Here is a list of the most common cold symptoms I hear in practice and what to look for at the pharmacy to make you feel better.
1. “My nose won’t stop running”
This is one of the most common symptoms associated with a cold, and can be incredibly annoying to be constantly grabbing for a tissue. Start taking a first generation histamine blocker, the most common is diphenhydramine (aka Benadryl) – yes these are marketed as allergy medication, but a side effect of these drugs is that they dry you out and will dry up that snot coming out of your nose and down your throat. Unfortunately, first generation anti-histamines can make you drowsy so best to take only at night time. Note that second generation anti-histamines ( i.e. Claritin, Allegra) do not have as much of a drying effect, but can take these during the day for possible relief.
2.“I am so stuffed up and congested”
Hands-down, most effective medication for this is pseudoephedrine (aka Sudafed) . Pseudoephedrine restricts blood vessels in your nassal passages, in effect reducing the pressure of your sinuses. Unfortunately, this constriction happens to all vessels in your body and can make your blood pressure go up a couple of points and may make you feel jittery because of this - so do not take if you already have high blood pressure and also do not take right before you want to go to bed. Another effective medication for sinus pressure is a nasal steroid such as Flonase. Note that nasal steroids take about a week to see full effect, so you are unlikely to get as much of a response compared to Sudafed.
Important note: Do not buy a product with phenylephrine (aka Sudafed PE), you will see this ingredient listed in any product that markets itself as a decongestant. This is the “Sudafed” that you see on the shelf that you can just walk out with without showing your ID. Phenylephrine has shown to be no more effective then placebo – and yes it will also raise your blood pressure, so not a good alternative for anyone
3. “My ears feel full”
This is an extension of your inflamed sinuses - your ears feel full because your sinuses are blocked, so how do you clear your ears? Clear your sinuses. As stated above, take pseudoephedrine and/or Flonase to help clear this congestion.
4. “I have a cold and the worst part is the cough”
There are a couple of different remedies for this.The American Academy of Chest Physicians recommends a combination of a first generation anti-histamine (i.e. diphenhydramine or Benadryl) PLUS a decongestant (pseudoephedrine or nasal decongestants such as Flonase).
Another popular ingredient for cough is dextromethorphan which you will as the main component in Robitussin DM or Delsym. Dextromethorphan theoretically works to make you stop coughing by blocking the cough reflex in the brain. Studies have shown this to be marginally effective, and I’ve had mixed results in practice as well. Read more about this here.
5. “My cold is gone, but I still have a cough”
AKA “post-infectious cough” can last up to 8 weeks after your cold goes away – 8 weeks! You can try one of the above remedies for cough, but if the cough is very irritating probably best to see your provider for an inhaler or prednisone which should make it go away quicker. Note that if it has been over 8 weeks your cough is likely due to some other cause and you should make an appointment to see your practitioner for evaluation.
6. “I'm coughing up thick phlegm”
For thick gunky mucus, Guaifenesin (aka Mucinex) is the ingredient you should look for to help with this. Note that this medication needs fluids to be able to work, so you must be hydrating yourself properly. Another potential benefit of taking this medication is that is has been shown to work as an anti-cough agent. Studies have shown this medication to be possibly effective for the above, this is another medication I've had mixed results with in practice.
7. “I have body aches”
Take nothing. Try light exercise, stretching, and avoid taking pain relievers. Body aches are a side effect of interferons, which are released in the presence of an infection, and whose job is to fight off the invader making you sick. In other words, body aches are a good sign because this means your body is trying to fight off the infection, let it be. Avoid taking ibuprofen because ibuprofen will block production of these virus killing cells - meaning longer duration and severity of cold symptoms for you.
8. “I had a fever of 102 this morning”
Take nothing. Plenty of fluids. A fever is a normal physiologic defense mechanism by your body to kill the pathogen making you sick - the American Academy of Pediatrics stresses that fever has beneficial effects and no evidence that a fever prolongs illness or causes any neurologic effect in the future. How does a fever work to help you? The increased body temperature stimulates production of your white blood cells (ie your immune system which functions to get rid of the bug making you sick), it lowers viral replication rate, (meaning less virus in your system), and high temperatures are toxic for some of the most virulent bacteria - such as those that cause pneumonia. Bottom line, let your body do its job and avoid taking fever reducers like acetaminophen or ibuprofen.
9. “I need to get better ASAP”
If you want to cut back on the length of your cold, start taking zinc gluconate now. Many studies have shown that zinc can decrease the length of your cold by 4-7 days – that’s like a 50% reduction in the length of your symptoms! If you are going to take anything for your cold, take zinc and take zinc gluconate specifically as it has shown to be the most absorbable formulation - the zinc needs to coat the throat where the virus normally lies. Also make sure to take in lozenge form as pills or drinks with zinc are less effective. Read more about this here.
Honorable mention: Vitamin C has also shown to be able to shorten the length of your cold, but there are limited studies on this, and the studies that do show a positive effect show only a ½ day reduction in the length of your cold when you take Vitamin C.