Recommended Syrups for Dry Cough
For dry cough, dextromethorphan-containing syrups are the most effective and recommended first-line treatment, with menthol-based preparations as an alternative option. 1
First-Line Options
Dextromethorphan-Based Syrups
Most effective evidence-based option for dry cough suppression 1
Dosing recommendations 2:
- Adults and children ≥12 years: 10 mL every 12 hours (not exceeding 20 mL in 24 hours)
- Children 6-12 years: 5 mL every 12 hours (not exceeding 10 mL in 24 hours)
- Children 4-6 years: 2.5 mL every 12 hours (not exceeding 5 mL in 24 hours)
- Not recommended for children under 4 years
Maximum cough reflex suppression occurs at 60 mg with prolonged effect 1
Available as extended-release formulations for 12-hour relief 2
Non-sedating opiate with better safety profile than codeine/pholcodine 1
Alternative Options
Menthol-Based Preparations
- Provides acute but short-lived cough suppression 1, 3
- Can be used as lozenges, syrups, or inhaled as vapors 1
- Minimal systemic absorption with typical lozenge formulations 3
- Limit consumption to recommended dosage (typically 8-12 lozenges per day) 3
Glycerol-Based Syrups
- Effective for soothing properties through lubrication and demulcency 4
- Often combined with honey and lemon for enhanced effect 1
- Safe option with minimal side effects 4
Honey-Based Remedies
- Simple and effective home remedy, especially for children 1, 5
- Evidence suggests honey is better than "no treatment" for reducing cough frequency 5
- Can be combined with lemon for enhanced palatability 1
Options to Avoid
Codeine or Pholcodine
- Not recommended due to significant adverse side effect profile 1
- No greater efficacy than dextromethorphan 1
Sedative Antihistamines
- May be suitable specifically for nocturnal cough but cause drowsiness 1
- Consider only when cough disrupts sleep 6
Special Considerations
- For patients with lung cancer experiencing cough, glycerol-based cough syrups have shown effectiveness 1
- Sugar-free preparations should be used for children to avoid tooth decay 7
- Green or yellow sputum suggests bacterial infection; medical consultation advised 7
- Persistent cough beyond 3 weeks requires medical evaluation 1
Warning Signs Requiring Medical Attention
- Coughing up blood
- Breathlessness
- Prolonged fever
- Underlying medical conditions (COPD, heart disease, diabetes, asthma)
- Recent hospitalization
- Symptoms persisting beyond three weeks 1
When selecting a cough syrup, consider the patient's age, underlying conditions, and concurrent medications to minimize risk of adverse effects or drug interactions.