As flu season brings sore throats, headaches and sleep-disrupting nasal congestion, consumers often face a choice between expensive branded remedies and cheaper alternatives.
Expensive max-strength cold and flu medicines offer little practical advantage over budget alternatives, according to Prof Jayne Lawrence, head of the pharmacy division at the University of Manchester.
Prof Lawrence said that while well-known brands undergo testing and extensive promotion, cheaper alternatives are equally tested. She said she personally recommends opting for less expensive options, reports BBC.
Over-the-counter cold and flu treatments generally fall into three categories: well-known brands such as Lemsip and Sudafed, supermarket own-label products, and single-ingredient medicines containing paracetamol or ibuprofen.
The price difference can be significant. A 16-tablet pack of Lemsip All-In-One Max Strength costs £7.30, more than 20 times the £0.35 price of basic supermarket paracetamol tablets.
Both products contain an identical 500mg dose of paracetamol, which relieves pain and reduces fever but does not treat the underlying viral infection.
However, many branded remedies contain additional active ingredients, such as the decongestant phenylephrine, which is intended to narrow swollen blood vessels in the nose and ease congestion.
Prof Lawrence pointed out that there is little evidence that oral phenylephrine tablets are effective compared with nasal sprays, as much of the drug breaks down before reaching the bloodstream.
In 2024, the US drug regulator proposed removing oral phenylephrine from cold and flu medicines because of its lack of effectiveness. However, the proposal has yet to be finalised.
Another common ingredient is guaifenesin, which is intended to loosen mucus in the airways. However, scientific evidence of its benefits remains inconclusive, with studies producing conflicting results.
A spokeswoman for Reckitt, which owns Lemsip and Nurofen, said all ingredients in its products are approved by regulators and formulated to address multiple symptoms simultaneously, including fever, congestion and coughs.
Some max-strength remedies also contain up to 65mg of caffeine per tablet, roughly equivalent to a mug of instant coffee. Caffeine acts as a mild stimulant, and research suggests it may enhance paracetamol’s effect, helping it work slightly faster, although the benefit is likely to be modest.
Flavoured hot drink powders also tend to cost slightly more per dose than standard pills or tablets. A study funded by a pharmaceutical company found that they were absorbed into the bloodstream faster and provided a soothing effect. However, it remains uncertain whether patients experience any significant improvement in their symptoms.
In-store displays also influence consumers’ purchasing decisions, according to a former manager at a major chemist chain.
Retailers routinely place higher-priced products at eye level to encourage shoppers to buy more expensive brands, while cheaper alternatives are kept on bottom shelves.
The former manager said nine times out of 10, customers specifically ask for a particular brand and continue buying well-known products even after being told that cheaper alternatives offer the same benefits.
Defending branded medicines, the PAGB, the trade association representing over-the-counter medicine manufacturers, said trusted and recognisable brands help simplify consumer choices, reassure shoppers and build confidence at a time when health misinformation is widespread.
Medical professionals advise that recovering from cold and flu symptoms primarily requires rest, plenty of fluids and painkillers such as paracetamol to control fever.
Patients are also warned against taking paracetamol alongside multi-symptom cold remedies that already contain the medicine, as doing so can lead to an accidental overdose.
Dr Jamie Hynes, vice-president of the Royal College of GPs, said NHS guidance recommends gargling with salt water to ease a sore throat. A homemade hot lemon and honey drink can also help soothe a cough.
Dr Hynes advised people to consult a GP if a cough lasts more than 21 days or is accompanied by unintentional weight loss. Symptoms such as chest pain or breathing difficulties require immediate medical attention.
Pregnant women are also advised to consult a midwife, pharmacist or GP before taking cold medicines, as some formulations are unsuitable during pregnancy.
