What are the recommended brands of medicine to prescribe for common cold symptoms?

Recommended Medicine Brands for Common Cold Symptoms

For adults with common cold symptoms, prescribe combination products containing an antihistamine, analgesic (acetaminophen or NSAID), and decongestant (pseudoephedrine or phenylephrine) as first-line therapy, as these provide the most significant symptom relief with approximately 1 in 4 patients experiencing meaningful improvement. 1

First-Line Treatment Approach

Combination Products (Preferred)

• Prescribe combination antihistamine-analgesic-decongestant products for adults and older children experiencing multiple cold symptoms, as these have the strongest evidence for significant symptom relief 2, 1
• Common brand examples include products containing chlorphenamine (antihistamine) + pseudoephedrine (decongestant) + acetaminophen or ibuprofen (analgesic) 3
• These combination products work synergistically to address nasal congestion, rhinorrhea, headache, and malaise simultaneously 1

Single-Agent Options for Specific Symptoms

For nasal congestion:

• Prescribe pseudoephedrine (oral decongestant) or phenylephrine for short-term use only (3-5 days maximum) to avoid rebound congestion 2, 1, 4
• Pseudoephedrine provides a modest 6% decrease in subjective symptoms after a single dose and 4% improvement with repeated doses over 3-5 days 4
• Important caveat: Limit decongestant use to short-term only, as prolonged use leads to rebound congestion 1

For pain, fever, and malaise:

• Prescribe ibuprofen or other NSAIDs as they effectively treat headache, ear pain, muscle/joint pain, malaise, and also improve sneezing symptoms 1
• Alternatively, prescribe acetaminophen (paracetamol), which may help relieve nasal obstruction and rhinorrhea, though it does not improve other cold symptoms as effectively as NSAIDs 1, 5

For rhinorrhea (runny nose):

• Prescribe ipratropium bromide nasal spray (0.06%), which is the only inhaled anticholinergic recommended for rhinorrhea in common cold 2, 1
• This medication effectively reduces rhinorrhea but has no effect on nasal congestion and may cause minor side effects like nasal dryness 1
• Chlorphenamine (antihistamine) exhibits higher efficacy in alleviating rhinorrhea compared to pseudoephedrine alone 3

Additional Evidence-Based Options

Zinc supplementation:

• Prescribe zinc acetate or zinc gluconate lozenges at ≥75 mg/day if the patient presents within 24 hours of symptom onset 2, 1, 6
• This significantly reduces cold duration when started early 6
• Critical timing: Zinc is only effective if started within 24 hours of symptom onset 1, 6
• Warn patients about potential side effects including bad taste and nausea 6

Nasal saline irrigation:

• Recommend over-the-counter saline nasal sprays or irrigation systems for modest symptom relief, particularly beneficial in children 2, 1

Vitamin C:

• Consider recommending vitamin C supplementation on an individual trial basis given its consistent effect on duration and severity, low cost, and safety profile 2, 1

Medications to AVOID

Do NOT prescribe:

• Antibiotics - no evidence of benefit for common cold and associated with significant adverse effects and antimicrobial resistance 1
• Intranasal corticosteroids - not effective for common cold symptom relief 1
• Dextromethorphan or codeine for cough due to URI - limited efficacy and not recommended 2, 7
• Antihistamines alone - limited short-term benefit with no clinically significant effect on nasal obstruction, rhinorrhea, or sneezing 1
• Echinacea products - not shown to provide significant benefits 2, 1
• Zinc preparations for cough specifically - not recommended 2

Treatment Algorithm by Symptom Severity

For mild, single-symptom presentation:

• Start with single-agent therapy targeting the most bothersome symptom 1
• Nasal congestion alone: short-term decongestant (pseudoephedrine or phenylephrine) 1
• Rhinorrhea alone: ipratropium bromide nasal spray 1
• Pain/fever alone: acetaminophen or NSAIDs 1

For multiple symptoms (most common):

• Use combination antihistamine-analgesic-decongestant products as first-line 1
• Add zinc lozenges (≥75 mg/day) if within 24 hours of symptom onset 1, 6
• Add saline nasal irrigation for additional relief 1

Critical Safety Considerations

In children:

• Do NOT prescribe over-the-counter cough and cold medications in children younger than 4 years due to potential harm and no proven benefits 8, 9
• For children ≥1 year old, honey is safe and effective 8
• Nasal saline irrigation and topical ointments containing camphor, menthol, and eucalyptus oils are safe options 8

Decongestant safety:

• Pseudoephedrine may induce less common but potentially life-threatening adverse effects compared to antihistamines 3
• Chlorphenamine demonstrates a more favorable benefit/risk profile than vasoconstrictors 3
• Always limit decongestant use to 3-5 days maximum 1

Common Pitfalls to Avoid

• Inappropriate antibiotic prescribing contributes to antimicrobial resistance and has no role in common cold treatment 1
• Prolonged decongestant use beyond 3-5 days leads to rebound congestion 1
• Missing the zinc window - zinc supplementation only works if started within 24 hours of symptom onset 1, 6
• Unrealistic patient expectations - counsel patients that cold symptoms typically last up to 2 weeks and treatment only provides symptomatic relief 1