What medications are recommended for treating the common cold?

Medications for the Common Cold

For symptomatic relief of the common cold in adults, use combination antihistamine-analgesic-decongestant products as first-line therapy, or alternatively use NSAIDs/acetaminophen for pain and fever with short-term decongestants for nasal congestion, and add zinc lozenges (≥75 mg/day) if started within 24 hours of symptom onset. 1

First-Line Treatment Approach

Combination Products for Multiple Symptoms

• Combination antihistamine-analgesic-decongestant products provide the most comprehensive symptom relief in adults and older children, with approximately 1 in 4 patients experiencing significant improvement. 1 This represents the strongest evidence-based recommendation from the American College of Physicians. 1
• These combination products address multiple symptoms simultaneously (nasal congestion, rhinorrhea, headache, malaise) and are more practical than managing multiple single agents. 2

Single-Agent Therapy for Targeted Symptoms

When patients have mild or isolated symptoms, single-agent therapy is appropriate:

For pain, fever, and general malaise:

• NSAIDs (ibuprofen) are highly effective for headache, ear pain, muscle/joint pain, malaise, and also improve sneezing symptoms. 1
• Acetaminophen may help relieve nasal obstruction and rhinorrhea, but does not improve sore throat, malaise, sneezing, or cough. 1, 3
• Both are safe at over-the-counter doses with no evidence they prolong illness duration. 4

For nasal congestion:

• Decongestants (oral or topical) have a small positive effect on nasal congestion in adults and adolescents. 1
• Critical caveat: Use only short-term (maximum 3 days for topical) to avoid rebound congestion. 1, 5 This is a common pitfall in practice.

For rhinorrhea (runny nose):

• Ipratropium bromide nasal spray is effective specifically for reducing rhinorrhea, though it has no effect on nasal congestion. 1, 2 Side effects include nasal dryness and are generally well-tolerated. 2

Evidence-Based Adjunctive Therapies

Zinc Supplementation

• Zinc lozenges (zinc acetate or zinc gluconate) at ≥75 mg/day started within 24 hours of symptom onset significantly reduce cold duration. 2, 1, 6 This is Level Ia evidence from the European Position Paper on Rhinosinusitis. 2
• Timing is critical: zinc must be started within 24 hours of symptom onset and continued throughout the cold. 6
• Weigh benefits against side effects of bad taste and nausea, though these are generally well-tolerated. 6

Nasal Saline Irrigation

• Nasal saline irrigation provides modest benefit for symptom relief, particularly effective in children. 1, 2
• This is a safe option without adverse effects. 2

Vitamin C

• Given its consistent effect on duration and severity, low cost, and safety profile, vitamin C may be worthwhile for patients to trial on an individual basis. 2, 1
• The evidence quality is moderate (Level Ia), but effects are modest. 2

Treatments to AVOID

Antibiotics

• Antibiotics have NO benefit for the common cold, provide no effect on cure or duration, cause more adverse events, and contribute to antimicrobial resistance. 2, 1 This is Level 1a negative evidence. 2
• The European Position Paper explicitly advises against antibiotics for post-viral acute rhinosinusitis. 2

Intranasal Corticosteroids

• Intranasal corticosteroids have no evidence supporting their use for common cold symptom relief. 1, 2 They are reserved for chronic rhinosinusitis or post-viral rhinosinusitis when symptom reduction is necessary. 2

Antihistamines Alone

• Antihistamines as monotherapy have limited short-term benefit with no clinically significant effect on nasal obstruction, rhinorrhea, or sneezing. 1
• Newer nonsedating antihistamines are ineffective against cough. 5

Other Ineffective Treatments

• Echinacea products do not provide significant benefits for treating colds. 2, 1
• Steam or heated humidified air has no proven benefits or harms. 2
• Systemic corticosteroids are not recommended and have potential harm. 2

Treatment Algorithm

Step 1: Assess symptom severity and timing

• If within 24 hours of symptom onset, start zinc lozenges ≥75 mg/day immediately. 1, 6

Step 2: For mild/isolated symptoms:

• Nasal congestion alone → Short-term decongestant (oral or topical, maximum 3 days). 1
• Rhinorrhea alone → Ipratropium bromide nasal spray. 1
• Pain/fever/malaise → NSAIDs or acetaminophen. 1

Step 3: For multiple symptoms:

• Use combination antihistamine-analgesic-decongestant products. 1

Step 4: Consider adjunctive therapies:

• Add nasal saline irrigation for additional relief. 1
• Consider vitamin C trial given safety and low cost. 1

Critical Pitfalls to Avoid

• Never prescribe antibiotics for uncomplicated common cold - this contributes to antimicrobial resistance without benefit. 2, 1
• Limit decongestant use to short-term only (≤3 days topical) to prevent rebound congestion. 1
• Do not miss the 24-hour window for zinc - effectiveness depends on early initiation. 6
• Set realistic expectations - cold symptoms typically last up to 2 weeks, and medications provide symptomatic relief but do not cure the illness. 1
• Avoid over-the-counter cold medications in children younger than 4 years. 7