Safety of Over the Counter Cold Medicines

Side Effects of Over the Counter Cold Medicine

Woman looking at medication
Choosing the right over-the-counter cold medicine can reduce side effects from unnecessary medicine. BSIP/UIG/Universal Images Group/Getty Images

The common cold affects millions of people in the United States every year, especially children. In fact, the average child experiences between 6 and 10 colds per year, each lasting up to 2 weeks. Symptoms of the common cold include a runny nose, sneezing, coughing and in many cases, fever. The common cold is often caused by the rhinovirus and cannot be cured by taking antibiotics, and while taking medicines for a cold doesn’t shortage the duration of symptoms, medicines can make a person feel more comfortable.

Usually, over the counter (OTC) cold medicines are taken for the symptoms of a common cold result. In fact, 10% of all children are taking some type of OTC cold and cough medicine at any given time. OTC cold medicines may contain antitussives (anti-cough medicine), decongestants, antihistamines, expectorants and antipyretic/analgesic (fever/pain) medicines. In most cases, OTC cold medicines are combination products that contain two or more of these medicines in a single syrup or pill. 

Are OTC Cold Medicines Safe?

While OTC cold medicines are generally considered safe, they are not without side effects, especially for young children. Since OTC cold medicines do not work very well for children under age 4 (and especially in children under age 2), the American Academy of Pediatrics does not recommend the routine use of OTC cold medicines for young children, especially for the treatment of a cough.

Overuse of OTC cold medicines has been associated with many side effects, including breathing difficulties, neurological impairment, cardiac arrhythmias and even death. Thousands of emergency room visits occur each year in the United States as a result of overdose from OTC cold medicines in young children, often because the medicines don’t work very well, so the child is given more and more medicine.

Other common reasons for overdose of OTC cold medicines in children include unknowingly giving the same medicine twice in two different products, failure to use a measuring device and using the wrong product.


Commonly used OTC oral decongestants include pseudoephedrine and phenylephrine, which act to cause constriction of the blood vessels in the tissue lining of the nose. Common side effects of these medications include insomnia, agitation, rapid heart rate and elevated blood pressure. Serious complications from overdose of oral decongestants have included seizures, cardiac arrhythmias, stroke and cerebral hemorrhage (bleeding in the brain).


OTC antitussive medicines, namely dextromethorphan, work on the cough center in the brain to stop a person from coughing. It is a generally safe medicine, although at high doses can cause confusion, slurred speech, sedation, weakness, seizures, cardiac arrhythmias and respiratory depression. Dextromethorphan is chemically related to codeine (a prescription antitussive medicine), and therefore has abuse potential at very high dosages.


For the purpose of treating the common cold, OTC antihistamines are usually taken for the side effects they cause, which can decrease cold symptoms. For instance, antihistamines cause anticholinergic side effects, meaning that they decrease mucus production and cause drowsiness, both of which may be helpful to stop a runny nose and allow a person with the common cold to feel better and get much needed rest. Common side effects at high dosages of antihistamines may include elevated blood pressure and heart rate, confusion and constipation.


An expectorant is an OTC cold medicine, namely guaifenesin, which increases mucus production and allows for thick mucus to become thin so that it can be cleared from the airways of the lungs. Guaifenesin is a generally safe medicine, although is known to commonly cause gastrointestinal upset.

What Is the Best Approach for Choosing an OTC Cold Medicine?

Choosing an OTC medicine can be difficult, and based on the potential side effects of various cold medicines, you don’t want to take any medicine that isn’t necessary. A free medical app is available, called MeditRight, which can help find the best OTC cold medicine based on symptoms, formulation preference (such as pill versus syrup) and side effect preference (such as avoiding drowsiness or insomnia). Download MeditRight for the iPhone or Android today and use it the next time you need to purchase an OTC cold medicine for yourself or for your family.


Yang M, So TY. Revisiting the Safety of Over-the-Counter Cough and Cold Medications in the Pediatric Population. Clinical Pediatrics. 2014;53(4):326-30.

Fashner J, Ericson K, Werner S. Treatment of the Common Cold in Children and Adults. Am Fam Physician. 2012;86(2):153-9.

Carr BC. Efficacy, Abuse, and Toxicity of Over-the-Counter Cough and Cold Medicines in the Pediatric Population. Current Opinion in Pediatrics. 2006;18:184-8.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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