What is a good medication for a nighttime cough?

Nighttime Cough Medicine Recommendation

For nighttime cough, use dextromethorphan 60 mg combined with a first-generation sedating antihistamine like diphenhydramine or promethazine to suppress both the cough reflex and provide sedation for sleep. 1, 2

Optimal Medication Approach

First-Line: Dextromethorphan at Proper Dosing

• Dextromethorphan is the recommended first-line antitussive due to its superior safety profile compared to codeine 1, 2
• Standard over-the-counter doses (15-30 mg) are subtherapeutic and often ineffective 1, 2
• Maximum cough reflex suppression occurs at 60 mg, which should be the target dose for nighttime relief 1, 2
• This dose is FDA-approved for helping patients get to sleep by suppressing the cough impulse 3
• Be cautious with combination products that may contain acetaminophen or other ingredients when using higher doses 1

Add Sedating Antihistamine for Nighttime Use

• First-generation sedating antihistamines (diphenhydramine, promethazine, chlorpheniramine) are particularly suitable for nocturnal cough because they both suppress cough AND cause drowsiness 1, 2, 4
• The sedative effect is actually beneficial at night when cough is disrupting sleep 1, 4
• This combination addresses both the cough reflex and sleep disturbance simultaneously 2

Why NOT Codeine

• Codeine has no greater efficacy than dextromethorphan but carries a much worse adverse effect profile (drowsiness, nausea, constipation, physical dependence) 1, 2
• Codeine is not recommended despite being FDA-approved for cough 1, 5

Alternative Non-Pharmacologic Options to Try First

• Honey and lemon may be as effective as pharmacological treatments for benign viral cough and should be considered before medications 1, 2
• Research shows honey can reduce cough frequency and severity more than dextromethorphan in some populations 6, 7
• Menthol inhalation provides acute but short-lived relief and can be used as an adjunct 1, 2

Important Caveats

• Do NOT use antitussives for productive cough where secretion clearance is needed 1, 2
• Limit treatment duration to short-term use (typically less than 7 days) 2
• If cough persists beyond acute illness, investigate underlying causes rather than continuing suppression 8, 9
• For postinfectious cough, try inhaled ipratropium before central antitussives 1, 2

Practical Nighttime Algorithm

1. Start with honey and lemon for mild symptoms 1, 2
2. If inadequate relief, add dextromethorphan 60 mg at bedtime 1, 2
3. If cough still disrupts sleep, combine dextromethorphan 60 mg with a sedating antihistamine (e.g., diphenhydramine 25-50 mg) 1, 2
4. Avoid codeine-containing products entirely 1, 2