Dr. Lucy McBride Wants to Know: Does Your Medicine Cabinet Have These 5 Cold and Flu Essentials?

A few weekends ago, I went to CVS to get my flu shot . While waiting my turn for the jab, I took a spin through the technicolor dream-like world of cold and cough remedies on display. I tried to put myself in my patients’ shoes: Do I need Nyquil or Dayquil? Mucinex DM, Mucinex D, or plain old Mucinex? Is generic Robitussin okay, or do I splurge on the brand name?

With so many different ingredients in each option—and the Food and Drug Administration’s recent announcement that a common ingredient in OTC cough and cold medicines, oral phenylephrine, isn’t effective—it’s enough to confuse even the savviest consumers. 

Recall that approximately 90 to 95 percent of upper respiratory infections (URIs) are caused by viruses and only about 5 to 10 percent are due to bacterial infections. Of course, bacterial infections can occur, especially as secondary infections following a viral URI. However, the fall and winter season is marked by a parade of viral infections—and treatment for most viruses is symptom management. 

So, in honor of cold and flu season, here are my 5 favorite things at the pharmacy to manage symptoms:

1. Nasal saline. Fun fact: New data  shows that good old saline nasal spray can reduce the severity and duration of respiratory symptoms from colds and flus. This is great news, because nasal saline is cheap and harmless. Rinsing your nose and sinuses with saline is an easy way to mobilize mucus and debris. Unlike decongestants—such as pseudoephedrine (Sudafed) which can elevate blood pressure and heart rate or certain antihistamines, such as diphenhydramine (Benadryl) which can be sedating—nasal saline is a winner for anyone with a stuffy nose. 

2. Guaifenesin. This is a gem of a product. The common brand names are Mucinex or Robitussin. Guaifenesin is an expectorant. It works by thinning mucus in the airways. When mucus is less thick and sticky, it is less irritating to the airways and easier to clear it out by coughing.

Be sure to read labels carefully: Robitussin as a brand makes formulations that include dextromethorphan (a cough suppressant) and/or phenylephrine (a decongestant). Mucinex as a brand also offers multi-symptom formulations, such as Mucinex DM, which contains dextromethorphan for cough suppression, and Mucinex D, which adds pseudoephedrine as a decongestant. 

I tend to avoid decongestants because they can cause jitteriness, high blood pressure, a rapid heart rate, insomnia and other stimulating effects. I also tend to avoid cough suppressants in patients who are sick with lots of mucus. Why? Coughing is a necessary protective reflex that helps keep the airways clear. When mucus accumulates in the respiratory tract, it can obstruct airflow and serve as a breeding ground for other bacteria or viruses. In other words, coughing helps with breathing and helps reduce the risk of secondary infections.

Of course in some cases, suppressing a cough makes sense—for example, a dry, unproductive cough that is causing discomfort or difficulty sleeping. Suppressing juicy coughs can be okay, too, if the benefits (such as getting a good sleep!) outweigh the downsides. But in general, it’s better to thin mucus than it is to suppress a cough when you’re sick. 

3. Steroid nasal sprays. Nasal steroids such as fluticasone propionate (Flonase) or triamcinolone acetonide (Nasacort) are real workhorses. Formerly by prescription only, these nasal sprays can help turn the proverbial sprinkler system off in the nasal passages and sinuses. Basically, they reduce inflammation on mucosal surfaces. You might already take one of these sprays for seasonal allergies (and indeed they are an appropriate tool in the toolbox for allergies to things like pollen, dust and mold), however they can also provide relief for nasal congestion associated with colds and flus.

The nasal steroids are generally very safe, however one downside is that they can thin and dry out the mucus membranes enough to cause nose bleeds. If that happens, you can apply Vaseline to add moisture and cut back on using the spray (and of course see your doctor for specific advice).

4. Antihistamines. Antihistamines are old faithfuls. Over the counter fexofenadine (Allegra), loratadine (Claritin), cetirizine (Zyrtec), or levocetirizine (Xyzal) are commonly recommended for allergy symptoms but can help alleviate symptoms of colds and flu, too. They work by blocking the action of histamine, a substance in the body that contributes to allergic reactions and inflammatory responses that cause sneezing, runny nose, and excess mucus production. In drying up the production of mucus and swelling in the nasal passages, they also reduce post-nasal drip and cough. 

The potential downsides are 1) antihistamines are drying, and when nasal and sinus passages are dry they sometimes ache, and 2) certain antihistamines such as diphenhydramine (Benadryl) and cetirizine (Zyrtec) can be sedating, so I remind people to take these two in particular at bedtime. 

5. Ibuprofen. Ibuprofen is my personal favorite. Also known as Advil or Motrin, this power player can help alleviate certain colds and flu symptoms by reducing fever, body aches, and pain from a sore throat or headaches. As a nonsteroidal anti-inflammatory drug (NSAID), Ibuprofen helps reduce inflammation in the body, which may provide relief from nasal congestion and discomfort.

However, especially if taken in excess, there are downsides of Ibuprofen, some of which can be serious. It can cause gastroesophageal reflux, gastritis, stomach ulcers, abdominal pain, kidney dysfunction, and liver dysfunction, to name a few. So for people with a sensitive stomach or known kidney disease, caution is key. Even for those with iron stomachs and normal kidney function should take Ibuprofen with plenty of water and not take more than the recommended dose without consulting their physician. 

The upshot: None of these medications is essential, nor are they cures for colds and flus. Most people do fine with hydration, rest, and time. However, it’s nice to have a kit in your back pocket to alleviate symptoms as needed. 

Of course, getting vaccinated against COVID, flu and RSV  if appropriate is key, especially for those at high risk!

Dr. Lucy McBride  is a primary care doctor in Washington, DC. She is the author of a popular medical newsletter, Are You Okay? , and a forthcoming book about whole-person health with Simon & Schuster. She hosts the Beyond the Prescription  podcast and is a frequent media contributor, advocating for a data-driven, patient-centered, holistic approach to health. You can sign up for her weekly newsletter here .