Safely and effectively treating your cold, flu and allergy symptoms with over-the-counter medications requires carefully matching your symptoms with the active ingredients in those products and not accidentally overdosing on ingredients that may appear in multiple products.
That risk is particularly high during the winter cold and flu season, when we may find ourselves trying to treat not just one, but a combination of symptoms — a throbbing headache, a high fever, a nagging cough, chest congestion, a stuffed or runny nose. The choices of over-the-counter medicines are many. Some target single symptoms. Others treat multiple symptoms at once. What the consumer/patient wants most is fast relief from whatever’s ailing them. They don’t always fully investigate or understand what they’re taking or how much of certain ingredients are in those products.
That can be dangerous. Consider acetaminophen, the pain and fever reliever found in Tylenol and more than 600 other over-the-counter medications. It’s a highly effective analgesic safely taken by millions of people following the recommended maximum dose of 3,000 milligrams per day.
Taking too much of it, however, can lead to serious liver damage, even death. During the cold and flu months, when people are taking more medications more frequently, the risk of inadvertently over-consuming acetaminophen is at its peak.
That’s why it’s crucial to read every package label carefully and add up the dosage amounts of that ingredient in each of the products you’re taking.
There are five basic types of over-the-counter products people use to treat cold and flu symptoms: analgesics for pain and fever; decongestants to help clear stuffed-up nasal passages and airways; wet-cough expectorants and /or dry-cough suppressants (antitussives); antihistamines that quell the effects of allergens like dust and pollen but are limited in treating cold symptoms; and multi-symptom products that treat a combination of symptoms.
The accompanying chart provides an at-a-glance guide to matching your symptoms to the type of drugs and ingredients to look for.
Symptoms, ingredients to look for and drug type
Body aches: Acetaminophen, aspirin, ibuprofen, naproxen Analgesic
Cough (dry): Dextromethorphan Antitussive
Cough (wet): Guaifenesin Expectorant
Fever: Acetaminophen, aspirin, ibuprofen, naproxen Analgesic
Headache: Acetaminophen, aspirin, ibuprofen, naproxen Analgesic
Runny nose, sneezing, congestion: Cetirizine, chlorpheniramine, desloratadine, diphenhydramine, fexofenadine, hydroxyzine, levocetirizine, loratadine Antihistamine
Congestion: Oxymetazoline, phenylephrine, pseudoephedrine Decongestant
For additional guidance, some of the more common brands and generic names for those drug types follow. Additional cautions are noted.
Analgesics. Tylenol (acetaminophen), Advil (ibuprofen), Aleve (naproxen) and Aspirin (acetylsalicylic acid). Refer to the earlier caution about acetaminophen overdose.
Decongestants. Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine). The FDA recently determined that the PE version of Sudafed is essentially ineffective and likely will be pulled from the market.
Regular Sudafed (pseudoephedrine) is effective but requires a signature to be purchased from behind the pharmacy counter. Also, beware that decongestants are not recommended for people with high blood pressure.
Antihistamines. Benadryl (diphenhydramine), Chlor-Trimeton (chlorpheniramine), Atarax, Vistaril (hydroxyzine), Zyrtec (cetirizine) and Allegra (fexofenadine), Clarinex (desloratadine), Claritin, Alavert (loratadine) and Xyzal (levocetirizine).
One big word of caution on products like Benadryl is that it can cause heavy drowsiness. It’s important to anticipate what your reaction may be before using.
Why did Berkshire Health Systems reinstate its mask policy? More COVID, flu and RSV patients — and sick staffers
Cough expectorants/suppressants. The generic suppressant antitussive dextromethorphan is in many over-the-counter medicines, including Robitussin DM, Delsym, Mucinex DM and Tussin DM.
Know that DM is often abused as a hallucinogen. The expectorant guaifenesin is the only expectorant approved by the FDA. It’s in multiple brand-name products, including Robitussin Chest Congestion, Mucinex, Tussin Chest.
Multi-symptom Treatments. These formulas typically include a combination of analgesics, decongestants, antihistamines and cough expectorants and/or suppressants. They treat many different cold and flu symptoms in one dose but should be used with caution. Make sure the product only includes drugs that treat symptoms you have.
Don’t hesitate to consult with your pharmacist if you have questions or concerns about any over-the-counter or prescription medication.
