Tough Out a Cold or Medicate It? Good Question

Sick woman with cold holding a tissue

A major issue with many OTC cold remedies is that they can swap cold symptoms with unwelcome (and possibly dangerous) side effects. Wander into the cold-and-flu aisle at your local drugstore and you’ll be joining many others trying to choose something — anything! — to ease the misery of cold symptoms. But which remedy is both safe and effective? Side effects of cold preparations range from the possibility of liver damage from an overdose of acetaminophen; to jitteriness or a rise in blood pressure (in some groups of people) from decongestants; to drowsiness — or its opposite, restlessness and dizziness — from antihistamines.

Makes you wonder if you should just tough out your cold.

According to the Centers for Disease Control and Prevention (CDC) website, adults get colds an average of 2-3 times a year, and children are affected even more frequently. As a result, as many as 7 out of every 10 adults use over-the-counter products (OTC) to treat signs and symptoms caused by cough, cold and influenza.

Whether cold weather actually causes people to get sick remains a much-debated issue, but there may actually be some truth to that old wives’ tale. A 2015 study found that the rhinovirus (the virus that causes the common cold) reproduces more easily at lower temperatures. Scientists noticed that cells infected with the rhinovirus have a harder time fighting off the infection at lower temperatures. Your nose is normally cooler than your core body temperature, making it easier for the rhinovirus to reproduce there. This is all the more reason to wash your hands frequently and try to avoid touching your nose with your hands — especially during cold and flu season.

Should You Take Something?

Most of us know this but it bears repeating: Nothing you can take actually cures a cold, says Paul Lyons, MD, professor of family medicine and senior associate dean for education at the University of California, Riverside School of Medicine. If a week goes by and you’re getting worse instead of better, or if your symptoms are very severe, then it may be worth checking with your healthcare provider.

Usually, however, colds don’t get worse, they just hang around until they finally run their course — which happens whether or not you take something to help yourself cope with the symptoms. In fact, most colds go away within 7 -10 days — so if you do come down with one, it’s all about treating the symptoms. And that’s where it gets tricky.

What Not to Take

No matter what you try to combat a cold, one thing that should not be in your arsenal is antibiotics. Why? The common cold is caused by a virus, not bacteria, and antibiotics don’t work against viruses. Many people ask their doctors for an antibiotic when they have a cold, however, feeling that it couldn’t hurt. It could, though (contributing to problems like antibiotic resistance; for more on this, read MedShadow.org’s Pros & Cons of Antibiotics). That said, if you do see a doctor for a persistent cold, he or she may decide to prescribe antibiotics if you appear to have a bacterial infection in addition to your cold.

Don’t take cough drops with menthol flavoring. A small study showed that cough drops with menthol actually extended the time you’ll have a cough! {See The Cough After the Cold}

Is It A Cold or the Flu?

The difference between a cold and the flu is minor for most people. The symptoms are much the same and in both cases you normally start to feel better after 3 days. A cold should be markedly better after a week, though the symptoms might linger. A flu will keep you down longer. Both a cold and a flu are viral but start from different viruses. The flu can turn into pneumonia, particularly in elderly, pregnant or others with compromised immune systems. Pneumonia can be either viral or bacteria based, and a doctor needs to diagnose that difference.

Watch Acetaminophen in Combination Products

“Most cough/cold/flu medications contain combinations of acetaminophen, decongestants and antihistamines,” says Jeffrey Steinbauer, MD, professor of family and community medicine at Baylor College of Medicine and chief medical information officer.

A common ingredient in OTC products as well as in prescription pain medications, acetaminophen has received a lot of publicity in recent years. “Acetaminophen is good for aches, pains and fever in low doses. However, at high doses it causes severe liver damage. Acetaminophen is now the leading cause of liver failure, and most often overdoses are unintentional,” says Dr. Steinbauer. The upshot: If you’re taking more than one medication for a cold, double check each product’s acetaminophen dose, and be sure you’re not taking more than 4000 mg per day.

In 2014, the FDA required manufacturers of certain prescription products containing acetaminophen like the pain medication Ultracet (tramadol and acetaminophen) to place boxed warnings on their labels to help make people aware of potential health risks.

To help avoid accidental overdose taking OTC drugs, read the label carefully to make sure you know what active ingredients the product contains. And, says Dr. Lyons, actually read and heed the instructions on the label: “Don’t take more than what’s on the box, don’t take the medication sooner than the instructions say, and don’t take more than the recommended dose.” The drug may well do you good, but in no instance, he says, does more of the drug work better.

Decongestants Can Be Problematic

Can’t breathe? Before you reach for a decongestant to clear your blocked nasal passages, consider this: All decongestants increase blood pressure. Says Dr. Steinbauer, “if you have high blood pressure or are taking medication for blood pressure, skip decongestant meds.” While Dr. Lyons agrees that people with high blood pressure should be careful with decongestants, he feels these drugs can be used safely for short periods of time in certain cases. “If patients are on medication for high blood pressure and/or are following a diet and exercise plan that has their blood pressure under control, then they can take decongestants,” though he stresses that their pressure should be checked regularly.

Pressure worries aside, decongestants — while they help relieve symptoms — should be used with caution. Unless your doctor tells you otherwise, it’s generally not a good idea to take oral or nasal decongestants of any type for a long period of time. The longer you take decongestants, the more likely you are to experience unwanted side effects. Not only that, but these drugs tend to lose their effectiveness over time. In fact, after a while, some decongestants — especially nasal sprays — may actually cause congestion when used too frequently or for too long (longer than 3-5 days).

Finally, decongestants can have one side effect that may make it harder for your body to kick the cold to the curb: jitteriness. That floaty, medicine-y, shaky feeling some of us get when taking these drugs may make it harder for you to sleep, and rest is really what you need right now. Lack of sleep wreaks havoc on an already shot immune system, making it even harder for your body to fight off the cold.

Try using a neti pot or other nasal irrigation. The water feels odd running up and through your sinuses, and it’s truly disgusting. But the results are well worth it. Clear breathing, at least until the mucus builds up again and no side effects.

Potential Antihistamine Hazards

Some antihistamines commonly cause drowsiness, which may become more severe when combined with many other OTC and prescription drugs. Older antihistamines like diphenhydramine (Benadryl) and doxylamine (found in some Unisom products) are common culprits. These drugs may cause unexpected reactions in certain age groups, too. For example, children and people ages 65 and older may become excited or restless. Diphenhydramine may also increase the effects of opioid pain relievers, another reason for caution.

Antihistamines in general may also cause confusion and dizziness in the elderly, possibly increasing their risk of falling. These dangers vary from person to person, so it’s important to listen to your body in order to recognize unusual changes.

“Antihistamines can also make your mouth dry, worsen glaucoma, and cause retention of urine, especially in older men,” adds Dr. Steinbauer. And just because a label says a drug is “non-drowsy” or “daytime” doesn’t necessarily mean it’s risk-free. “Daytime medications usually do not have sedating antihistamines but still have decongestants,” he says.

Another thing many people may not realize is that antihistamines can also cause arrhythmias, or irregular heartbeat. People who already have an abnormal heartbeat should be especially mindful. “If you have any heart rhythm problems, you should consult with your physician about over-the-counter medications that might be safe for you,” says Dr. Steinbauer.

Too Little of a Good Thing in Cough Suppressants

People should also be aware of risks associated with the active ingredients frequently found in OTC cough and cold drugs. The most common cough suppressant in cough and cold medications is dextromethorphan. “This can be mildly sedating, though the drug has few other side effects,” says Dr. Steinbauer.

Cough and cold meds also often contain an expectorant called guaifenesin. “Expectorant” is a fancy way of saying “helps thin mucus so you can cough it up.” It’s a helpful ingredient, to be sure — especially if congestion is leading to a lot of sinus pain. But many of these combo meds aren’t serving you well, says Dr. Steinbauer, because they end up having too little guaifenesin to do much good (an effective therapeutic dose of guaifenesin is 1200 mg per day). This is a case in which separating out your meds is wise. Try a guaifenesin-only product. At present, guaifenesin is only available in generic or the brand Mucinex.

But tread carefully: Read the labels on each and every one of the Mucinex products because they differ. Mucinex contains only guaifenesin as the active ingredient. However, Mucinex DM, Mucinex D, Mucinex Sinus Max, Mucinex Multi-Symptom Cold and Mucinex Extra-Strength contain different combinations of guaifenesin with one or more additional drugs. If you’re confused, some generic guaifenesin products may be easier to figure out, but instructions for use may be different. Ask your pharmacist if you need help.

Try honey. It tastes good and feels soothing, and one 2014 review suggests that it’s better than a placebo at easing coughs. Add a teaspoon or 2 to a cup of tea or swallow it straight off the spoon.

Caution: Honey should not be given to infants younger than a year old because it can contain the bacterium Clostridium botulinum.

What Else Can You Try?

Not far from the OTC cold remedies in your pharmacy, you’ll see natural or complementary products that promise help. Do they work? Possibly, with some caveats. Vitamin C has long been known to help boost immunity. However, it works best if take it before you get sick. The reality is that if you have a cold, your immune system is already shot, so much so that loading up on C won’t help you kick the cold (though certainly eating oranges has many other benefits!).

Products like Emergen-C are also popular. There are formulations of this purportedly cold-preventing/treating product that contain a variety of B vitamins and trace minerals like chromium and manganese. While this combination of elements can certainly help support the immune system as your body tries to fight the infection, it’s a good idea to trying to get as much of what you need naturally by regularly eating a variety of fresh fruits and vegetables.

Then there’s zinc, often taken in lozenge form. Zinc does help keep your immune system healthy and strong, helping heal wounds and skin irritation, as well as helping keep you in fighting shape to handle colds. Whether zinc actually reduces the time you’re down with a cold is still a debatable issue, and requires further studies with larger populations.

The bottom line is that supplements may help the body, but it’s always better to try to eat a healthy, balanced diet on a regular basis instead of trying to make up for it when you get sick. Remember, too, that managing your cold symptoms doesn’t always require a trip to the pharmacy. The best weapons in your arsenal are rest and plenty of liquids. Fluids — water, juice, broth or soup — are essential to battle dehydration. “Fever and cough cause us to lose more water than usual through normal breathing,” says Dr. Steinbauer. Keeping hydrated also helps you cough up the mucous in your nasal passages, which moves the cold along faster. And that’s always a welcome result.

Further Reading


Frieda Wiley

Frieda Wiley

Frieda Wiley is a medical writer and consultant pharmacist who calls the serene Piney Woods of East Texas home. Her work has appeared in Arthritis Today, Diabetes Self-Management, Everyday Health, and Next Avenue. She also develops content for medical students and allied healthcare professionals.


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