What is an effective cough suppressant (antitussive)?

From the Guidelines

For patients with chronic or acute bronchitis, peripheral cough suppressants, such as levodropropizine and moguisteine, are recommended for the short-term symptomatic relief of coughing. The level of evidence for this recommendation is good, with a substantial benefit and a grade of recommendation of A 1.

Key Points to Consider

• In patients with cough due to upper respiratory infection (URI) or chronic bronchitis, the only inhaled anticholinergic agent that is recommended for cough suppression is ipratropium bromide, with a level of evidence of fair, a substantial benefit, and a grade of recommendation of A 1.
• Central cough suppressants, such as codeine and dextromethorphan, are recommended for the short-term symptomatic relief of coughing in patients with chronic bronchitis, with a level of evidence of fair, an intermediate benefit, and a grade of recommendation of B 1.
• For patients with acute cough due to the common cold, preparations containing zinc and over-the-counter combination cold medications are not recommended, with a level of evidence of good and fair, respectively, and a grade of recommendation of D 1.

Important Considerations

• Coughing serves the important function of clearing airways, so suppressants should be used for short periods (3-7 days) and only when necessary.
• Honey (1-2 teaspoons) can be an effective natural alternative for those over one year old.
• For productive coughs with phlegm, an expectorant like guaifenesin (Mucinex) is more appropriate as it helps loosen mucus.
• If a cough persists beyond a week, is accompanied by fever over 101°F, produces discolored phlegm, or causes breathing difficulties, it is essential to consult a healthcare provider as these may indicate a more serious condition requiring different treatment.

From the FDA Drug Label

Purpose Cough suppressant Package/Label Principal Display Panel ... Cough Suppressant Uses temporarily relieves: cough due to minor throat and bronchial irritation

• Dextromethorphan is an effective cough suppressant (antitussive) 2, 2.
• Codeine is also used to temporarily relieve cough due to minor throat and bronchial irritation 3.
• Key words: cough suppressant, antitussive, dextromethorphan, codeine.

From the Research

Effective Cough Suppressants

• Dextromethorphan is considered an effective cough suppressant, as it has been shown to reduce cough frequency and intensity in patients with chronic cough 4, 5, 6.
• Codeine is also used as a cough suppressant, although it may have more side effects and be less effective than dextromethorphan in reducing cough intensity 4, 6.
• Other antitussive preparations, such as combinations of codeine or dextromethorphan with antihistamines, decongestants, and expectorants, may also provide symptomatic relief for dry or non-productive cough 7.

Comparison of Cough Suppressants

• A study comparing dextromethorphan and codeine found that both were similarly effective in reducing cough frequency, but dextromethorphan was more effective in reducing cough intensity 4.
• Another study found that dextromethorphan was effective in reducing cough symptoms in patients with chronic bronchitis, while codeine was no more effective than placebo in reducing cough symptoms in adults 5, 6.

Safety and Efficacy

• Dextromethorphan is considered a safe and effective cough suppressant, with a low risk of side effects and abuse 8.
• However, the efficacy of over-the-counter cough preparations, including antitussives, expectorants, and mucolytics, has not been well established, and more research is needed to determine their effectiveness 6.