From the Guidelines
For an acute cough, the most effective treatment is honey, which can offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo, as suggested by the most recent study 1. The recommended dosage of honey is 1-2 teaspoons, and it is effective for adults and children over one year old. Other options for acute cough treatment include:
- Over-the-counter medications like dextromethorphan (15-30 mg every 4-8 hours) to suppress cough, as recommended by 1
- Guaifenesin (200-400 mg every 4 hours) to help thin mucus
- Antihistamines like diphenhydramine (25-50 mg every 4-6 hours) or decongestants such as pseudoephedrine (30-60 mg every 4-6 hours) for coughs with nasal congestion
- Using a humidifier and avoiding irritants like smoke to provide relief It's essential to note that most acute coughs resolve within 1-3 weeks without specific treatment, but if the cough is accompanied by high fever, difficulty breathing, chest pain, or persists beyond three weeks, medical attention should be sought as antibiotics or other treatments may be needed for bacterial infections, as suggested by 1, 1, and 1. Key points to consider when treating an acute cough include:
- Avoiding unnecessary medications and focusing on symptom management
- Using honey as a first-line treatment due to its effectiveness and safety profile
- Considering the use of dextromethorphan or other cough suppressants for short-term relief, but being aware of their potential side effects and limitations, as discussed in 1 and 1.
From the FDA Drug Label
Uses temporarily relieves: cough due to minor throat and bronchial irritation as may occur with a cold or inhaled irritants Purpose Cough suppressant USES Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive.
The recommended evidence-based cough suppressants are:
- Codeine (PO): for temporary relief of cough due to minor throat and bronchial irritation 2
- Dextromethorphan (PO): as a cough suppressant 3 For a more productive cough, guaifenesin (PO) can be used to loosen phlegm and thin bronchial secretions 4.
From the Research
Cough Suppressants
- Centrally acting opioids such as morphine, codeine, and dextromethorphan are currently available cough suppressants 5
- Peripherally acting antitussives include moguisteine and levodropropizine 5
- Dextromethorphan has been shown to be effective in reducing cough frequency and intensity in patients with chronic cough 6, 7
Efficacy of Cough Suppressants
- Dextromethorphan was found to be more effective than codeine in reducing cough intensity in patients with chronic cough 6
- A study in children aged 6-11 years with acute cough due to the common cold found that dextromethorphan reduced total coughs over 24 hours and cough frequency during daytime 7
- Guaifenesin/dextromethorphan treatment improved lung function and quality of life in a patient with chronic obstructive pulmonary disease (COPD) 8
Treatment Options
- Slow-release morphine has been reported to be useful in controlling intractable cough with good tolerance to constipation and drowsiness 5
- Centrally acting drugs such as amitryptiline, paroxetine, gabapentin, and carbamezepine have been reported to be successful in treating chronic cough 5
- New opioids such as nociceptin or antagonists of TRPV1 may be more effective in treating cough 5