Medications for Sore Throat and Cough
For sore throat and cough, ibuprofen or paracetamol are recommended as first-line treatments for symptom relief, with dextromethorphan being the preferred pharmacological option for cough suppression. 1, 2
Sore Throat Treatment
First-Line Analgesics
- Ibuprofen or paracetamol are strongly recommended for relief of acute sore throat symptoms 1
- Ibuprofen shows a slightly better efficacy profile than paracetamol for pain relief 1
- Both medications have comparable safety profiles when used according to usual contraindications for short-term treatment 1
- Ibuprofen (up to 1.2g daily) is as well tolerated as paracetamol and better tolerated than aspirin for sore throat pain 3
Administration Tips
- Many patients don't use analgesics effectively before consulting healthcare providers 4
- For optimal effect, analgesics should be taken regularly at appropriate doses rather than as needed 1
- Proper patient education about effective analgesic use can improve satisfaction and reduce unnecessary antibiotic prescriptions 4
Second-Line Options
- Corticosteroids may be considered in conjunction with antibiotic therapy for adults with severe presentations (3-4 Centor criteria), but are not routinely recommended 1
- Local anesthetics such as lidocaine, benzocaine, or ambroxol can be recommended for direct symptom relief 5
Not Recommended
- Zinc gluconate is not recommended due to conflicting results and increased adverse effects 1
- Alternative treatments like herbal remedies and acupuncture have inconsistent evidence supporting their use 1
Cough Treatment
First-Line Approach
- Simple home remedies like honey and lemon are recommended as initial treatment for dry cough 2
- Voluntary cough suppression may be sufficient to reduce cough frequency 2
Pharmacological Options
- Dextromethorphan is the preferred pharmacological option for cough suppression 2, 6
- Dextromethorphan works by centrally modulating the cough reflex with maximum suppression at 60 mg 6
- Available as extended-release formulations providing up to 12 hours of relief 7
- Use with caution as some preparations contain additional ingredients 2
Alternative Cough Suppressants
- Menthol can suppress cough reflex when inhaled, though effects are acute and short-lived 2, 6
- First-generation antihistamines with sedative properties are particularly useful for nocturnal cough 2, 6
Not Recommended for Cough
- Codeine and pholcodine have no greater efficacy than dextromethorphan but have worse side effect profiles 2, 6
Important Considerations
Safety Precautions
- Monitor for adverse effects including gastrointestinal events, dizziness, dry mouth, and somnolence 8
- Some dextromethorphan preparations contain sodium metabisulfite, which may cause allergic reactions in sensitive individuals 7
Warning Signs Requiring Further Evaluation
- Cough with increasing breathlessness (possible asthma or anaphylaxis) 2
- Cough with fever, malaise, or purulent sputum (possible serious lung infection) 2
- Significant hemoptysis or possible foreign body inhalation requires specialist referral 2
Common Pitfalls
- Assuming patients have already tried appropriate doses of analgesics before consultation 4
- Using codeine-containing products which offer no advantage over safer alternatives 6
- Prescribing antibiotics for viral sore throats instead of focusing on symptomatic relief 5
- Inadequate dosing of analgesics leading to perception of ineffectiveness 4