What is the best remedy for cough spasms?

Best Remedy for Cough Spasms

Start with honey and lemon as a simple home remedy, which is as effective as pharmacological treatments for benign viral cough, then escalate to dextromethorphan 60 mg (not the standard lower over-the-counter dose) if additional relief is needed. 1, 2

First-Line Approach: Non-Pharmacological

• Honey and lemon mixtures should be your initial recommendation for acute viral cough spasms, as they provide symptomatic relief comparable to medications without side effects 1, 2

• Voluntary cough suppression techniques can reduce cough frequency through central modulation of the cough reflex 1, 2

• Simple drinks and linctuses may work through this same central modulation mechanism 1

Second-Line: Pharmacological Treatment

Dextromethorphan (Preferred Antitussive)

• Dextromethorphan at 60 mg provides maximum cough reflex suppression, which is substantially higher than typical over-the-counter dosing of 15-30 mg 1, 2, 3

• Standard OTC doses are subtherapeutic and unlikely to provide adequate relief 2, 3

• Dextromethorphan has superior safety compared to codeine-based products, with fewer adverse effects 2, 3, 4

• Important caveat: Check combined preparations carefully at higher doses, as some contain paracetamol or other ingredients that could lead to toxicity 1, 2

• FDA-approved as a cough suppressant 5

Alternative Options for Specific Situations

For nocturnal cough spasms:

• First-generation sedating antihistamines (like diphenhydramine or promethazine) suppress cough and help with sleep disruption 1, 2, 3
• Diphenhydramine has demonstrated ability to inhibit cough reflex sensitivity in acute viral infections 6

For quick but temporary relief:

• Menthol inhalation (as crystals or proprietary capsules) provides acute, short-lived cough suppression 1, 2, 3

What NOT to Use

• Avoid codeine and pholcodine - they have no greater efficacy than dextromethorphan but cause drowsiness, nausea, constipation, and physical dependence 1, 2, 4

• Do not use antitussives for productive cough where secretion clearance is beneficial 2, 3

Special Circumstances

For severe postinfectious cough spasms:

• Try inhaled ipratropium before central antitussives 2, 3
• Consider prednisone 30-40 mg daily for short course if severe paroxysms persist 2, 3

If pertussis suspected:

• Macrolide antibiotics are indicated with 5-day isolation 2

Practical Algorithm

1. Start: Honey and lemon mixture 1, 2
2. If inadequate: Dextromethorphan 60 mg (not standard 15-30 mg dose) 1, 2, 3
3. If nighttime spasms: Add sedating antihistamine 1, 2, 3
4. For immediate brief relief: Menthol inhalation 1, 2, 3
5. If postinfectious: Inhaled ipratropium first, then consider short-course prednisone for severe cases 2, 3

Common Pitfalls

• Using subtherapeutic dextromethorphan doses (15-30 mg) that won't adequately suppress cough 2, 3
• Prescribing codeine products despite no efficacy advantage and worse side effect profile 1, 2
• Overlooking simple, effective home remedies in favor of immediate pharmacological intervention 1, 2
• Failing to check ingredient lists when recommending higher dextromethorphan doses 1, 2