What medications are used to treat dry cough in India?

Medications for Dry Cough Treatment in India

For dry cough in India, dextromethorphan is the first-line medication of choice due to its efficacy and better safety profile compared to codeine-based preparations. 1

First-Line Treatment Options

Non-Pharmacological Approaches

• Simple home remedies like honey and lemon are recommended as initial treatment for acute viral cough 2, 1
• Maintaining good hydration is important for managing cough 3

First-Line Medications

• Dextromethorphan-based preparations:

  • Dosage: 10-15 mg three to four times daily 1
  • Extended-release formulations available for 12-hour relief 4
  • Ranked as the first choice by 68% of Indian physicians 5
  • Non-sedating and has fewer side effects than codeine 2, 1

• Menthol inhalation:

  • Provides acute, short-lived cough suppression 2
  • Can be prescribed as menthol crystals or proprietary capsules
  • Recommended dosage: 2-5% menthol solution 1

Second-Line Treatment Options

Antihistamine Combinations

• First-generation antihistamines with sedative properties (like chlorpheniramine):
  • Particularly useful for nocturnal cough 2, 1
  • Often combined with dextromethorphan in fixed-dose combinations 6, 5
  • Note: Newer non-sedating antihistamines (like bilastine) are being studied for use in combination formulations with reduced drowsiness 7

Decongestant Combinations

• Fixed-dose combinations containing antihistamines, dextromethorphan, and decongestants (like phenylephrine):
  • Effective for cough associated with rhinitis or upper airway cough syndrome 3
  • Widely used in Indian clinical practice 5

Last-Resort Options

Codeine-Based Preparations

• Codeine (10-30 mg every 4-6 hours) 1, 8:
  • Often combined with antihistamines or expectorants like guaifenesin 8
  • Should be considered only when other treatments have failed 3
  • Has no greater efficacy than dextromethorphan but has more side effects 2
  • Still widely used in India but ranked second after dextromethorphan by physicians 5

Treatment Algorithm Based on Cough Duration

For Acute Dry Cough (< 3 weeks)

1. Start with home remedies (honey and lemon)
2. If insufficient relief: Add dextromethorphan-based preparation
3. For nocturnal symptoms: Consider adding a sedating antihistamine
4. For associated nasal symptoms: Consider fixed-dose combinations with decongestants

For Chronic Dry Cough (> 8 weeks)

1. Identify and treat underlying cause (essential before symptomatic treatment) 3
2. For symptomatic relief: Start with dextromethorphan
3. Consider codeine-based preparations only as a last resort when other treatments fail 3

Important Considerations

• Red flags requiring immediate attention: Hemoptysis, foreign body inhalation, increasing breathlessness, fever, purulent sputum, or biphasic cough pattern 1
• Avoid unnecessary antibiotics: Not indicated for acute viral cough or acute bronchitis 1
• Monitor for adequate expectoration: Despite cough suppression 1
• Special populations:
  • Elderly: Start at lower doses due to increased sensitivity 1
  • Pregnant women: Avoid codeine if possible, especially in third trimester 1
  • Children: Codeine is not recommended due to safety concerns 1, 9

The management of dry cough in India follows similar principles as global guidelines but with consideration of local availability and prescribing patterns, with dextromethorphan being the most commonly prescribed antitussive medication.