From the Guidelines
For a cough, the most effective medication depends on the type of cough, and according to the most recent and highest quality study 1, over-the-counter cough medications should not be prescribed until they have been shown to make cough less severe or resolve sooner. When considering the management of cough, it's essential to differentiate between acute and chronic cough, as well as the underlying cause, such as upper respiratory infection (URI), chronic bronchitis, or other conditions.
- For dry, non-productive coughs, peripheral cough suppressants like levodropropizine and moguisteine are recommended for short-term symptomatic relief 1.
- For wet, productive coughs, agents that increase cough clearance, such as hypertonic saline solution and erdosteine, are recommended on a short-term basis 1.
- If allergies are causing the cough, antihistamines may be helpful, but their use should be balanced with potential adverse events, especially in children 1.
- For nighttime cough relief, combination products containing both a cough suppressant and an antihistamine can be effective, but their use should be limited to no more than 7 days. It's crucial to note that if the cough persists beyond a week, is severe, or is accompanied by fever, shortness of breath, or bloody mucus, a doctor should be consulted, as prescription medications like codeine-based cough suppressants or antibiotics might be needed for underlying conditions 1. In children, the use of over-the-counter cough and cold medicines should be avoided until they have been shown to be effective and safe 1, and honey may offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo, but it is not better than dextromethorphan 1. Ultimately, the management of cough should be individualized, taking into account the underlying cause, patient age, and potential adverse events, with the goal of improving morbidity, mortality, and quality of life.
From the FDA Drug Label
Drug Facts Active Ingredients Purpose (in each teaspoonful (5 mL)) Codeine Phosphate USP 10 mg ................... Antitussive Package/Label Principal Display Panel Compare to Delsym® active ingredient Dextromethorphan Polistirex Extended-Release Oral Suspension Cough Suppressant The medications for cough are:
From the Research
Medications for Cough
- Antitussive preparations, which are available as combinations of codeine or dextromethorphan with antihistamines, decongestants, and expectorants, are used for effective symptomatic relief of dry or non-productive cough 4.
- First-generation antihistamines like chlorpheniramine and centrally acting opioid derivatives like codeine are often used alone or in combination in the management of nonspecific cough 4.
- Dextromethorphan and codeine have been compared in a double-blind, crossover trial, and both preparations were similarly effective in reducing cough frequency, although dextromethorphan lowered cough intensity to a greater degree than codeine 5.
Treatment of Cough in Children
- The use of codeine- and dextromethorphan-containing cough remedies in children has been addressed by the American Academy of Pediatrics, which emphasizes the need for education about the lack of proven antitussive effects and the potential risks of these products 6.
- For children, established safe and effective treatments for cold symptoms, including cough, are acetylcysteine, honey (for children one year and older), nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils 7.
Treatment of the Common Cold
- Informing patients about the self-limited nature of the common cold can help manage expectations, limit antibiotic use, and avoid over-the-counter purchases that may not help 7.
- Treatments with proven effectiveness for cold symptoms in adults include over-the-counter analgesics, zinc, nasal decongestants with or without antihistamines, and ipratropium for cough 7.