A sore throat generally lasts a day or two. The best thing for this is to start Zicam and to use throat drops. Halls is a good brand for this and can give temporary relief, but I have often found that symptoms return quickly.
Once the sore throat gives way to the runny nose, with that annoying drippy feeling, you are in a full-blown cold. What should you take for the symptoms? I like an antihistamine for the runny nose. Antihistamines can block the leaky blood vessels in the nose from causing a runny nose. Even though they work best for allergies, the symptoms that they relieve in a cold are similar. Some examples of this are Zyrtec and Claritin in the less drowsy category and Benadryl in the more drowsy category.
The cold medication Nyquil is a combination pill that contains an older antihistamine to cause drowsiness along with a cough medicine and the pain medication Tylenol. Nyquil is indeed great to help one sleep with a cold. Keep in mind that it has several medicines in it and may not be the best choice if you are not coughing or in pain.
Decongestants are medicines that relieve a stuffy nose and facial/sinus pressure. They will not help with runny nose or mucus but will help you breathe easier from your nose. There are two types of decongestants – oral and nasal sprays. Oral decongestants are stimulant medicines that reduce mucosal swelling. The classic medication in this category is Sudafed. Sudafed does the opposite of the anti-histamines – it amps everything up. Sudafed can feel like drinking several cups of coffee. It can cause jitteriness, palpitations, and elevated blood pressure. It does work very effectively for nasal and sinus congestion. However, I would not recommend this medication for those with any heart conditions or high blood pressure. I also would most certainly not recommend this medication at night.
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Oral decongestants are available in combination with the non-drowsy antihistamines Claritin and Zyrtec – known as Claritin D and Zyrtec D respectively. In one pill, you can treat both a runny nose and the stuffy nose that accompanies it. Assuming no health contraindications, I recommend the 12 hours formulation first thing in the morning so it is out of your system by bedtime.
Topical decongestants are nasal sprays containing steroids that reduce nasal inflammation. Examples include Flonase, Nasonex, Nasocort, and Rhinocort. These work locally in the nose so they have limited side effects, mostly nasal irritation and burning or bloody nose. They do not cause jitteriness or drowsiness and are a great option for nasal congestion, especially in those with high blood pressure and heart conditions.
My best recommendations for this stage of a cold are a Claritin/Zyrtec D 12 hour first thing in the morning for those with no contraindications or Flonase and Claritin for those with high blood pressure or heart issues. At night, Nyquil works best for sleep. Remember to never take Nyquil during the day as it causes a lot of drowsiness! Dayquil is a combination medicine containing cough medicine, a Sudafed-like decongestant, and Tylenol. It can be substituted for Claritin D during the day if cough is present.
Medicines for thick mucus and cough
As a cold progresses to thicker mucus, a different medication may be needed. This thicker mucus can settle in the sinuses or lungs and lead to secondary bacterial infections. It is important that the mucus thins so it can drain out and help the cold resolve faster.
A great medication for this purpose is Mucinex which works to thin mucus so it drains out more easily. Mucinex comes in several formulations and mixes. It can get confusing to pick the right Mucinex. The main types are regular Mucinex (blue box), Mucinex DM (green box), and Mucinex D (red box).
Mucinex DM has an added cough medicine that can be useful if the thick mucus that you are feeling is causing a cough. Mucinex D has a decongestant in it similar to Sudafed and Claritin D as it helps decongest the nose as well as to clear the thick mucus. This is best used for mucus in the upper respiratory tract. The same precautions as I mentioned in the earlier section for oral decongestants apply here.
In the end, there are a lot of cold medicines on the market – a whole aisle full of them. Above, I tried to simplify and narrow down the options to the ones I recommend to my patients and family. Before using any of these medicines, always check with the pharmacist or your physician to make sure none of them interact with your current prescriptions. If a cold is not getting better with symptomatic treatment, it could be strep throat or might be turning into a sinus or lung infection. Overall, it is best to see a doctor in person to evaluate any issues that would require an antibiotic.
Do you have a favorite cold medication? Feel free to share in the comments below!