• Complementary Therapies for the Common Cold

    images for herbs in beverages article When a cold strikes, many people immediately think of antibiotics to cure what ails them. However, antibiotics are not effective against colds because colds are caused by viruses, and antibiotics are designed to fight bacteria, not viruses.
    What about natural therapies? The evidence may still be inconclusive, but some of these natural therapies may help minimize the misery of a cold.
    Consider these examples:

    Pelargonium Sidoides

    How Does It Work?

    Pelargonium sidoides (EPs) is a plant that grows in South Africa. It is traditionally used in southern Africa for treating respiratory problems. The root of the plant is what is used for treatment.

    What Is the Scientific Evidence?

    Researchers have found that liquid herbal solutions containing EPs might reduce cold symptoms. For example:
    • A review of 12 randomized trials evaluating EPs extract found that it may be effective in improving symptoms of acute rhinosinusitis and the common cold in adults.
    • A randomized trial of 207 patients aged 18-55 years with cold symptoms, also found that EPs was effective in treating the common cold. It reduced the severity of symptoms and shortened cold duration compared to placebo.

    How Do I Use It?

    A typical adult dose of EPs extract is 30 drops three times daily. However, follow the instructions on the label for proper dosage.


    How Does It Work?

    Zinc—in the form of zinc gluconate or zinc acetate—can be given as a nasal spray or as a lozenge to treat a cold. These forms of zinc release ions that directly inhibit viruses in the nose and throat.

    What Is the Scientific Evidence?

    The findings from scientific studies of zinc have been mixed; however, the overall results appear to be favorable. For example:
    Zinc Nasal Spray
    • In a double-blind, placebo-controlled study, people given zinc nasal spray (zinc gluconate) had cold symptoms for an average of 2.3 days, while those who took a placebo were sick for an average of nine days.
    • Another study, which used a different form that had a lesser amount of zinc, did not find any benefit from the use of zinc.
    Zinc Lozenges
    A systematic review looking at 13 trials evaluating zinc lozenges found that zinc reduced both duration and severity of cold symptoms. Some of the trials also suggested that starting treatment within 24 hours of symptoms may offer greater benefit.

    How Do I Use It?

    The official United States dietary recommendations for daily intake of zinc are as follows:
    • Infants 0-6 months: 2 milligrams (mg)
    • Infants 7-12 months: 3 mg
    • Children 1-3 years: 3 mg
    • Children 4-8 years: 5 mg
    • Males 9-13 years: 8 mg
    • Males 14 years and older: 11 mg
    • Females 9-13 years: 8 mg
    • Females 14-18 years: 9 mg
    • Females 19 years and older: 8 mg
    • Pregnant women 18 years and younger: 13 mg
    • Pregnant women 19 years and older: 11 mg
    • Nursing women 18 years and younger: 14 mg
    • Nursing women 19 years and older: 12 mg
    In the studies using zinc to treat the common cold, then doses were much higher. For example, in one study, patients received 12.8 mg of zinc (42 mg of zinc acetate) every 2-3 hours while cold symptoms persisted.


    How Does It Work?

    While echinacea has been promoted as a substance which temporarily stimulates the immune system, this action has not been proven. There is no evidence that echinacea strengthens or "nourishes" the immune system when taken over the long term.
    There are three main species of echinacea:
    • Echinacea purpurea
    • E. angustifolia
    • E. pallida
    E. purpurea is the most widely used, but the other two are also available. It is not clear if any one type is better than the others.

    What Is the Scientific Evidence?

    Echinacea has been the subject of much study, and results have been mixed. Among some of the cold and flu-related research is the following:
      Several double-blind, placebo-controlled studies enrolling a total of more than 1,000 individuals have found that echinacea can make colds shorter and less severe. Other studies have found no effect from echinacea.
      • In a systematic review of 16 randomized trials that looked at echinacea, nine found that the herb had a significant effect in treating the common cold.
      • Among a group of 80 people with early cold symptoms, those given E. purpurea recovered in six days; those given placebo recovered in nine days.
      • A study of 246 people given E. purpurea found that those taking the herb had significantly less severe symptoms, such as runny nose, sore throat, sneezing, and fatigue than those taking placebo.
      • A double-blind, placebo-controlled trial, involving 524 healthy children between the ages of 2-11, found that echinacea did not affect the duration or severity of cold symptoms compared to the effects of a placebo.
    • Several studies have tried to determine if taking echinacea regularly will prevent colds. However, no studies have shown this to be true. But when combining echinacea with other remedies, results have been positive. For instance, a double-blind, placebo-controlled study using a combination product containing echinacea, propolis, and vitamin C did find preventive benefits. In the study, 430 children aged 1-5 years were given either the combo treatment or placebo for three months. The results did show a reduction in the frequency of respiratory infections, but researchers were not certain which ingredients in the combo treatment was responsible for the reduction.

    How Do I Use It?

    Echinacea is usually taken at the first sign of a cold and continued for 7-14 days. The three main types of echinacea can be used interchangeably. Depending on the form, dosages are:
    • Echinacea powdered extract: 300 mg, three times a day
    • Alcohol tincture (1:5): 3-4 ml, three times daily
    • Echinacea juice: 2-3 ml, three times daily
    • Whole dried root: 1-2 g, three times daily


    How Does It Work?

    Andrographis is a shrub found throughout India and other Asian countries. It is sometimes called "Indian echinacea" because it is believed to provide many of the same benefits. It is unclear how andrographis helps to prevent and treat colds, but some evidence suggests that it might stimulate immunity.

    What Is the Scientific Evidence?

    According to a few well-designed studies, andrographis can reduce the symptoms of colds and possibly prevent colds as well. For instance, a randomized trial of 223 adults with uncomplicated upper respiratory tract infection were randomized to either Andrographis paniculata (KalmCold) at 100 mg or placebo twice a day for five days. Participants reported to researchers their symptom scores for cough, expectoration, nasal discharge, headache, fever, sore throat, earache, malaise/fatigue, and sleep disturbance. KalmCold was shown to improve symptoms better than placebo (97.2% vs. 84.3%).

    How Do I Use It?

    A typical dosage of andrographis is 400 mg three times a day. Doses as high as 2,000 mg three times daily have been used in some studies. Andrographis is usually standardized to its content of andrographolide, typically 4%-6%.

    Vitamin C

    How Does It Work?

    Vitamin C is a nutrient of great controversy. While some experts believe megadoses of this vitamin can keep you healthy, others feel it is overhyped. The truth is somewhere in the middle.
    Many studies have found that vitamin C supplements—at a dose of 1,000 mg daily or more—can modestly reduce symptoms of colds and help you get over a cold faster. This evidence regards daily use of vitamin C throughout the cold season.

    What Is the Scientific Evidence?

    Many people start taking vitamin C when cold symptoms start. According to a review of studies, taking vitamin C at the onset of cold symptoms does not appear to reduce duration or severity. The review looked at both randomized and nonrandomized trials. In an analysis of seven placebo-controlled trials with 3,249 respiratory episodes, researchers found that there was no significant difference between groups in cold duration.

    How Do I Use It?

    Vitamin C is available as a single dietary supplement. There is as much controversy about recommended levels as there is about the true health benefits of this vitamin. Many nutritional experts, though, recommend a total of 500 mg of vitamin C daily. This dose is almost undoubtedly safe. The Upper Limit (UL) established by the Food and Nutrition Board is:
    Age Upper Limit
    1-3 years 400 mg
    4-8 years 650 mg
    9-13 years 1,200 mg
    14-18 years 1,800 mg
    19+ years 2,000 mg


    How Does It Work?

    Honey has traditionally been used to treat everything from infected wounds to constipation. Honey is made up of mainly sugars called fructose and glucose. Its sugar concentration is high enough to kill microorganisms. Evidence has shown that it may be effective in treating coughs caused by upper respiratory tract infection.

    What Is the Scientific Evidence?

    Researchers have found that honey may reduce coughing at night in children. A randomized trial consisted of 130 children aged 2-17 years with untreated rhinorrhea and cough for no more than seven days. The children were given either buckwheat honey, artificial honey-flavored dextromethorphan, or nothing. There were significant differences in symptom improvement among the different treatments. Honey consistently scored the best. Parents also favored honey in relieving their children's cough.

    How Do I Use It?

    Consider taking 1-5 tablespoons several times daily. However, infants younger than 12 months should not eat honey.

    Safety of Complementary Therapies

    Few of the substances discussed here are subject to regulation by the United States Food and Drug Administration (FDA). This lack of standardization means that actual dosages may differ from those given on the bottle or package. While widely used, few of these agents have been subjected to the kinds of official testing that the FDA requires for pharmaceuticals. If you take these substances be sure to inform your doctor. Some complementary therapies may influence the effectiveness or safety of medical prescriptions taken at the same time.


    National Center for Complementary and Alternative Medicine http://nccam.nih.gov/

    American Herbal Products Association http://www.ahpa.org/


    Barrett B. Viral upper respiratory infection. Integrative Medicine. 2nd ed. Philadelphia, PA: Saunders Elsevier; 2007.

    Bukutu C, Le C, Vohra S. Complementary , holistic, and integrative medicine: the common cold. Pediatr Rev. 2008 Dec;29(12):e66-71. Review. No abstract available.

    Colds and flus. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated March 29, 2011. Accessed April 15, 2011.

    DynaMed Editors. Upper respiratory infection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated March 3, 2011. Accessed May 3, 2011.

    Hemilä H, Chalker E, Douglas B. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD000980. DOI: 10.1002/14651858.CD000980.pub3.

    Honey. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated February 1, 2011. Accessed May 3, 2011.

    Linde K, Barrett B, Bauer R, Melchart D, Woelkart K. Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD000530. DOI: 10.1002/14651858.CD000530.pub2.

    Lizogub VG, Riley DS, Heger M. Efficacy of a Pelargonium sidoides preparation in patients with the common cold: a randomized, double blind, placebo-controlled clinical trial. Explore (NY). 2007 Nov-Dec;3(6):573-584.

    Paul IM, Beiler J, McMonagle A, et al. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007 Dec;161(12):1140-1146.

    Pelargonium sidoides. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated February 1, 2011. Accessed May 3, 2011.

    Poolsup N, Suthisisang C, Prathanturarug S, Asawamekin A, Chanchareon U. Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials. J Clin Pharm Ther. 2004 Feb;29(1):37-45.

    Saxena RC, Singh R, Kumar P, et al. A randomized double blind placebo controlled clinical evaluation of extract of Andrographis paniculata (KalmCold) in patients with uncomplicated upper respiratory tract infection. Phytomedicine. 2010 Mar;17(3-4):178-185.

    Singh M, Das RR. Zinc for the common cold. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD001364. DOI: 10.1002/14651858.CD001364.pub3.

    Timmer A, Günther J, Rücker G, et al. Pelargonium sidoides extract for acute respiratory tract infections. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006323. DOI: 10.1002/14651858.CD006323.pub2.

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