Pharmacies’ cold and flu aisles are brimming with options, but most share a relatively small list of active ingredients in a variety of combinations. MedPage Today He spoke with a pharmacist and a doctor to find out which over-the-counter (OTC) medications are truly effective and which ones patients should leave on the shelves.

Jack Kann, RPh, MPA, MBA, director of pharmacy at South Shore University Hospital in Bay Shore, New York, said: MedPage Today It turns out that the best approach to cold and flu medications is to match specific symptoms with the right active ingredient.

Many common OTC medications have multi-symptom formulations, which Kann said could potentially lead to unnecessary medication taking with unnecessary side effects.

Dr. of Cambridge Health Alliance in Massachusetts, who has been working on OTC supplements for a long time. Pieter Cohen agrees that multi-symptom medications are not the best approach.

“I recommend avoiding those with combined ingredients, because when you have combination ingredients, it’s much more difficult to understand what you’re treating,” Cohen said. MedPage Today. Having so many active ingredients “makes it really hard to understand what effect it’s going to have,” he said.

Instead, he recommends a single-component approach that targets specific symptoms. Acetaminophen (Tylenol), which can reduce fever and pain, and antihistamines, such as loratadine (Claritin) or diphenhydramine (Benadryl), which can relieve symptoms such as sneezing and runny nose, are effective against colds and flu, Cohen said. and tends to be a good starting point.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or acetylsalicylic acid (Aspirin), also work well to treat pain and fever, but they have more side effects than acetaminophen, he said. Kann added that different antihistamines work better for different people, so finding a good match involves some trial and error.

When it comes to other over-the-counter cold and flu medications, such as expectorants, cough suppressants and decongestants, Cohen said the evidence supporting effectiveness is weaker.

Last year, an FDA advisory committee ruled that oral phenylephrine, the only OTC decongestant found in popular products such as Sudafed PE and Suphedrine PE, not working.

“There aren’t many effective decongestants,” Kann added, noting that pseudoephedrine also acts “behind the counter“Almost twenty years ago it was much more effective than phenylephrine.

“I wouldn’t try to take anything by mouth to decongest your nose,” Cohen said.

He noted that nasal sprays containing corticosteroids, such as fluticasone, can be helpful, but can take up to a week to work. On the other hand, Cohen recommends not using nasal sprays containing oxymetazoline (Afrin). Oxymetazoline works as a rapid decongestant and, although not dangerous, can be addictive.

“I often see patients who become addicted to breathing with over-the-counter oxymetazoline nasal spray, so they have to carry it with them at all times, and if they stop using it, their nose becomes completely blocked,” he said. “This is because there is a phenomenon of rebound problems where the nasal passages enlarge in response to overuse and if one does not stop, it can eventually cause permanent damage to the nose.”

For this reason, he strongly advises patients not to take oxymetazoline even for a day.

Cohen said he usually skips OTC for nasal decongestants, expectorants and cough suppressants, and will opt for prescription if he really needs something to relieve specific symptoms. During the interview, Cohen had a lingering cough from a recent cold and said he wasn’t taking anything for any of his symptoms.