What medications can be used to treat a cough?

Medications for Cough Treatment

For most cough cases, dextromethorphan is the recommended first-line medication for symptomatic relief of cough, while guaifenesin can be used for productive coughs to help loosen phlegm. 1, 2, 3

Medication Selection Based on Cough Type

Dry Cough (Non-Productive)

1. First-line options:

   • Dextromethorphan: 10-15 mg three to four times daily 1
     • Effectively suppresses acute cough in clinical studies
     • Maximum cough reflex suppression occurs at higher doses around 60 mg
     • Available as extended-release formulation for 12-hour relief 3
     • Non-sedating opiate derivative with fewer side effects than codeine

2. Second-line options (when dextromethorphan fails):

   • Benzonatate: 100-200 mg four times daily 1
   • Levodropropizine: 75 mg three times daily 1

3. Third-line options (for persistent cases):

   • Codeine: 30-60 mg every 4 hours 1
     • Can suppress cough counts by 40-60% in chronic bronchitis
     • Limited to 3-7 days of use due to dependency risk
     • Maximum daily dose should not exceed 120mg

Productive Cough (With Phlegm)

• Guaifenesin: Helps loosen phlegm and thin bronchial secretions 2
  • Makes coughs more productive by facilitating mucus clearance
  • Often combined with other medications for symptomatic relief

Special Populations Considerations

Children

• Honey: Modestly decreases frequency and severity of cough compared to dextromethorphan or no treatment in children 4
• Avoid codeine: Not recommended for children due to safety concerns 1
• Caution with dextromethorphan: Follow age-appropriate dosing guidelines

Elderly

• Use lower doses of codeine due to increased sensitivity to side effects 1
• Monitor for adverse effects more closely

Pregnant Women

• Avoid codeine, especially in the third trimester 1
• Consult healthcare provider before using any cough medication

Important Precautions and Contraindications

• Dextromethorphan contraindications: 3

  • Do not use with MAOIs or within 2 weeks of stopping MAOIs
  • Contains sodium metabisulfite which may cause allergic reactions
  • Not recommended for chronic cough associated with smoking, asthma, or emphysema

• Codeine precautions:

  • Limit use to 3-7 days due to dependency risk 1
  • Assess response after 2-4 days and discontinue if no improvement
  • Avoid in patients with respiratory depression

• General warnings:

  • Seek medical attention if cough lasts more than 7 days, returns, or occurs with fever, rash, or persistent headache 3
  • Red flags requiring immediate attention: hemoptysis, foreign body inhalation, increasing breathlessness, fever, purulent sputum, or biphasic cough pattern 1

Treatment Duration

• Most cough medications should be used for short-term symptomatic relief (3-7 days)
• Discontinue if no improvement after 2-4 days of therapy 1
• Persistent cough beyond 7 days requires medical evaluation for underlying causes

Non-Pharmacological Approaches

• Simple home remedies like honey and lemon are recommended as initial treatment for acute viral cough 1
• Avoid unnecessary antibiotics for acute viral cough or acute bronchitis 1

Remember that treating the underlying cause of cough is the most effective approach when possible, with symptomatic medications providing temporary relief while addressing the primary condition.