What medications can be taken for the common cold?

Medications for the Common Cold

For symptomatic relief of the common cold in adults, use combination antihistamine-decongestant-analgesic products as first-line therapy, which provide significant benefit in approximately 1 in 4 patients, or select single agents targeting your predominant symptoms: NSAIDs or acetaminophen for pain/fever, oral or nasal decongestants for congestion (maximum 3-5 days), and zinc lozenges (≥75 mg/day) if started within 24 hours of symptom onset. 1, 2

First-Line Treatment Options

Combination Products

• Antihistamine-decongestant-analgesic combinations are the most effective single intervention for multiple cold symptoms, providing substantial benefit for nasal congestion, postnasal drainage, sneezing, and throat clearing 1, 2
• First-generation antihistamines (brompheniramine or dexbrompheniramine) combined with pseudoephedrine are specifically effective and well-tolerated 3

Single-Agent Therapy by Symptom

For nasal congestion:

• Oral decongestants (pseudoephedrine) or nasal decongestants (oxymetazoline) provide small but positive effects 1, 3
• Critical limitation: Use nasal decongestants for only 3-5 days maximum to prevent rebound congestion 3, 2

For pain, fever, headache, and malaise:

• NSAIDs (ibuprofen 400-800 mg every 6-8 hours or naproxen) are effective for headache, ear pain, muscle/joint pain, malaise, and also improve sneezing 2, 4, 5
• Acetaminophen may help relieve nasal obstruction and rhinorrhea, but does not improve sore throat, malaise, sneezing, or cough 2, 6

For rhinorrhea (runny nose):

• Ipratropium bromide nasal spray effectively reduces rhinorrhea but has no effect on nasal congestion 1, 2
• Minor side effects include nasal dryness 2

Highly Effective Adjunctive Treatment

Zinc lozenges (zinc acetate or zinc gluconate ≥75 mg/day) significantly reduce cold duration when started within 24 hours of symptom onset 1, 3, 2

• Must be taken throughout the entire cold duration 1
• Potential side effects include bad taste and nausea 2
• Timing is critical—zinc is only effective if started within the first 24 hours 2

Additional Supportive Measures

• Nasal saline irrigation provides modest symptom relief, particularly in children 1, 2
• Vitamin C supplementation may provide individual benefit given its consistent effect on duration and severity, low cost, and safety profile 1, 2

Medications to AVOID

Antibiotics:

• No benefit whatsoever for the common cold and are associated with significant adverse effects 1, 2, 7
• Inappropriate antibiotic use contributes to antimicrobial resistance 2

Intranasal corticosteroids:

• No evidence supports their use for common cold symptomatic relief 1, 7

Systemic corticosteroids:

• Not recommended for common cold or post-viral rhinosinusitis due to lack of benefit and potential harm 1, 7

Newer antihistamines:

• Loratadine, cetirizine, and fexofenadine are ineffective for common cold symptoms 3, 2

Echinacea:

• Most Echinacea products are not effective, with only questionable weak benefit from some preparations 1, 2

Homeopathic products:

• No significant benefit compared to placebo 1, 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, 2

Step 2: Choose medication strategy based on symptoms

For single predominant symptom:

• Nasal congestion → Short-term decongestant (oral pseudoephedrine or topical oxymetazoline for maximum 3-5 days) 3, 2
• Pain/fever/headache → NSAIDs (ibuprofen 400-800 mg every 6-8 hours) or acetaminophen 2, 4
• Rhinorrhea → Ipratropium bromide nasal spray 2

For multiple symptoms:

• Use combination antihistamine-decongestant-analgesic product 1, 2

Step 3: Add supportive measures

• Nasal saline irrigation for additional relief 1, 2
• Consider vitamin C supplementation 1, 2

Critical Pitfalls to Avoid

• Do not prescribe antibiotics—they provide no benefit and cause harm through adverse effects and antimicrobial resistance 1, 2, 7
• Limit nasal decongestant use to 3-5 days maximum to prevent rebound congestion 3, 2
• Do not use corticosteroids (intranasal or systemic) for common cold 1, 7
• Zinc must be started within 24 hours of symptom onset to be effective 2
• Set realistic expectations—cold symptoms typically last up to 2 weeks 2