What are the most effective over-the-counter (OTC) medications for treating cold sores?

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Last updated: June 6, 2025 • View editorial policy

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

The most effective over-the-counter medication for treating cold sores is docosanol (Abreva), which can shorten healing time when applied at the first sign of a cold sore, typically used 5 times daily until the sore heals 1. When considering treatment options for cold sores, it's essential to prioritize medications that can reduce healing time and alleviate symptoms.

  • Docosanol (Abreva) is the only FDA-approved OTC medication that can shorten healing time when applied at the first sign of a cold sore.
  • Pain-relieving products containing benzocaine (20%) or lidocaine (2-4%) can be applied directly to sores 3-4 times daily to reduce discomfort.
  • Drying agents like zinc oxide or alcohol-based products can help dry out blisters. The mechanism of action of docosanol involves creating a barrier that prevents the herpes simplex virus from entering healthy cells, making it an effective treatment option 2.
  • For best results, start treatment at the earliest symptoms (tingling or burning sensation) rather than waiting for blisters to form.
  • Cold sores typically heal within 7-10 days regardless of treatment. It's also important to note that while docosanol has been shown to be effective in reducing healing time, its efficacy is modest, and lifestyle measures are still essential in managing herpes labialis 3.
  • Supplements like lysine (1000mg daily) may help prevent recurrences, though evidence is limited. Overall, docosanol (Abreva) is a safe and effective topical treatment for the management of recurrent herpes labialis, with essentially equivalent efficacy compared to other available prescription topical antiviral agents 1.

References

Research

Topical n-docosanol for management of recurrent herpes labialis.

Expert opinion on pharmacotherapy, 2010

Research

Docosanol: a topical antiviral for herpes labialis.

Expert opinion on pharmacotherapy, 2004

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.