What is the best over‑the‑counter medication for a common cold in an otherwise healthy adult?

Best Over-the-Counter Medication for a Cold

For an otherwise healthy adult with a common cold, a combination antihistamine-decongestant-analgesic product is the most effective over-the-counter option, providing meaningful symptom relief in approximately 1 out of 4 patients treated. 1, 2

First-Line Recommendation: Combination Products

The strongest evidence supports using a fixed-dose combination containing an older (first-generation) antihistamine, a decongestant, and an analgesic (acetaminophen or ibuprofen). 1, 3, 2 These combination products outperform single-agent therapies because they target multiple cold symptoms simultaneously—nasal congestion, rhinorrhea, sneezing, headache, body aches, and malaise. 2, 4

Why Combination Products Work Best:

• First-generation antihistamines (like brompheniramine or chlorpheniramine) reduce rhinorrhea, sneezing, and postnasal drainage through their anticholinergic effects 2
• Decongestants (pseudoephedrine or phenylephrine) relieve nasal congestion 1, 2
• Analgesics (acetaminophen or NSAIDs) control headache, body aches, sore throat, and fever 1, 3

Important caveat: Newer non-sedating antihistamines (loratadine, cetirizine, fexofenadine) are completely ineffective for cold symptoms and should not be used. 2

Targeted Single-Symptom Treatments

If you prefer to treat specific symptoms individually rather than using a combination product:

For Nasal Congestion:

• Oral decongestants (pseudoephedrine) or topical nasal decongestants (oxymetazoline spray) provide modest relief 1, 2
• Critical warning: Limit topical decongestants to 3 days maximum to avoid rebound congestion (rhinitis medicamentosa) 1, 2

For Runny Nose (Rhinorrhea):

• Ipratropium bromide nasal spray is highly effective specifically for rhinorrhea, though it does not help congestion 1, 2

For Pain, Fever, and Body Aches:

• NSAIDs (ibuprofen or naproxen) are superior to acetaminophen for headache, ear pain, muscle/joint pain, and malaise 1, 2
• Acetaminophen may help nasal obstruction and rhinorrhea but is less effective for other symptoms 1, 3
• NSAIDs also significantly improve sneezing 1

For Cough:

• Dextromethorphan (60 mg dose) can suppress cough, though evidence for URI-related cough is limited 1, 5
• Honey is an effective alternative for cough (not just for children) 1

Evidence-Based Adjunctive Therapies

Zinc Lozenges:

Zinc acetate or gluconate lozenges at ≥75 mg/day started within 24 hours of symptom onset significantly reduce cold duration. 1, 2 However, weigh this benefit against common side effects including nausea and bad taste. 2 The 24-hour window is critical—zinc is ineffective if started later. 2

Nasal Saline Irrigation:

Nasal saline irrigation 2-3 times daily provides modest symptom relief by clearing secretions, with no drug interactions or significant adverse effects. 1, 3, 2

Vitamin C:

Given its consistent effect on reducing cold duration and severity, low cost, and excellent safety profile, vitamin C supplementation is reasonable to try on an individual basis. 1, 2

What NOT to Use

Completely Ineffective Treatments:

• Antibiotics provide zero benefit for viral colds, cause significant adverse effects, and promote antimicrobial resistance 1, 3, 2
• Intranasal corticosteroids have no role in common cold treatment 1, 2
• Echinacea products lack proven benefit 1, 2
• Codeine or pholcodine have no greater efficacy than dextromethorphan but carry significantly more adverse effects 1

Clinical Context and Expectations

• Normal cold duration: 7-10 days, with up to 25% of patients having symptoms for 14 days 2
• This is normal and does not indicate bacterial infection 2
• Only 0.5-2% of viral URIs develop bacterial complications 2

When to Reassess:

Return for evaluation if: 3, 2

• Symptoms persist ≥10 days without any improvement
• High fever (≥39°C) with purulent discharge and facial pain for ≥3-4 consecutive days
• Worsening symptoms after initial improvement ("double-sickening")

Common Pitfalls to Avoid

• Do not prescribe or request antibiotics based on symptom duration alone, purulent nasal discharge (which is normal in viral colds), or patient pressure 3, 2
• Do not use topical decongestants beyond 3 days—this causes rebound congestion requiring more medication 1, 2
• Do not miss the 24-hour window for zinc effectiveness 2
• Do not use newer antihistamines (loratadine, cetirizine)—they are completely ineffective for colds despite being effective for allergies 2