DETROIT – If you’ve walked into any pharmacy, you’ve been greeted by an insane choice of combination cold remedies. With a variety of labels like cold and flu, night-time, cough and sinus, extra strength, and maximum strength, it’s difficult for anyone to know exactly what they need. I’m going to try to break it down by the symptom you want to treat and the ingredient you should look for.
A common symptom many people start with is a fever and the medication you are looking for is acetaminophen, known to most as Tylenol. If the product label says “fever” or “pain reliever” it probably has acetaminophen in it. It is important to know if acetaminophen is in the product because taking too much can cause liver damage. If the combination product has acetaminophen in it, you should not take more acetaminophen separately. Also, instead of acetaminophen, some combination products use ibuprofen, known to many as Motrin, to reduce a fever or treat body aches. This is different than acetaminophen. I personally prefer ibuprofen for a fever and body aches but some people may not tolerate it because of stomach irritation.
Another common symptom people want to treat is a cough. Dextromethorphan is the active ingredient most often used for this purpose. Often the medication will have the initials “DM” in their name.
To break up and loosen a cough the active ingredient you are looking for is guaifenesin. It would probably be labeled as an expectorant.
If you have a runny nose or congestion, until recently, the most common “non-drowsy” active ingredient was phenylephrine. You may have heard though that an FDA committee has called its effectiveness into question when taken by mouth. There is a good chance that it will be removed from many products because it isn’t considered effective. CVS has already removed cold medicine that only uses phenylephrine from its shelves, but it is still in many combination products. I should point out, that it’s not considered harmful, it’s probably just not helpful.
Unfortunately, the next most used active ingredients for a runny nose and congestion fall into the “drowsy” category. That is to say, they will make most people sleepy and they are often in combination with products labeled “nighttime.” I am talking about antihistamines, some of the most used are doxylamine, diphenhydramine (known to many as Benadryl), brompheniramine, and chlorpheniramine.
The last active ingredient that I personally think is the most effective for treating a runny nose and congestion is pseudoephedrine. Unfortunately, because it can be used in the manufacture of illegal drugs, it is kept behind the pharmacy counter, and you will have to ask for it specifically. It doesn’t require a prescription, the DEA just doesn’t want someone to be able to buy more than a certain amount at once. There are combination products with pseudoephedrine as well and these are also kept behind the pharmacy counter.
My personal preference is not to use a combination product. If I had a cough and runny nose I might use a product with only dextromethorphan and take pseudoephedrine. If I had a fever and body aches I would add ibuprofen. By taking separate products I’m treating my symptoms more directly and decreasing the chance of medication overlap or extra side effects.
If you do choose a combination product, I would encourage you to read the active ingredient label carefully and look for what you need. If you have any questions you should to talk to the pharmacist to help make the choices, this is also especially important if you have other medical conditions and are on other medications.
Finally, I encourage you to save some money by buying the generic versions of all of these medications. While generics might have a different taste or texture, the active ingredients are exactly the same and often the price is several dollars less for the generic. None of these medications will make your illness go away any faster, they only make it a little easier to tolerate the symptoms while your body fights the infection.
Here’s a basic cheat sheet of active ingredients:
| Fever or body aches | acetaminophen |
| Fever or body aches | ibuprofen |
| Cough | dextromethorphan |
| Loosen a cough | guaifenesin |
| Daytime congestion | phenylephrine (may be ineffective) |
| Daytime congestion | pseudoephedrine |
| Nighttime congestion | doxylamine, diphenhydramine, chlorpheniramine, or brompheniramine |