Are max strength cold and flu pills worth the money?

A stock photo of a young woman lying across a couch under a patterned blanket. She has a laptop computer on her lap and is blowing her nose with a tissue.

Image source, Getty ImagesByJim ReedHealth reporter

Published43 minutes ago

Your throat's painful, your head throbs and your blocked nose has kept you awake all night. It's that time of year again - flu season - and you'll try anything to feel normal.

But is that pricey max strength flu remedy really any better than a basic box of painkillers?

"The big brands have been around for a while, they've been tested, and there are adverts on the TV saying they're really good," says Prof Jayne Lawrence, head of the pharmacy division at the University of Manchester.

"But in reality, there's very little difference. Personally, I'd always go for the cheaper ones - and they’ve also been tested."

The trade association representing over-the-counter medicine makers says familiar brands can reassure shoppers and help them find the right product on crowded supermarket shelves.

Cold and flu drugs fall into three broad camps: household names such as Lemsip and Sudafed; supermarket own-label alternatives; and single-ingredient medicines containing paracetamol or ibuprofen.

The difference in price can be striking.

A packet of 16 Lemsip All-In-One Max Strength tablets retails at £7.30, more than 20 times the £0.35 cost of paracetamol pills in some supermarkets.

Both contain 500mg of paracetamol, which doesn't treat the underlying infection but does relieve pain and can bring down a fever.

The Lemsip version, along with many of its competitors, also contains the decongestant phenylephrine.

It's meant to constrict leaky or swollen blood vessels in the nose which can cause congestion.

But Prof Lawrence says there is little evidence it works when taken as a tablet, rather than as a nasal spray, because much of the drug is broken down before it can reach the bloodstream.

In 2024, the US drug regulator said it wanted phenylephrine removed from all cold and flu pills, saying it was simply not effective, although that proposal has yet to be finalised.

Some cold and flu remedies contain a third active ingredient - guaifenesin - which is meant to loosen mucus in the airways.

That sits in more of a grey area: some studies report improvements in chest congestion, while others find little or no benefit.

A spokeswoman for Reckitt, which owns Lemsip and Nurofen, said the ingredients in its products are approved by regulators and formulated for multiple symptoms including fever, congestion and coughs.

The caffeine effect

Many popular max strength remedies can also contain up to 65mg of caffeine per pill, about the same as a mug of instant coffee.

As well as acting as a mild stimulant, research suggests caffeine may boost the effect of paracetamol, external and help it work slightly sooner, although any benefit is likely to be modest.

Almost every brand can also be found as a flavoured powder to dissolve in hot water, typically costing slightly more per dose than pills or tablets.

That warm drink can be soothing and a study funded by a drug company, external found it may be absorbed into the bloodstream more quickly, but whether patients notice any major difference in their symptoms is much less certain.

A section of shelves in a supermarket containing a variety of cold and flu and painkiller remedies in different coloured boxes.

Image caption,

The entire over-the-counter medicines market in the UK, including cold and flu remedies, is worth £3.3bn a year according to industry estimates

Yet ingredients are only part of the story.

Bigger brands have more money to spend on in-store adverts and displays, according to a former manager at a large chemist chain.

Well-known names or premium own-label products are often positioned at eye level, while budget alternatives are tucked away on the bottom shelves.

"You are always going to promote the ones which are more expensive," says the former manager, who doesn't want to be named as she still works in the industry.

When it comes to medicines, some shoppers assume that paying extra means getting something more trusted or effective.

"Nine times out of ten, people would come in and ask for a certain brand," she adds.

"Even if I explained there was little difference, and I was only trying to save them money, they would still want the big name."

The PAGB, which represents the consumer healthcare sector, argues that "trusted and recognisable" brands can simplify choice and build confidence at a time when "health misinformation is widespread".

What doctors suggest

If you're suffering with cold and flu symptoms, doctors advise the following:

Rest, plenty of fluids and painkillers like paracetamol to control temperature swings
Remember not to double up by taking paracetamol alongside cold and flu remedies that also contain it, as this can easily lead to an accidental overdose
The NHS recommends gargling with salt water, external to relieve a sore throat, while a homemade hot lemon and honey drink can soothe a nasty cough, external, adds Dr Jamie Hynes, vice president of the Royal College of GPs
See a GP if a cough has lasted for more than 21 days, says Hynes, or if you've lost weight unintentionally or, in urgent cases, if experiencing chest pain or breathing difficulties
And, note some cold medicines are not suitable for pregnant women so do check with a midwife, pharmacist or GP before taking