What is the recommended cough syrup for a dry cough?

Recommended Cough Syrup for Dry Cough

Dextromethorphan is the recommended first-line antitussive agent for dry cough due to its superior safety profile compared to opioid alternatives, with optimal dosing at 60 mg for maximum cough reflex suppression. 1

First-Line Treatment Options

• Dextromethorphan is the most effective non-opioid antitussive with a better safety profile than codeine or pholcodine 2, 1
• Standard over-the-counter dosing of dextromethorphan is often subtherapeutic; maximum cough reflex suppression occurs at 60 mg and provides prolonged relief 2, 1
• Extended-release formulations (like Delsym®) provide 12-hour cough relief 3
• Caution should be used with higher doses of dextromethorphan as some combined preparations contain other ingredients like paracetamol 2

Alternative Options

• Menthol by inhalation suppresses the cough reflex and provides acute but short-lived relief; can be prescribed as menthol crystals or proprietary capsules 2, 1
• First-generation antihistamines with sedative properties effectively suppress cough but cause drowsiness, making them particularly suitable for nocturnal cough 2, 1
• Non-sedating antihistamine combinations (like bilastine/dextromethorphan/phenylephrine) have shown efficacy for dry cough with less drowsiness than traditional combinations 4

Not Recommended

• Codeine or pholcodine have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile and are not recommended 2, 1
• Albuterol is not recommended for acute or chronic cough not due to asthma 2

Special Considerations

• Avoid dextromethorphan if taking monoamine oxidase inhibitors (MAOIs) or within 2 weeks of stopping MAOI treatment 3
• Dextromethorphan contains sodium metabisulfite, which may cause allergic-type reactions in sensitive individuals 3
• Consult a doctor if cough lasts more than 7 days, returns, or occurs with fever, rash, or persistent headache 3
• For patients with chronic bronchitis, central cough suppressants like dextromethorphan are recommended only for short-term symptomatic relief 2

Treatment Algorithm for Dry Cough

1. For mild dry cough: Start with dextromethorphan at appropriate doses (30-60 mg) 1
2. For nighttime cough disrupting sleep: Consider first-generation antihistamines with sedative properties 2, 1
3. For quick but temporary relief: Use menthol inhalation 2
4. For prolonged relief: Consider extended-release dextromethorphan formulations 3
5. For cough with nasal congestion: Consider combination products with dextromethorphan and a decongestant, preferably non-sedating formulations 4

Common Pitfalls to Avoid

• Using subtherapeutic doses of dextromethorphan that may not provide adequate relief 1
• Prescribing codeine-based antitussives which have no efficacy advantage but increased side effects 2, 1
• Continuing treatment beyond 7 days without medical reassessment 3
• Using cough suppressants for productive cough where clearance of secretions is beneficial 5

While a single 30 mg dose of dextromethorphan may have limited efficacy in some studies 6, higher doses (60 mg) have shown better cough suppression 1, and the medication remains the safest and most effective option for symptomatic relief of dry cough.