The cold season inevitably brings colds and bouts of flu. The Romanian pharmacy market offers dozens of OTC products for acute symptoms, but most are combinations of the same 4-5 active substances. Here is the 2026 comparative guide to choosing correctly.
First, the difference between a cold and flu
Both are caused by viruses, but they develop differently:
- A cold — runny nose, sneezing, mild sore throat, dry cough. No high fever (under 38°C). Lasts 5-7 days.
- Flu — sudden onset, high fever (39-40°C), intense muscle pain, exhaustion, cough. Lasts 7-14 days, with a risk of complications.
Antibiotics treat NEITHER a cold NOR flu — viruses are immune to them. An antibiotic is given only if a bacterial superinfection develops, diagnosed by a doctor.
1. Antipyretics and painkillers — the basis of treatment
Paracetamol (INN)
The safest choice for fever and mild-to-moderate pain. It does not irritate the stomach, does not interfere with anticoagulants, and is accepted in pregnancy.
- Adult dosage: 500-1000 mg per dose, maximum 4 g/day, minimum interval of 4-6 hours.
- Brands: Paracetamol Zentiva/Terapia (generic — the cheapest), Panadol (GSK brand), Paracetamol Sinus (combined with a decongestant).
- Caution: high doses can be toxic to the liver. Do not combine with heavy drinking.
Ibuprofen (INN)
A non-steroidal anti-inflammatory drug (NSAID). Stronger than paracetamol for inflammatory pain, but harsher on the stomach and kidneys.
- Adult dosage: 200-400 mg per dose, maximum 1200 mg/day without a prescription.
- Brands: Nurofen (brand), Ibuprofen Terapia (generic), Nurofen Forte, MIG 400.
- Contraindicated: stomach ulcer, kidney failure, the last trimester of pregnancy.
Paracetamol vs ibuprofen — when do I choose which?
- High fever (39°C+): paracetamol + ibuprofen alternating every 3 hours (a protocol accepted in medical practice).
- Muscle or joint pain: ibuprofen (anti-inflammatory effect).
- Sensitive stomach, pregnancy, young children: paracetamol.
- Both are available for children as a syrup, at a dosage adjusted to body weight.
2. Antivirals — Tamiflu and other options
Oseltamivir (Tamiflu)
It is prescription-only (Rx), NOT OTC. We include it because many people ask for it at the pharmacy for flu symptoms. Its effectiveness is proven only if you start within the first 48 hours after symptoms begin.
- It shortens flu by 1-2 days and lowers the risk of complications.
- You need a medical consultation — see a doctor quickly if you have severe flu symptoms and risk factors (diabetes, COPD, a weakened immune system, older age).
Zanamivir (Relenza)
Also prescription-only, inhaled, an alternative for patients who do not tolerate oseltamivir.
OTC remedies with antiviral claims
Products such as Oscillococcinum, Kaloba and Umckaloabo have limited clinical evidence. Some patients report improvement, but independent studies are inconsistent. Vitamin C and zinc have modest evidence for shortening a cold by about 1 day, if you start at the first symptoms.
3. Cough syrups
Dry cough (cough suppressant)
- Dextromethorphan (Tussin Forte) — suppresses the cough reflex.
- Butamirate (Sinecod) — a centrally acting cough suppressant, without opioid effects.
- Codeine — effective, but it REQUIRES a prescription.
Productive cough (expectorant/mucolytic)
- Acetylcysteine (ACC, Fluimucil) — thins the mucus and makes it easier to cough up.
- Ambroxol (Mucosolvan) — similar, slightly gentler.
- Guaifenesin — the classic expectorant.
The golden rule: do not combine a cough suppressant with an expectorant. You suppress the cough but stimulate secretion — the mucus builds up. Choose according to the type of cough: dry → cough suppressant, productive → expectorant.
4. Nasal decongestants
Topical (sprays)
- Xylometazoline (Olynth, Otrivin) — fast effect, lasts 10-12 hours.
- Oxymetazoline (Nasivin) — similar.
- Do not use for more than 5-7 days — risk of medication-induced rhinitis (rebound effect).
Systemic (tablets)
- Pseudoephedrine (Sudafed, combined in Paracetamol Sinus) — raises blood pressure; caution in people with hypertension.
- Phenylephrine — gentler but also less effective.
Saline solutions
The safe alternative, with no contraindications — a saline or seawater spray (Aqua Maris, Humer). Ideal for children, pregnant women and prolonged use.
5. Combination products — convenient or a waste?
Products such as Coldrex, Theraflu, Teraplus and Paraxin contain 3-4 active substances (paracetamol + pseudoephedrine + vitamin C + sometimes a cough suppressant). Advantage: a single tablet or sachet. Disadvantages:
- You pay extra compared with the separate ingredients.
- You get ingredients you may not want (a decongestant when your nose is not blocked).
- Risk of overdose if you also take paracetamol separately.
An economical strategy: buy generic paracetamol, generic ibuprofen and a saline spray. In total under 30 RON, covering most symptoms.
When to see a doctor (not the pharmacy)
- A fever above 39°C that lasts more than 3 days.
- Severe chest pain, dyspnoea (difficulty breathing).
- Sinusitis with intense facial pain.
- A cough lasting more than 2 weeks or with yellow-green sputum.
- Symptoms in young children, older people or people with a weakened immune system.
- A sudden worsening after 4-5 days (suspected bacterial superinfection).
Conclusion
For a typical cold, your OTC box should contain: paracetamol (or ibuprofen), a syrup (a cough suppressant OR an expectorant, depending on the cough), a saline nasal spray and possibly vitamin C + zinc. In total under 50 RON, bought after comparing on HartaFarmacii.
If you are unsure about the diagnosis, see a doctor — it is the only safe way to identify flu, bacterial pneumonia or other complications.
Frequently asked questions
- Can paracetamol and ibuprofen be taken together?
- Yes, alternating, 3 hours apart. It is a common medical protocol for high fever in adults and children (under supervision). You do not take them at the same time but alternate them — up to the maximum daily dose of each.
- Do antibiotics treat a cold or flu?
- No. Colds and flu are viral, and antibiotics act only on bacteria. An antibiotic is prescribed only if a bacterial superinfection develops (pneumonia, severe sinusitis), diagnosed by a doctor.
- How long does Tamiflu take to work?
- Oseltamivir (Tamiflu) shortens flu by 1-2 days ONLY if you start within the first 48 hours after symptoms begin. It is prescription-only, not OTC — you need a medical consultation for the prescription.
- Are combination products such as Coldrex worth buying?
- It depends. They are convenient if all your symptoms are covered (fever + blocked nose + cough). But you pay 30-40% more than for the separate ingredients and get substances you may not want. A better strategy: buy the individual components and combine them as needed.
- Can nasal sprays cause dependence?
- In the long term — yes, if you use a xylometazoline or oxymetazoline spray for more than 5-7 days. Medication-induced rhinitis (rebound effect) develops — the nose stays blocked without the spray. A safe alternative: saline solution (Aqua Maris, Humer), which you can use as much as you like.