When you’re feeling awful because of a cold, you just want something to fix you—if not to cure you, at least to help you temporarily feel better. Unfortunately a lot of remedies are placebos, but some things in the drugstore work better than others.
Before we talk about which medicines are best, here’s an important note to consider: Cold medicines do not cure your cold, nor do they shorten its duration. If you’re reading this because you want to know how to get rid of a cold fast, or what a doctor would prescribe you to get rid of a cold—sorry. Colds are caused by viruses, and there’s no medication that will kill them off the way that antibiotics can kill off bacteria. The point of cold medicines is to help you be a little less miserable while you wait for your immune system to fight it off.
Ignore brand names on cold medicines
The companies that make cold medicines rely on our stuffy-headed memories. If you bought Sudafed (or Mucinex, or Dayquil) the last time you had a cold, they hope you’ll buy the same thing this time, while makers of store brands are hoping you buy something the same color and figure it’s good enough. But the brand name tells you next to nothing about what’s actually inside the package.
Each of the major cold medicine brands sells a variety of products with completely different ingredients. Sometimes, there are so many that the same brand will sell the same thing under two different names. My favorite example of this is the labyrinth of Mucinex products: Their Maximum Strength Fast-Max Severe Congestion and Cough has the same dosage and ingredients as their Maximum Strength Sinus-Max Pressure, Pain, & Cough. Meanwhile, Maximum Strength Sinus-Max Severe Congestion & Pain—which sounds like it should be very similar to the other Sinus-Max product—takes out a cough-related ingredient and swaps in some acetaminophen (that’s Tylenol). You are never going to have much luck navigating the cough and cold aisle on brand names and symptoms alone.
So where to go instead? Well, for quick relief of congestion, you’ll need the good stuff they keep behind the counter.
Pseudoephedrine (original Sudafed) is the good stuff
If you have a stuffy nose, pseudoephedrine is the real deal. In the old days, you could find it on the store shelves. Sudafed was one brand name. (Sudafed, pseudoephedrine, get it?) But pseudoephedrine can be converted into methamphetamine, so a 2006 law restricted its sale. It’s still an over the counter medication, but you’ll need to take the time to show your ID to the pharmacist if you want to buy some.
Studies have shown pseudoephedrine to be effective at clearing nasal congestion. When you feel like your nose is “stuffed” with dried or gooey mucus, that’s not literally true. Blood vessels in the lining of your nose and sinuses swell up, and that’s what narrows the air passages. Pseudoephedrine makes those blood vessels constrict, reducing the swelling and opening your airways so you can breathe easier.
(Pseudoephedrine also constricts blood vessels in other parts of the body, which is why it can increase blood pressure in some people, and why it is sometimes used off-label for priapism, also known as prolonged erections.)
Anything with “PE” in the name isn’t worth buying
Phenylephrine is the decongestant that replaced pseudoephedrine in over-the-counter products. Phenylephrine, the “PE” ingredient, has been known for years to be useless at treating cold symptoms when taken by mouth. This led two pharmacists to write a paper in 2022 entitled “Why Is Oral Phenylephrine on the Market After Compelling Evidence of Its Ineffectiveness as a Decongestant?”) Finally, as of November 2024, the FDA agreed that phenylephrine products will (eventually) be removed from store shelves.