5 Tips for Choosing Safe Cold Medicine for Seniors

5 tips to help caregivers choose safer OTC cough and cold medicines for seniors

If your older adult gets a cold or flu, your first instinct is to relieve their symptoms. But choosing over-the-counter cough and cold medicine can be confusing and potentially harmful if not done carefully. Hedva Barenholtz Levy, PharmD shares 5 tips to help caregivers choose safer OTC cough and cold medicines for older adults.


When caring for an older adult who is experiencing symptoms of a cold or flu, our first instinct is to help relieve symptoms.

Hundreds of remedies for cough and cold symptoms are available on retail shelves.1 And nearly half of older adults use over-the-counter (OTC) products on a regular basis, often taking them alongside prescribed medications.2,3

But choosing among OTC cough and cold products can be overwhelming and potentially harmful if not done carefully.

Side effects and interactions are an important concern, especially because older adults typically have several health conditions and take multiple daily medications.

These five tips will help guide you through the maze, and more importantly, will help older adults and family caregivers make safer choices when using OTC cough and cold medicines.




1. Take only ingredients that are needed

Single-ingredient products are safest because they avoid unnecessary exposure or ingestion of excess amounts of medicine.

There are basically four types of medicines found in OTC cough and cold products:

  1. Antihistamines to treat runny nose, sneezing
  2. Oral and nasal decongestants to treat stuffy nose
  3. Cough medicines to either loosen a cough or suppress it
  4. Pain and fever reducer (usually acetaminophen)

Drug companies create hundreds of unique products by mixing and matching these ingredients in different combinations.

As a result, people often end up buying products that contain unnecessary medicines for symptoms they do not have.

More importantly, exposing the body to additional medications – even nonprescription ones – can increase the risk of side effects and interactions.

In addition, because people usually buy more than one OTC product to relieve different symptoms, there is an increased risk of taking too much of a single ingredient when it is contained in different products. 

A notable concern is the risk of ingesting too much acetaminophen (a pain and fever reducer) that is commonly included in many OTC products. Too much acetaminophen increases the risk of liver damage.


2. Check for interactions with prescription and nonprescription medications as well as with health conditions

Interaction information is required to be included on the product label for all OTC products.

Do not gloss over it; this is important information. 

For example, antihistamines interact with alcohol, medicines that cause sedation, and certain antidepressant medications. 

Decongestants interact with certain antidepressants and can worsen conditions like high blood pressure, hyperthyroidism, diabetes, heart disease, glaucoma, and enlarged prostate. 

With the wide variety of OTC products on the market, the potential for a drug or health-condition interaction is high.

Before making a purchase, it’s well worth the time to double check with the pharmacist to prevent a serious interaction.




3. Take the correct amount of the medication

Dosing information is required on the product label. The amount of the medication that equals one dose will be stated, as well as the maximum amount that should be taken in a 24-hour period. 

OTC labels now have a standardized format to make it easier for consumers to locate key information. 

Remember to add up the amount of a medicine found in multiple products when calculating the amount taken in 24 hours. 


4. Beware that many ingredients are of questionable benefit

Several ingredients have been found to be ineffective or of uncertain benefit4,5:

  • Phenylephrine, an oral decongestant
  • Antihistamines when used alone to treat cold symptoms
  • Cough medicines to thin the mucus (guaifenesin) or to suppress a cough (dextromethorphan)

Dextromethorphan is associated with drug interactions and side effects at high doses. 

For nasal congestion, effective options include oral pseudoephedrine (but be careful of side effects and interactions), nasal decongestant sprays if used for no more than 3 days, and non-drug options like saline nasal spray and Breathe Right strips. 

For managing cough and cold symptoms, non-drug treatments like fluids, rest, good nutrition, hot tea with honey, and chicken soup are preferred.


5. Seek medical attention when needed

Symptoms should improve within seven days. If symptoms persist or worsen, seek attention from a healthcare provider right away.

Do not continue to self-treat what appears to be a simple cold or the flu if symptoms are not improving.


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Guest contributor: Hedva Barenholtz Levy, PharmD, BCPS, BCGP, is Director at HbL PharmaConsulting and a clinical pharmacist who specializes in working with older adults residing in the community setting. She promotes the safe and effective use of medications through comprehensive medication reviews and by educating patients, healthcare professionals, and others who work with older adults.



  1. McCoul ED. Assessment of pharmacologic ingredients in common over-the-counter sinonasal medications. JAMA Otolaryngol Head Neck Surg 2020;146:810-15.
  2. Qato DM, Alexander GC, Conti RM, et al. Use of prescription and over-the-counter medications and dietary supplements among older adults. J Am Med Assoc 2008;300:2867-78.
  3. Kinsey JD, Nykamp D. Dangers of nonprescription medicines: educating and counseling older adults. Consult Pharm 2017;32:269-80.
  4. Hatton RC, Hendeles L. Over-the-counter oral phenylephrine: a placebo for nasal congestion. J Allergy Clin Immunol Pract 2015;3:709-10.
  5. Weinberger M, Hendeles L. Nonprescription medications for respiratory symptoms: facts and marketing fictions. Allergy Asthma Proc 2018


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