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With the arrival of cooler weather, the season of hacking and sniffling is here. Once again, haggard-looking people roam the aisles of American pharmacies, clutching tissues and looking for relief — and often coming up empty-handed.

Last year, the FDA recommended that phenylephrine, a decongestant in many popular cold medicines that’s been proven to be ineffective when taken orally, be removed from pharmacy shelves. (It’ll take a while for that to happen, which explains why you might still find the ingredient in NyQuil and other cold medicines.)

But that doesn’t mean all the other syrups and gels and tablets available for purchase are effective. In fact, most over-the-counter cold medicines do very little to reduce the symptoms that cause us the most misery during respiratory virus season.

Today on Vox, I’m writing about a few exceptions worth knowing about, plus several non-pharmaceutical interventions that may slightly reduce your suffering while you wait things out.  Briefly, here’s what can help.

Cold symptoms are often caused by viruses for which we don’t have vaccines, simple or cheap tests, and antiviral medications. However, there are some important exceptions: Covid and the flu can be prevented with vaccines, and there are RSV immunizations for babies and adults 65 and up. Testing can identify all of these viruses, and there are medications — like Tamiflu and Paxlovid  — to help reduce the severity of flu and Covid infections, respectively, in certain groups of people. Talk to a clinician to find out if these are right for you.

Taking some preventive steps is also worthwhile. Handwashing, ventilating and filtering air in shared spaces, strategic masking, and staying away from sick people can all help prevent illness. Even if these practices only lower the viral dose you take in, that can still make for a less uncomfortable cold season.  

Unless you have a fever lasting more than three days or other concerning symptoms like shortness of breath, cold symptoms aren’t generally a sign of an underlying illness that needs to be treated with medication. However, lots of people want to feel better, and they especially want to get better rest than a stuffed nose or a gnarly cough allows them.

When it comes to cold medicine,  not everything marketed to you is equally likely to be helpful. Here’s what’s been proven to work:

Pain and fever reducers

Drugs that reduce pain and inflammation, like Tylenol or ibuprofen,  can relieve the fevers, aches, and pains that accompany colds, along with some of the exhaustion and even some of the sneezing. Children, including babies, can safely take these medications in weight-appropriate doses; check the packaging to ensure you’re giving the correct amount.

Decongestants and antihistamines

For adults with stuffy noses, the only decongestant to bother with is pseudoephedrine, the active ingredient in regular Sudafed (not in Sudafed PE). Because of its illicit use in producing methamphetamine, pseudoephedrine is held behind counters and sold in only limited quantities to consumers. You’ll have to ask the pharmacist for it.

There’s evidence pseudoephedrine might work better to address snot-related symptoms when combined with an antihistamine. But the antihistamines in your allergy medication (Zyrtec, Allegra, and Claritin) won’t be as effective for a cold; the varieties in most combination cold medicines are usually older ones, which seem to work better for nasal symptoms caused by viruses.

Decongestants and antihistamines aren’t safe for kids under 6 and need to be used with caution in older children.

Side effects of these medications can include drowsiness, dry mouth, and trouble sleeping. Additionally, they’re not safe for use in people with high blood pressure, glaucoma, kidney disease, and other conditions. People with preexisting conditions and those taking certain medications, including some antidepressants, should check with a health care clinician or pharmacist before taking these medications.

Nasal sprays and inhalers

Nasal sprays or inhalers containing certain anti-runny-nose components have been proven to make coughs and colds somewhat less miserable. The active ingredients to look for are cromolyn sodium (in over-the-counter brands like Nasalcrom) and ipratropium bromide (available as the prescription-only Atrovent). These haven’t been studied in kids under 6, so again, only use them per package directions in older children. 

Cough medicines

When it comes to cough medicines in particular, a 2014 review study found little evidence to suggest they’re effective. This category includes drugs advertised as cough suppressants (e.g. dextromethorphan, which is supposed to lower the frequency of cough) or expectorants (e.g. guaifenesin, which theoretically helps make coughing more effective at getting the gunk out). Plus, these medications can be dangerous to young children, and aren’t recommended for kids under 6.

It’s worth noting that in small but well-designed studies, one of which was conducted by pharmaceutical companies, dextromethorphan slightly decreased coughing in both adults and older children. Overdoses can be dangerous, though, and the benefit is so small that most experts don’t think it’s worth the trade-off so don’t recommend it to patients generally. However,  it’s safe to use in moderation. Just opt for formulations that contain only dextromethorphan (rather than combination medications) and take it according to the package directions.

Honey, zinc, and vitamin C

There’s evidence that a couple teaspoons of honey reduces nighttime coughing, making it a safer and more cost-effective choice than cough medicine for most people (note that honey is not safe for babies less than a year old). Additionally, oral zinc might shorten the time some people experience cold symptoms after infection, although its nasty taste and the nausea it causes some people may not be worth the benefit. (Avoid nasally administered zinc; overdoses can lead to a permanent loss of smell.)

There’s also some evidence that very active people taking big doses of vitamin C — a gram a day for a week — have shorter and less severe colds, but it’s not totally clear whether the effect translates to people who have normal activity levels.

Some of the most effective treatments for colds are things you can do for free, more or less. Sleeping propped up on lots of pillows can help reduce nighttime cough and congestion by allowing gravity to drain all that extra gunk downward from your nose, sinuses, and throat. You can even elevate the head of your bed by putting bricks or cinder blocks under the top legs.

Getting plenty of rest on a regular basis — eight hours or more a night — may make cold symptoms less severe if you do get infected, and can help you fight off colds by boosting your immune system. Drink plenty of fluids to avoid dehydration, keep your mucous membranes nice and moist, and loosen all the sticky stuff. 

Routine viral coughs and colds are typically the worst for the first three to five days, and you might have a fever for the first two to three.  Runny noses and congestion can hang around for seven to 10 days, and a post-viral cough (usually caused by persistent irritation) can last up to three weeks. 

And if things don’t get better, it might be time to get professional help.

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Today’s edition was produced and edited by senior editor Lavanya Ramanathan, with contributions from staff editor Melinda Fakuade. We'll see you tomorrow!

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