What are the recommendations for using cough drops to relieve a cough?

Recommendations for Using Cough Drops to Relieve a Cough

For acute viral cough, simple home remedies like honey and lemon may be as effective as pharmacological treatments and should be considered first before using medicated cough drops. 1

First-Line Options for Cough Relief

• Non-medicated cough drops or home remedies:

  • Honey and lemon mixtures provide effective symptom relief for benign viral coughs 2, 1
  • Menthol-containing lozenges provide quick but short-lived cough suppression 2, 1
  • Voluntary cough suppression techniques may be sufficient to reduce cough frequency in some patients 1

• Medicated cough drops:

  • Dextromethorphan-containing cough drops are recommended for short-term symptomatic relief of coughing in chronic bronchitis 2
  • Standard over-the-counter dosing of dextromethorphan (found in many cough drops) is often subtherapeutic; optimal cough suppression occurs at 60 mg 1
  • Menthol suppresses cough reflex when administered by inhalation or in lozenge form, but provides only acute, short-lived relief 1

When to Use Different Types of Cough Drops

• For non-productive cough:

  • Dextromethorphan-containing cough drops may provide modest reduction in cough counts (19-36%) in adults with upper respiratory infections 1
  • First-generation antihistamine-containing cough drops can suppress cough but cause drowsiness, making them particularly suitable for nighttime cough 1

• For productive cough:

  • Avoid central cough suppressants like dextromethorphan as they may interfere with clearing secretions 1, 3
  • Consider protussive agents that help with mucus clearance instead 4

Cautions and Limitations

• Excessive use of menthol cough drops may actually worsen cough symptoms in some individuals 5

  • Research has found significant associations between cough severity and:
    • Average menthol dose per cough drop
    • Number of cough drops consumed daily
    • Total amount of menthol consumed per day 5

• Codeine-containing cough drops are not recommended due to:

  • No greater efficacy than dextromethorphan 1
  • Higher risk of adverse effects including drowsiness, nausea, constipation, and physical dependence 1, 6

• For cough due to upper respiratory infections:

  • Central cough suppressants have limited efficacy and are not recommended 2
  • Peripheral cough suppressants also have limited efficacy for this use 2

When to Seek Medical Attention

• If cough persists for more than three weeks 2
• If you cough up blood 2
• If you experience breathlessness 2
• If you have prolonged fever and feel unwell 2
• If you have an underlying medical condition such as chronic bronchitis (COPD), heart disease, diabetes, or asthma 2
• If you have recently been hospitalized 2

Practical Algorithm for Cough Drop Use

1. For mild, acute cough: Start with non-medicated options like honey/lemon drops or plain menthol lozenges 2, 1
2. For more bothersome cough: Consider dextromethorphan-containing cough drops, understanding that standard doses may be subtherapeutic 1
3. For nighttime cough: Consider antihistamine-containing cough drops if sleep disruption is a major concern 1
4. Limit menthol cough drop consumption to avoid potential worsening of symptoms with excessive use 5
5. If cough persists beyond expected duration for viral illness (typically 1-2 weeks), seek medical evaluation 2

Remember that cough drops provide symptomatic relief but do not treat the underlying cause of cough. For chronic or persistent cough, proper diagnosis and specific treatment of the underlying condition is essential 4, 7.