Are Max Strength Cold and Flu Pills Worth the Money? Experts Say Often Not

A packet of 16 Lemsip All-In-One Max Strength tablets sells for £7.30. In some supermarkets, a basic pack of paracetamol pills costs £0.35. That is a gap of more than 20 times, and both products contain the same 500mg of paracetamol, which does not treat the underlying infection but does relieve pain and can bring down a fever.

The question for anyone waking up with a sore throat, a pounding head and a blocked nose is whether the extra money buys anything. Prof Jayne Lawrence, head of the pharmacy division at the University of Manchester, says the big brands have been around a long time, have been tested and are advertised on television. In reality, she says, there is very little difference, and she would personally always choose the cheaper option, which has also been tested.

Cold and flu medicines fall into three broad groups: household names such as Lemsip and Sudafed, supermarket own-label versions, and single-ingredient products containing paracetamol or ibuprofen. The Lemsip product, like many competitors, also contains the decongestant phenylephrine, which is meant to constrict leaky or swollen blood vessels in the nose. Lawrence says there is little evidence it works as a tablet, because much of the drug is broken down before reaching the bloodstream. It is more likely to work as a nasal spray. In 2024, the US drug regulator said it wanted phenylephrine removed from all cold and flu pills as ineffective, although that proposal has not been finalised.

Some remedies add a third ingredient, guaifenesin, intended to loosen mucus in the airways. The evidence there is murkier: some studies report improved chest congestion, while others find little or no benefit. A spokeswoman for Reckitt, which owns Lemsip and Nurofen, said its ingredients are approved by regulators and formulated to address multiple symptoms, including fever, congestion and coughs.

Many max strength products also contain up to 65mg of caffeine per pill, about what is in a mug of instant coffee. Research suggests caffeine may help paracetamol work slightly sooner, though any benefit is likely modest. Most brands also come as flavoured powders dissolved in hot water, usually costing a little more per dose. A drug company-funded study found the warm drink may be absorbed more quickly, but it is much less certain that patients notice a meaningful difference in symptoms.

Shelf placement and habit play a part too. A former manager at a large chemist chain, who asked not to be named because she still works in the industry, says bigger brands have more money for in-store adverts and displays. Well-known names or premium own-label products tend to sit at eye level, with budget options on the bottom shelves. You always promote the more expensive ones, she says. Nine times out of ten, customers asked for a specific brand, and even when she explained there was little difference and she was trying to save them money, they still wanted the big name.

The PAGB, the trade association for the consumer healthcare sector, argues that trusted, recognisable brands simplify choice and build confidence at a time when health misinformation is widespread.

Doctors' advice is plain: rest, drink plenty of fluids, and use painkillers such as paracetamol to control temperature swings. Do not take paracetamol alongside a cold and flu remedy that also contains it, since that can easily cause an accidental overdose. Dr Jamie Hynes, vice president of the Royal College of GPs, notes the NHS recommends gargling salt water for a sore throat, and a homemade hot lemon and honey drink can soothe a cough. He advises seeing a GP if a cough lasts more than 21 days or if weight loss is unintentional, and seeking urgent help for chest pain or breathing difficulties. Some cold medicines are unsuitable in pregnancy, so check with a midwife, pharmacist or GP first. Watch for whether the US decision on phenylephrine is finalised.