What is the treatment for a dry cough?

Treatment of Dry Cough

For most acute dry coughs caused by viral infections, start with honey and lemon mixtures, and if additional relief is needed, use dextromethorphan 30-60 mg (not the subtherapeutic over-the-counter doses). 1

Acute Dry Cough (Less Than 3 Weeks)

First-Line Approach

Most short-term dry coughs are viral and self-limiting, requiring no medical intervention. 2

• Honey and lemon mixtures are the simplest, cheapest, and often effective first approach 1
• Antibiotics are not indicated, even if you feel unwell, as viral infections do not respond to antibiotics 2
• Paracetamol can be used for associated fever and body aches 2

Second-Line Pharmacologic Treatment

If symptomatic relief is needed because the cough interferes with daily activities or sleep:

• Dextromethorphan 30-60 mg is the recommended first-line antitussive agent due to superior safety profile compared to opioid alternatives 1, 3

  • Standard over-the-counter dosing is often subtherapeutic; optimal cough suppression occurs at 60 mg 1
  • FDA-approved for temporary relief of cough due to minor throat and bronchial irritation 3
  • Avoid codeine - it has no greater efficacy than dextromethorphan but significantly more side effects 1

• Menthol lozenges or vapor inhalation provide acute but short-lived cough suppression through cold and menthol sensitive receptors 2, 1

• First-generation sedating antihistamines (like chlorpheniramine) can suppress cough and are particularly suitable for nocturnal cough due to their sedating effect 1, 4

Critical Caveat

Do not use dextromethorphan if you are taking MAOIs (certain antidepressants or Parkinson's medications) or within 2 weeks of stopping them. 3

Chronic Dry Cough (More Than 3 Weeks)

You must see a doctor if the cough persists beyond 3 weeks to identify and treat the underlying cause, as symptomatic treatment alone is insufficient. 2

When to Seek Immediate Medical Attention

Regardless of duration, see a doctor urgently if you have: 2

• Coughing up blood
• Breathlessness
• Prolonged fever and feeling unwell
• Pre-existing conditions (COPD, heart disease, diabetes, asthma)
• Recent hospitalization

Common Underlying Causes to Investigate

The most common causes of chronic dry cough include: 5, 6, 7

• Post-viral cough hypersensitivity
• Asthma (cough-variant)
• Rhinosinusitis with post-nasal drip
• Gastroesophageal reflux disease
• ACE inhibitor medications

Treatment Approach for Chronic Cough

• Treat the underlying cause when identified - this is the most effective strategy 2
• For post-infectious cough with severe paroxysms, consider prednisone 30-40 mg daily for a short period 1
• Inhaled ipratropium may be tried before central antitussives for post-infectious cough 1
• If pertussis is suspected, macrolide antibiotics are indicated 1
• In idiopathic cases where no cause is found, increased cough reflex sensitivity is often present, and symptomatic antitussive therapy as described above may be necessary 6, 7

Common Pitfalls to Avoid

• Using subtherapeutic doses of dextromethorphan (typical OTC doses) that provide inadequate relief 1
• Prescribing codeine-based antitussives which have no efficacy advantage but increased side effects and addiction potential 1, 6
• Failing to stop smoking - this significantly worsens cough and respiratory symptoms 2
• Using antitussives for productive/wet cough where clearance of secretions is beneficial 1
• Delaying medical evaluation when cough persists beyond 3 weeks or red flag symptoms are present 2