Which cold remedies actually help to reduce symptoms?

Some days, it can seem like everyone around you is sick.

And should you start coughing, sneezing and sniffling yourself – life can be pretty miserable.

But before you reach for your favourite cold remedies, be aware, they’re not all created equal. While some do seem to have an effect, some haven’t been studied much, and many don’t appear to do much at all.

Here’s a look at common cold remedies, and whether they will actually help to alleviate your symptoms.

First of all, some bad news. There is no way to actually cure a cold.

“You can do things that make you feel better, but nothing cures it,” said Dr. Michael Rieder, who holds the CIHR/GSK chair in pediatric pharmacology at Western University.

There is, however, some research on ways to shorten its duration. The typical cold incubation period is between twelve hours and four days, Rieder said, and the cold itself usually lasts between seven and eleven days in most people.

Zinc

Zinc might make that shorter, Reider said. “There are a couple of trials showing that if you are otherwise healthy and you get a cold, if you take zinc in the first 24 hours, it reduces duration.”

The evidence is mixed though. Jennifer Isenor, an associate professor at the College of Pharmacy at Dalhousie University, is skeptical about zinc.

“Newer evidence actually doesn’t support it,” she said. A randomized controlled trial on zinc lozenges published in January 2020 found that zinc didn’t help to shorten a cold’s duration.

The evidence on most things that purport to shorten a cold is weak, Rieder said. “So the primary emphasis is really still on symptom control.”

Vitamin C

The evidence on whether Vitamin C can prevent colds, reduce their duration or help minimize symptoms isn’t great, Isenor said.

“It has not been shown to have benefit in the general population.”

“Even in megadoses, no one has actually shown that Vitamin C alone does very much in terms of reducing incidence. But there is a suggestion that if you give large doses, it might reduce the duration — there is some suggestion of that, although the data is not firm on that,” Rieder said.

Vitamin C has been talked about in relation to colds for a long time, he said, “and you know, no one’s ever shown that it works.”

Echinacea

The results on Echinacea are inconclusive, Rieder said. “There’s a couple of trials that suggest that Echinacea might reduce the total number of colds.”

Unfortunately, he said, it only seems to work if you’re taking it steadily for several months while healthy – not if you are already sick.

“It’s not like, when you get sick, take Echinacea,” he said. “By then the horse may have left the stable.”

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Cough syrup

Cough syrups have a “modest” effect in adults and “don’t work” in kids, Rieder said.

Rieder, who wrote the Canadian Pediatric Society’s guidelines on colds, said there’s not enough proof that cough medicine works on children, and so, kids probably shouldn’t take it.

“We don’t recommend anything in kids beyond symptom relief with acetaminophen or ibuprofen, so Tylenol or Advil,” he said. “And that’s because there’s no evidence of efficacy, and there is some evidence of harm.”

Health Canada recommends against giving cough and cold mediation to children under six years old, Isenor said.

Health Canada reviewed the medications in 2009 and found that they weren’t effective. The department also points to possible risks with the products. “Serious harm, including misuse, overdose and side-effects may occur in children under 6 years of age when using over-the-counter cough and cold products, although the risk of such serious harm is low,” the department wrote in a bulletin in 2016.

“And then even for those that are older, there’s really insufficient evidence to support their use,” Isenor said.

Honey might help to relieve kids’ cough symptoms, she said. “There is certainly some (evidence) that does show that honey is better than no treatment or placebo and that it’s relatively safe.”

It shouldn’t be given to kids under a year old because of the risk of botulism, but otherwise, a teaspoon of honey can help, she said.

Vapour rubs might also have some effect. Otherwise, fluids and throat lozenges are good options for a sore throat and might help with coughing, she said.

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For adults, some prescription cough syrups with codeine have a bit of an effect, Rieder said, though he doesn’t generally recommend them for safety reasons. Starting in January, some liquid cough syrups with codeine became restricted prescription drugs and have had to be stored in a special safe in pharmacies, along with other controls.

Antihistamines

“There’s some evidence that the older antihistamines, like the first-generation ones, diphenhydramine (Benadryl), improve runny nose and sneezing,” Rieder said.

However, there are concerns about their safety, Isenor said, particularly in children, older adults and people with certain medical conditions or who take certain medications. “And it’s probably not that effective anyway on the runny nose and things.”

Second-generation antihistamines don’t have any effect at all on cold symptoms, Rieder said, though they’re good for treating allergies.

Decongestants

Studies on nasal sprays have shown some small improvements in congestion, Isenor said, but it’s not clear whether it’s clinically significant for most people.

Again though, she said, there are some safety concerns with kids, older adults and people on certain medications or with certain medical conditions.

Nasal sprays can generally only be used for a few days too, she said. “Otherwise there is something known as ‘rebound congestion.’ So you can get the congestion back, and worse.”

Saline sprays, drops and saline irrigation systems like Neti-Pots haven’t been shown to have much of an effect, but they are relatively safe, she said. “People can try it if they feel it’s helpful.”

Pain relievers

Pain medications, like acetaminophen and ibuprofen, have shown some benefit in helping people feel a bit better, both Isenor and Rieder said.

They help with muscle aches that often go along with a cold, Rieder said.

A 2014 review of cold treatments found that these medications did help with fever, though not with other symptoms, unsurprisingly.

Combination medications

Many cold medications, like Nyquil and lots of other cough-and-cold formulations, combine a cough suppressant, decongestant, antihistamine and often a pain reliever, like acetaminophen in a single medication, Isenor said.

A 2014 review in the Canadian Medical Association Journal found a “small to moderate effect” in adults for medications that combined antihistamines and decongestants.

But, Isenor said, you want to be careful about combining them with other drugs. “One big concern is if they’re using the combination products, especially with acetaminophen, if they add on additional acetaminophen (…) there is potential for overdose.”

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Chicken soup

Chicken soup is good, Rieder said, but there’s nothing that special about it. “Hydration is always good because when you have a cold, you want to stay hydrated, and chicken soup has electrolytes in it.”

“It has no other specific benefit.”

Antibiotics

Antibiotics don’t help with viral infections like a cold, Isenor said, and they can contribute to antibiotic resistance – a very serious public health issue.

Best remedy

Given that so many long-held remedies have been more or less debunked, what should you do?

Despite the plethora of products out there, the best thing for a cold is rest, Rieder said.

“If you’re sneezing every 10 minutes, sweating all over the place, don’t go to work. Stay home, go to bed, watch Netflix, take it easy, take some of that chicken soup we talked about with a cup of tea with honey.”

“Take it easy and get better.”