What treatment options are available for a dry cough?

Treatment Options for Dry Cough

For a dry, bothersome cough, dextromethorphan is the recommended first-line treatment due to its proven efficacy and favorable safety profile compared to other options. 1, 2

First-Line Treatment Options

Dextromethorphan

• Dosage: 30 mg every 6-8 hours, not exceeding 120 mg in 24 hours 2
• Mechanism: Acts centrally to suppress the cough reflex 2
• Best for: Dry, non-productive cough, especially when sleep is disturbed 1
• Duration: Short-term use (3-7 days) for acute cough 2
• Available as: Over-the-counter oral suspension or tablets 3

Codeine

• Can be prescribed for dry, bothersome cough 1
• However, not recommended due to significant adverse side effects and no greater efficacy than dextromethorphan 2
• Risk of dependence with prolonged use 4

When to Avoid Cough Suppressants

• Productive cough with sputum (cough helps clear mucus) 1
• Bacterial infections (yellow/green sputum) 5
• Cough in conditions where clearance is important (pneumonia, bronchiectasis) 1

Home Remedies

• Honey: Effective simple remedy, can be combined with lemon for palatability 2
• Menthol lozenges or vapor: May provide symptomatic relief 1

Treatments NOT Recommended

• Expectorants, mucolytics, antihistamines, and bronchodilators: Should not be prescribed for acute lower respiratory tract infections (Grade A1 recommendation) 1
• Zinc preparations and OTC combination cold medications: Not recommended (Grade D recommendation) 2

Special Considerations

• For elderly patients: Seek medical evaluation if cough persists beyond 1-2 weeks 2
• For patients with chronic conditions (COPD, heart disease, diabetes, asthma): Consider adjusting dosage of chronic medications temporarily 1

When to Seek Medical Attention

• Cough persisting beyond 3 weeks 1, 2
• Coughing up blood 1
• Breathlessness 1
• Prolonged fever 1
• Recent hospitalization 1

Treatment Algorithm for Dry Cough

1. Initial assessment: Confirm dry, non-productive nature of cough
2. First-line therapy: Dextromethorphan 30 mg every 6-8 hours (max 120 mg/day)
3. If ineffective after 3-7 days: Reassess for underlying causes
4. For persistent cough (>3 weeks): Medical evaluation required to rule out other conditions

For Refractory Cases

• In chronic idiopathic cough: Low-dose morphine has shown benefit 1
• Neuromodulators (gabapentin, pregabalin) with speech therapy may be considered for persistent cases 2, 4
• Nebulized local anesthetics (lidocaine, mepivicaine) have weak evidence of benefit 1

Remember that most acute coughs are self-limiting and will resolve within 1-3 weeks. Symptomatic treatment should be reserved for cases where the cough significantly impacts quality of life, particularly sleep.