Does acetaminophen help nasal congestion from the common cold?

- Jennifer Middleton, MD, MPH

I don't know about you, but when I get a upper respiratory tract infection (URI or "cold"), one of the first things that I reach for is acetaminophen. I've never thought that it did much for the nasal congestion, but it at least seems to take the edge off of the headache, muscle aches, and fever.

Cold and flu season is right around the corner - except for my household, where it unfortunately arrived this weekend.  So, I am finding Cochrane's recent review of acetaminophen for the common cold rather timely.  The reviewers only found 4 small studies of "low to moderate quality," but 2 of these studies did show that acetaminophen reduced nasal congestion, and 1 showed that it reduced rhinorrhea.

I had never thought of acetaminophen as a treatment for nasal symptoms before, but the Cochrane reviewers wisely recommend caution in interpreting these small studies, stating that they are insufficient "to reach a conclusion."

Does this mean that I will be less likely to use and recommend acetaminophen for cold symptoms? Nope. A lack of high-quality studies supporting its efficacy isn't the same as a high-quality study showing that it doesn't work.  I still like recommending acetaminophen for headache, myalgias, and fever, and if it gets some of those nasal symptoms, that'd be a nice bonus.  What this review will hopefully spark, though, is some higher-quality prospective studies to more precisely define acetaminophen's utility for URI symptoms.

So, we'll keep on using acetaminophen in our house until this current virus runs its course.  AFP also recently reviewed "Treatment of the Common Cold in Children and Adults" with pragmatic evidence-based recommendations for patients (and doctors) with URIs.  And, when all of those over-the-counter options for colds get overwhelming, this AFP Cochrane for Clinicians article can provide guidance.  We're also drinking plenty of fluids, resting when possible, and my husband is taking zinc lozenges (though the taste isn't worth it to me, given zinc's only modest effect on URIs).

Will Cochrane's review change your recommendations for acetaminophen use in the common cold?