What medications can be given for a cough?

From the Guidelines

For a cough, the most effective treatment option is to use dextromethorphan (found in Robitussin DM, Delsym) for suppressing coughs at 10-30mg every 4-8 hours for adults, as recommended by the American College of Chest Physicians 1.

Treatment Options

• Over-the-counter options include dextromethorphan for suppressing coughs and guaifenesin (Mucinex) as an expectorant at 200-400mg every 4 hours to thin mucus.
• Combination products like Robitussin DM contain both ingredients.
• For nighttime relief, antihistamines such as diphenhydramine (Benadryl) at 25-50mg can help, especially for allergy-related coughs.
• Honey (1 teaspoon) is effective for children over one year old.
• For persistent coughs, prescription options include benzonatate (Tessalon Perles) at 100-200mg three times daily, or codeine-containing products for severe cases.

Important Considerations

• Most coughs from viral infections resolve within 1-2 weeks with these treatments.
• It's essential to stay hydrated, use a humidifier, and see a doctor if the cough persists beyond three weeks, produces blood or thick green/yellow mucus, or is accompanied by high fever, as these may indicate a more serious condition requiring different treatment.
• The choice of treatment may be dictated primarily by availability rather than pharmacologic parameters, as noted in the study by Molassiotis et al 1.

Additional Recommendations

• Opioids, such as hydrocodone, dihydrocodeine, and morphine, may be effective for cough suppression in patients with lung cancer, as suggested by the study by Moroni et al 1.
• Levodropropizine, a peripherally acting antitussive, may also be effective for cough suppression, but its availability may be limited in some countries.
• Benzonatate, a peripherally acting antitussive, may be effective for cough suppression in patients with malignant pulmonary involvement, as noted in the study by Molassiotis et al 1.

From the FDA Drug Label

Uses temporarily relieves • cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants • the impulse to cough to help you get to sleep For a cough, dextromethorphan (PO) can be given to temporarily relieve cough due to minor throat and bronchial irritation, such as those that occur with the common cold or inhaled irritants 2.

• It is used to relieve the impulse to cough, helping the patient get to sleep.
• However, it is essential to follow the instructions and precautions outlined in the drug label, including consulting a doctor before use if the patient has a chronic cough or cough with excessive phlegm, and stopping use if side effects occur or if the cough persists for more than 7 days 2.

From the Research

Medications for Cough

• For adults, dextromethorphan may modestly decrease cough symptoms compared to placebo 3
• For children, honey may modestly decrease frequency and severity of cough compared to dextromethorphan or no treatment 3, 4
• Antitussives, such as codeine, may not be more effective than placebo in reducing cough symptoms in adults 5
• Expectorants, such as guaifenesin, may have variable results in reducing cough symptoms in adults 5, 4, 6
• Mucolytics may reduce cough frequency and symptom scores in adults and children 5, 4, 6
• Antihistamine-decongestant combinations may have conflicting results in reducing cough symptoms in adults and children 5, 4, 6
• Antihistamines may not be more effective than placebo in relieving cough symptoms in adults and children 5, 4, 6

Considerations for Medication Use

• Patients with pre-existing medical conditions, such as high blood pressure or asthma, should consult their pharmacist or doctor before taking any medication 7
• Patients should be aware of the possibility of overdosage, especially when taking multiple remedies simultaneously 7
• Green or yellow sputum may indicate a bacterial infection, and consulting a doctor is advisable 7
• Productive coughs may be helped by expectorants, while dry coughs may be helped by suppressants 7
• Cough preparations often contain antihistamine, which may cause drowsiness 7
• Paediatric formulations are advisable for young children, and sugar-free preparations should be used to avoid the risk of tooth decay 7