Guide To Over-The-Counter Cough Relief

Man Coughing
By: Christopher Petersen, University of Iowa College of Pharmacy, 2018 PharmD. Candidate

A cough is an important reflex for your body’s natural way to get mucus and other foreign material out of the lungs. Cough is the most common symptom for which people seek medical care and Americans spend more money annually on over-the-counter (OTC) cough and cold products than any other category of OTC products.

Selecting The Appropriate OTC Cough Medication:

With so many OTC cough medications; choosing the drug that is best for you depends on the nature and cause of the cough. There are typically two different kinds of coughs; one is described as wet because with this type of cough mucus is coughed up. Clear mucus is often indicative of bronchitis where colored mucus may suggest a bacterial infection. The other kind of a cough is described as dry or hacking. Dry coughs may be associated with viral infections, acid reflux, heart disease, and can be a potential side effect from other medications.

Wet Cough Recommendations: Guaifenesin

Brand: Mucinex, Robitussin Mucus + Chest Congestion

Guaifenesin is a protussive (expectorant) that works by changing the texture of the mucus in the lungs and it increases the amount of mucus removed by coughing.

Dry Cough Recommendations: Dextromethorphan

Brand: DayQuil Cough, Delysm 12 Hour Cough, Robitussin Long-Acting Cough Gels

Dextromethorphan is an antitussive (cough suppressant). These work to control or stop the cough by decreasing the likelihood of coughing. Stopping a wet cough may lead to a bacterial infection since the bacteria remains in the lungs.

Nonproductive Cough Recommendations: (First-Generation Antihistamines)

Brand: Benadryl (diphenhydramine), Chlor-Trimeton (chlorpheniramine)

Many people do not think to use antihistamines for cough relief. Antihistamines are relatively low cost medications that work by increasing the tolerance for not coughing. They are most often used for deceasing coughs associated with a runny nose or allergies. Mucus running down the back of the throat from the nose is often the cause the cough. The drying effects of antihistamines decrease the mucus in the nose and therefore it is less likely for one to cough.

Combination Products: Dextromethorphan and Guaifenesin

Brand: Robitussin Cough + Chest Congestion DM, Mucinex-DM, DayQuil Mucus Control

Recommendations for dextromethorphan and guaifenesin in combination are debated among medical professionals. Some say that using dextromethorphan will suppress the cough and therefore one will not cough up the mucus. This may get rid of the beneficial effects of guaifenesin. Others say that dextromethorphan will decrease the urge to cough and therefore reduce the amount of coughing; when one does cough the guaifenesin will work to increase the amount of mucus coughed up.

Multi-Symptom Combination Products:

Brand: (DayQuil/NyQuil, Robitussin Multi-Symptom Cold, Tylenol Cold + Flu, Mucinex Multi-Symptom Cold & Fever, Advil Cold & Flu, Alka-Seltzer Plus Flu)

 These products often contain similar active ingredients including an analgesic (pain medication), cough suppressant, nasal decongestant, and an antihistamine. These products have been marketed very well and may seem convenient. Combination products can potentially lead to drug interactions, side effects, and may worsen certain medical conditions. More active ingredients in a product means that you have more potential for side effects. It is recommended to select the product with only the ingredients that are necessary to treat your symptoms. Ask your pharmacist what product may be best for you if you are unsure of what the ingredients in a product.

Dosage Formulations: Liquid, Tablet, Capsule etc.

Cough products are available in a variety of dosage formulations and all have similar effects. It is generally recommended that you select the dosage formulation that is most convenient for you. Ask your pharmacist if the product you are looking for is available in the dosage form that you prefer.

What Else Can I Do?

Drinking water soothes the throat, loosen mucus, and helps prevent dehydration. Using cough drops may reduce coughing by relieving throat irritation. Humidifiers increase the moisture in the air, which may decrease airway irritation. Humidifiers work well for babies and young children (< 6 years of age) as cough medications have not been proven to be effective in this population. Mucus in the nose may be the cause of the cough in babies and a nasal bulb may be used to clear their mucus.

When To Seek Further Medical Attention:

  1. Cough that lasts longer than 7 days or keeps coming back
  2. Children < 4 years old
  3. Cough that produces colored mucus or blood
  4. Cough that may be a side effect of a certain class of medication (angiotensin converting enzyme inhibitors: lisinopril, enalapril, benazepril, captopril)
  5. Cough that is accompanied by a fever >102
  6. Cough associated with a chronic medical condition, such as COPD, asthma, heart failure, or chronic bronchitis
  7. Cough that worsens as a cold or flu resolves
  8. Cough associated with breathing in dust or particles
Tietze, K. J. (2015). Chapter 12: Cough. In Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 18th Edition. Washington, District of Columbia: American Pharmacists Association. doi:10.21019/9781582122250.ch12
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