Pick the right cold and flu medicine

a woman who is blowing her nose

Your head is pounding, your nose is running, and your throat feels like it’s been scoured with steel wool. Your pharmacy’s over-the-counter medicine aisle is a mile long and the bottles are covered with confusing instructions and warnings. What do you pick when you’re already sick? Let’s break down the most common cold and flu medicines and their possible side effects.


Medicines containing acetaminophen, such as Tylenol®, are typically used to relieve headaches and muscle aches, soothe sore throats, and reduce fevers. When used as directed, acetaminophen is safe and effective. However, there are more than 600 over-the-counter and prescription medicines that contain acetaminophen alone or in combination with other medicines,1 many of which are cold and flu products. This can be a problem, as taking too much acetaminophen can lead to serious liver damage,2 so make sure to read the ingredients on each medicine you’re taking. For most adults, the maximum dose of acetaminophen is 3,000 mg per 24-hour period, unless instructed and supervised by a health care provider.


Like acetaminophen, medicines containing ibuprofen, such as Advil® and Motrin®, are used to relieve pain and control fever. However, ibuprofen can cause stomach disturbances such as indigestion, heartburn, and bleeding.3 Consider taking ibuprofen with food or a glass of milk if you experience stomach disturbances when taking this medicine.4 Avoid taking ibuprofen if you are taking other anti-inflammatory medicines or have kidney problems.


Naproxen, commonly sold under the brand name Aleve® is used to treat pain and inflammation. However, you shouldn’t take it if you’ve previously had an asthma attack or severe allergic reaction after taking aspirin or another nonsteroidal anti-inflammatory drug (NSAID). Common stomach-related side effects include indigestion, heartburn, and bleeding. Take naproxen with food to reduce adverse effects.5


Medicines containing pseudoephedrine or phenylephrine, such as Sudafed® are used to relieve nasal and sinus congestion. Common side effects of pseudoephedrine and phenylephrine include nervousness, restlessness, and trouble sleeping.6 Pseudoephedrine and phenylephrine may increase your blood pressure and heart rate and it is best to avoid taking either of these if your blood pressure is not controlled. Most pseudoephedrine products are stored behind the pharmacy counter due to strict regulations on this medication.

Nasal decongestant spray

Nasal decongestant sprays containing oxymetazoline are used to temporarily relieve stuffy noses. However, using nasal decongestant sprays too often or for too long can actually worsen your symptoms.7 You may also experience discomfort or irritation in the nose, mouth, or throat, or sneezing.8


Medicines containing diphenhydramine (Benadryl®, cetirizine (Zyrtec®), loratadine (Claritin®), and fexofenadine (Allegra®) are used to relieve runny nose, sneezing, and itchy eyes. Antihistamines can cause drowsiness, which helps if you’re having trouble falling asleep.9 The drowsiness caused by diphenhydramine is why it is used in most over-the-counter sleep aid or “PM” products, so make sure to read the ingredients of each medicine you are taking. On the other hand, the drowsiness may also be an unwelcome side effect if you need to stay awake or drive your car. Avoid taking antihistamines if you need to stay alert. Alcohol can also make this side effect worse.10

Of course, the best treatment for a cold or the flu is to avoid getting it. Wash your hands frequently throughout the day, avoid contact with people who are sick, and get your yearly flu shot. If you’re concerned about picking the right cold or flu medicine, or have questions about possible interactions with medicines you’re currently taking, be sure to talk to your pharmacist. 

This material is provided for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional. You should consult with your doctor to determine what is right for you.


  1. “Don’t Double Up on Acetaminophen,” U.S. Food and Drug Administration, September 10, 2018, last accessed November 1, 2018, https://www.fda.gov/consumers/consumer-updates/dont-double-acetaminophen
  2. “Don’t Double Up on Acetaminophen.”
  3. “Ibuprofen Patient Tips,” Drugs.com, November 9, 2017, last accessed November 1, 2018, https://www.drugs.com/tips/ibuprofen-patient-tips
  4. “Ibuprofen Patient Tips.”
  5. “Naproxen Patient Tips,” Drugs.com, September 11, 2017, last accessed November 12, 2018, https://www.drugs.com/tips/naproxen-patient-tips
  6. “Pseudoephedrine Side Effects,” Drugs.com, June 7, 2018, last accessed November 2, 2017, https://www.drugs.com/sfx/pseudoephedrine-side-effects.html.
  7. “Oxymetazoline nasal,” Drugs.com, May 23, 2018, last accessed November 13, 2018, https://www.drugs.com/mtm/oxymetazoline-nasal.html.
  8. “Oxymetazoline nasal Side Effects,” Drugs.com, June 7, 2018, last accessed November 13, 2018, https://www.drugs.com/sfx/oxymetazoline-nasal-side-effects.html
  9. “Antihistamines,” Drugs.com, February 14, 2018, last accessed December 5, 2018, https://www.drugs.com/drug-class/antihistamines.html.
  10. “Benadryl Patient Tips,” Drugs.com, October 18, 2017, last accessed November 2, 2017, https://www.drugs.com/tips/benadryl-patient-tips

Related posts