The Cough Medicine Aisle: A Pharmacist's Decision Guide

Dry cough vs wet cough

A dry cough is irritating, hacking, and produces little or no mucus. Common with viral upper respiratory infections, allergies, postnasal drip, asthma, and some medications. A wet or productive cough produces mucus or phlegm. Common later in colds, with bronchitis, and with some lung conditions.

The treatment approach differs. Dry coughs benefit from suppression. Wet coughs benefit from thinning the mucus and helping you clear it.

Dextromethorphan (DM)

The standard OTC cough suppressant. Modestly effective in studies, more useful for some patients than others. Works centrally to reduce the urge to cough. Found in Delsym, Robitussin DM, Mucinex DM, and many combination products.

Side effects include drowsiness, dizziness, and at high doses confusion. Interacts significantly with several antidepressants including MAO inhibitors. Should not be combined with SSRIs at high doses due to serotonin risk.

Guaifenesin

An expectorant that thins mucus and makes it easier to cough up. Found in Mucinex, Robitussin chest congestion, and many combination products. Most effective when you drink plenty of water alongside it.

Modest evidence, but generally safe and reasonable for productive coughs with thick mucus.

Honey

One of the better evidenced cough remedies, particularly for nighttime cough. Studies in children over age 1 have shown 1 to 2 teaspoons of honey at bedtime reduces nighttime cough and improves sleep. Adults benefit similarly.

Do not give honey to infants under 12 months because of botulism risk.

Throat lozenges

Help soothe the throat irritation that drives some coughs. Menthol and pectin lozenges are reasonable. Benzocaine lozenges provide more numbing but should not be used in children under 2.

What to avoid

• Combination cold and cough products often contain ingredients you do not need. Build your own kit instead.
• Cough medicines in children under 6 are generally not recommended due to limited efficacy and side effects.
• Codeine containing cough medicines have limited additional benefit over OTC options for most patients and carry sedation and dependency risk.

When a cough warrants a clinician visit

• Cough lasting more than 3 weeks.
• Cough with blood.
• Cough with high fever.
• Cough with significant shortness of breath or chest pain.
• Cough with unexplained weight loss.
• Cough in a smoker that has changed in character.

When to talk to a pharmacist

• You take antidepressants and are considering DM.
• You take blood pressure medications.
• You are pregnant or breastfeeding.
• You have asthma or COPD.
• Your cough has been going on for several weeks.
• You are buying cough medicine for a child.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.