This article is part of an ongoing series entitled, Beyond Rx: OTC Corner, which will include topics such as OTC medications, dietary supplements, and other health care approaches that will help nurse practitioners and physician assistants provide patients with tools to manage their health.

Robert D. Sheeler, MD, is guest editor of the series. He is an associate professor of family medicine, Mayo Clinic, in Rochester, Minn. He is board certified in family medicine, integrative medicine, and holistic medicine.

Treatment for patients with a common cold does not require a prescription. Clinicians should provide evidence-based advice to their patients for the many other options that are available.

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Cold and cough combinations

The first stop at the pharmacy for a patient with a cold is an overwhelming selection of combination medicines for cold and cough.

Although antihistamine/decongestant combinations (without an analgesic) produce no measurable difference in nasal congestion or rhinorrhea, a decongestant/analgesic combination (without an antihistamine) can be helpful in relieving nasal obstruction.1 A Cochrane review of 27 randomized controlled trials studying combination cold treatments found that a single administration at bedtime of an oral antihistamine/decongestant/analgesic combination is better than placebo at producing a feeling of general symptom improvement.1

However, cardiovascular and other risks of taking the medication must be weighed against the modest benefit. These medications have no benefit in young children, however, and the US Food and Drug Administration warns against decongestant use in the pediatric population.

Nasal sprays and topical products

Patients may use nasal sprays either as adjuncts or as alternatives to systemic treatments. Intranasal ipratropium bromide helps rhinorrhea, but it can cause epistaxis. Topical nasal decongestants (such as oxymetazoline) provide rapid symptom relief, but continued use past 5 days leads to rhinitis medicamentosa, or rebound nasal congestion, on withdrawal of the medication.

Saline nasal irrigation can be helpful, particularly in children. Guidelines, such as those from the Institute for Clinical Sciences Improvement, recommend gargling with warm salt water (¼ tsp of salt per 8-oz glass of water) to treat a sore throat.

One over-the-counter treatment that is available only from online retailers that carry European products is carrageenan-containing nasal spray. The seaweed derivative, already used extensively in cosmetics and foods in the United States, is thought to inhibit rhinovirus replication in the human respiratory tract by forming a gel-like envelope around the virus. In a double-blind, randomized controlled trial involving 211 adults with early cold symptoms, administration of carrageenan-containing nasal spray three times daily reduced both the viral load in nasal secretions and the duration of illness by more than 2 days.2

Topical products containing aromatics such as camphor, eucalyptus, and menthol also provide symptomatic relief of nasal congestion and cough when applied to the chest or neck.


Echinacea, or purple coneflower, used to be more popular among children and adults, but it has decreased in popularity in recent years. Although there is a lot of heterogeneity in the preparations of echinacea studied in the literature, in general, a preparation of aerial parts of Echinacea purpurea is most likely to have positive effects. Echinacea is more likely to prevent colds than shorten their duration.