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Name Brand vs. Generic Cold Medicines

Pediatrics Expert Advice from Shari Nethersole, M.D.

Q: What's the difference between name brand and generic cold medicines in the store, and how do you know which product to buy your child when there are so many choices? How do you get rid of that chronic cough the kids have that just won't go away? It's so hard to get the kids to use things that will help them get rid of what's in their chest.


A typical cold lasts 7-14 days, with runny nose primarily in the first few days, and cough starting later and persisting longer. It's important to remember that a cold is caused by a virus, and there currently are no good antiviral treatments available that will shorten the length of a cold. The cold remedies you will find in most pharmacies are intended to treat the symptoms of the cold, but will not make the cold go away.

There are four major classes of cold medications.

  • Decongestants are supposed to improve nasal stuffiness and allow a child to breath more easily through the nose. Active ingredients include pseudoephedrine and phenylpropanolamine. The major side effect is that they can cause sleeplessness, and tend to "wake you up". Sometimes, young children can have an opposite reaction, and get very drowsy after taking them.
  • Antihistamines are used to help improve a runny nose, however medical evidence shows that while they are definitely helpful in stopping a runny nose caused by allergies, they are not particularly useful in stopping a runny nose caused by a cold. Active ingredients include chlorpheniramine, bromopheniramine, and diphenhydramine. The major side effect of this class of drugs is sedation. Many people get very sleepy after taking antihistamines. Young children sometimes have an opposite reaction and get very excited after taking them.
  • Cough suppressants decrease the frequency and intensity of a cough. They work by telling your brain not to cough as much. When used in excess, they can cause sedation, but have minimal side effects if used in normal doses. The most common active ingredient in cough suppressants is dextromethorphan.
  • Expectorants thin the mucous that accumulates in the throat and upper airway, making it easier to cough up the mucous. The most common active ingredient is guafenesin. There is no scientific evidence to show that these truly help.

The first thing to remember is that when large studies have been done, they have not shown that any cold medications really help. So, my first recommendation is to avoid using them at all. If you feel you must use an over the counter cold medication, figure out which symptom of the cold you really want to improve, and then get a cold medicine that "treats" that specific symptom. For example, you can buy a decongestant alone, rather than getting a remedy that has a decongestant, cough suppressant, and an expectorant in it. Similarly, do not buy a multi-symptom cold reliever if the only problem is cough. A cough suppressant alone would be better.

  • If nasal congestion is the major problem, consider using a decongestant nasal spray rather than an oral medicine. This way the medicine is going right to where it is needed, and there are fewer side effects. The spray should only be used for 3 or 4 days.
  • Only give the cold remedy for 2 or 3 days, when the symptoms are at their peak. Prolonged use can lead to more side effects and complications.
  • If your child has chronic respiratory problems such as asthma or cystic fibrosis, you should talk with your doctor before giving cold medications.
  • Don't give cold medicines to infants (children under 1 year of age). Only give the dosage that is recommended on the package. More is not necessarily better. The dosage is usually based on your child's weight, and excessive amounts can cause greater side effects.
  • The generic cold medicines are just as effective (or ineffective) as the name brand ones.

There are other things that you can do to make your child feel better during a cold that don't involve buying medications. Keeping the air in the room moist with a humidifier helps to prevent a scratchy throat and dry nose. Make sure your child is drinking large amounts of liquids, and getting a full night's sleep. An extra nap may also help.

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