We researched dozens of cold sore medicines and evaluated them for ingredients, price, application, and safety. We also consulted with experts, including Dr. Shainhouse.
What to Look for in a Cold Sore Medicine
Ingredients
Cold sore medications, both prescription and OTC, rely on a variety of different active ingredients to offer relief and healing, per Dr. Shainhouse. There are drying agents (Domeboro solution, calamine lotion, zinc oxide, witch hazel), which when dabbed on the sore help dry up the blister and its fluid. Topical steroids or anti-inflammatory cream, like hydrocortisone, can be applied a few times a day to reduce the pain, itch, redness, and inflammation. They provide comfort and can be used with anti-virals. Prescription topical anti-viral creams can reduce the severity and duration of a cold sore. The most effective are penciclovir and acyclovir and should be started ASAP at the first signs of a prodrome, per Dr. Shainhouse.
Another option is topical anesthetics, like prescription lidocaine or OTC benzocaine, which are available as mouthwashes, creams, and ointments. They can be applied to the sore up to three times a day as needed for local pain relief. Dr. Shainhouse recommends applying them before eating, especially if the sore is making it too painful to eat.
Form
Cold sore relief comes in many different forms. There are oral medications and topical options as well as devices and patches that block the virus causing the cold sores and treat symptoms.
Topical over-the-counter cream, such as Abreva, has not shown significant efficacy in medical studies, per Dr. Shainhouse. “One study suggests that it may reduce the total time of the cold sore episode by 18 hours.”
“Certain medications, such as Abreva, may also help cold sores heal faster if used as soon as you feel a cold sore developing. Abreva works by helping to prevent the herpes virus from spreading to healthy skin cells,” adds Jin Lin, DMD, pediatric dentist with Hurst Pediatric Dentistry.
Topical barrier gels and ointments help lessen discomfort while the sore heals. “They act as a barrier from outside irritants (food, drinks, talking) and may keep out bacteria, which can cause a secondary infection in the viral sore. Try Vaseline, Aquaphor, Chapstick (don’t double-dip or keep the stick/jar for cold sores only!). Topical hydropropyl cellulose adheres to the lesion to keep out irritants (Zilactin and Ziladent are both over the counter), per Dr. Shainhouse.
Here are the best cold sore treatments on the market.
“Cold sores are blisters, caused by the herpes virus, that often form around the lips, although they can also form on the gums or the roof of the mouth. Once the blister pops, a scab forms,” explains Jin Lin, DMD, pediatric dentist with Hurst Pediatric Dentistry.
“Canker sores, in contrast, are small ulcers that appear inside your mouth, often on the inside of your cheeks or lips,” he continues. “They typically have a white, yellow, or grayish center and a red border. The exact cause of canker sores is unknown, but common triggers include stress and trauma to soft tissues in the oral cavity—for example if you bite the inside of your cheek.”
Most medications aimed at treating cold sores are antivirals in order to stop the herpes virus from replicating. This means they won’t work on canker sores, where there is no virus.
In addition, says Chris Airey, MD, Medical Director at Optimale, “most cold sore medicine you can buy without a prescription is not meant to be ingested and is intended for topical use.” So you can’t apply them inside your mouth. One notable exception is Zilactin, which is safe for inside your mouth. Its active ingredient is benzyl alcohol, which helps numb the pain of canker sores and cold sores, though it doesn’t treat cold sores in the same way as Abreva.
However, “Abreva and Zovirax and Valtrex (two prescription cold sore options) are considered safe for pregnant patients,” says Todd Minars, MD, dermatologist with Minars Dermatology. “The FDA hasn’t specifically evaluated the products for use on pregnant patients [but] research has been done to suggest they’re more than likely safe.”
In addition, he adds “once a parent passes their 36th week of pregnancy these antivirals carry less concern for the developing baby.”
That said, according to Airey, “sometimes if medication is taken at the first signs of a cold sore, you can prevent a breakout entirely.”
Plus, while the healing does take time, some topical treatments can reduce your pain within just a few minutes, making you feel better even if the cold sore hasn’t gone away.
Price at time of publish: $16
Because it’s safe inside the mouth, it helps treat canker sores, fever blisters, and gum irritations in addition to cold sores. It makes all activities more comfortable as the cold sore totally heals.
Price at time of publish: $19
Price at time of publish: $19
While it’s a little pricier than some of its competitors, the Virulite Invisible Light Electronic Cold Sore Treatment Device is a great investment for anyone with regular cold sores who is tired of replacing their topical cream treatment every few months.
Price at time of publish: $129
Price at time of publish: $12
It is a dietary supplement so speak with your doctor before adding it to your regimen.
Price at time of publish: $35
We considered each medicine based on their dosages, usage, and active ingredients to find products to treat all forms of cold sores and multiple application modes. Finally, we looked at prices for each product; many of the products on our list are inexpensive, over-the-counter solutions.
Why Trust Verywell Health
As a seasoned health writer, Jennifer Nied understands how vital quality product recommendations are for treating symptoms safely and effectively at home. For over 10 years, she has reviewed products, interviewed experts, scrutinized ingredients, and pored over research studies and claims, to help readers like you understand what works for your specific conditions. Every product in this piece was selected taking into account recommendations from doctors, published research, and real customer reviews.
Additional reporting to this story by Simone Scully
Simone Scully is a New York-based writer and editor with years of experience writing about health, wellness, science, and lifestyle. Her byline has appeared at Healthline, Well+Good, Narratively, Romper, Motherifigure’s magazine, Nautilus, Narratively, AskMen, among other places.
