Is there good evidence to support over-the-counter (OTC) medication use for the common cold?

From the Guidelines

There is limited evidence supporting over-the-counter medications for the common cold, with most providing only modest symptom relief rather than shortening illness duration. Decongestants like pseudoephedrine can temporarily reduce nasal congestion but may cause insomnia or increased blood pressure 1. Antihistamines may help with runny nose and sneezing but often cause drowsiness. Pain relievers such as acetaminophen (325-650mg every 4-6 hours, maximum 3000mg daily) or ibuprofen (200-400mg every 6-8 hours with food) can reduce fever and relieve headache or sore throat. Zinc lozenges started within 24 hours of symptom onset may modestly reduce symptom duration, as evidenced by a study that found zinc administered as zinc acetate or zinc gluconate lozenges at a dose of >=75 mg/day significantly reduces the duration of common cold 1. Vitamin C hasn't shown consistent benefits for prevention or treatment. Combination cold medicines should be used cautiously to avoid duplicate ingredients and side effects. Most colds resolve within 7-10 days regardless of treatment, so supportive care with rest, hydration, and saline nasal irrigation may be equally effective. OTC medications primarily target specific symptoms rather than addressing the underlying viral infection, which explains their limited effectiveness.

Some key points to consider:

• Antihistamines have a limited short-term beneficial effect on severity of overall symptoms in adults but not in the mid to long term 1.
• Decongestants may have a small positive effect on subjective measures of nasal congestion in adults with the common cold 1.
• NSAIDs can relieve discomfort or pain caused by the common cold, but do not significantly reduce the total symptom score or duration of colds 1.
• Ipratropium bromide is likely to be effective in ameliorating rhinorrhoea, but has no effect on nasal congestion and its use is associated with more side effects compared to placebo or no treatment 1.
• Nasal saline irrigation possibly has benefits for relieving the symptoms of acute URTIs, mainly in children 1.

It's essential to weigh the benefits of these medications against the risk of adverse effects, especially in young children, where there is no evidence of effectiveness for many OTC medications 1.

From the FDA Drug Label

NSAIDs are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as different types of arthritis, menstrual cramps, and other types of short-term pain.

The FDA drug label does not answer the question about good evidence to support over-the-counter (OTC) medication use for the common cold. 2 2

From the Research

Evidence for Over-the-Counter Medication Use

• There is evidence to support the use of over-the-counter (OTC) medications for relieving symptoms of the common cold, but the effectiveness varies depending on the medication and the individual's symptoms 3, 4, 5, 6, 7.
• Dextromethorphan may be beneficial in adults with cough, but its effectiveness has not been demonstrated in children and adolescents 3.
• Topical and oral nasal decongestants have been shown to relieve nasal symptoms and can be used in adolescents and adults for up to three days 3.
• Antihistamines and combination antihistamine/decongestant therapies can modestly improve symptoms in adults, but the benefits must be weighed against potential side effects 3, 6.
• Acetaminophen may help relieve nasal obstruction and rhinorrhoea, but does not appear to improve some other cold symptoms, such as sore throat, malaise, sneezing, and cough 7.

Safety and Efficacy of OTC Medications

• Aspirin, paracetamol, and ibuprofen are safe in OTC doses and have been shown to be effective in treating colds and flu symptoms, although the evidence is limited 5.
• Antihistamine-decongestant-analgesic combinations have been shown to have some general benefit in adults and older children, but the effect on individual symptoms is probably too small to be clinically relevant 6.
• The use of OTC nasal preparations containing phenylpropanolamine has been associated with adverse effects, and the US Food and Drug Administration has issued a warning about its use 6.

Limitations of the Evidence

• Many of the studies on OTC medications for the common cold have methodological limitations, such as small sample sizes and short durations 3, 4, 5, 6, 7.
• The evidence for the effectiveness of OTC medications in children is limited, and many medications are not recommended for use in children under a certain age 3, 4, 6.
• Further large-scale, well-designed trials are needed to determine the effectiveness and safety of OTC medications for the common cold 7.