What are the recommended medications and brand names for treating seasonal cold and cough?

Recommended Medications for Seasonal Cold and Cough

For seasonal cold and cough, dextromethorphan (brand names: Delsym, Bromfed DM) is the preferred pharmacological option at 30-60 mg dosing, though simple home remedies like honey and lemon should be tried first. 1

First-Line Treatment Approach

Non-Pharmacological Options

• Honey and lemon mixtures are the simplest, cheapest, and often most effective first-line treatment for benign viral cough associated with seasonal colds 1, 2
• These home remedies may be as effective as pharmacological treatments and should be considered before medications 3
• Voluntary cough suppression techniques can reduce cough frequency through central modulation of the cough reflex 1

Pharmacological Options When Additional Relief Needed

Dextromethorphan (Primary Recommendation)

• Generic name: Dextromethorphan hydrobromide
• Brand names: Delsym (extended-release), Bromfed DM (combination product) 4, 5
• Optimal dosing: 30-60 mg for maximum cough suppression, as standard over-the-counter doses are often subtherapeutic 1, 2
• Mechanism: Non-sedating opiate that centrally suppresses the cough reflex with a clear dose-response relationship 3
• Evidence: Shown to reduce cough frequency by 19-36% in adults with upper respiratory infections 2

Important caveat: Some combination preparations contain additional ingredients like acetaminophen, brompheniramine, or pseudoephedrine, requiring caution with higher doses 1, 4

Alternative Medications

For Nighttime Cough

• First-generation antihistamines (e.g., chlorpheniramine, brompheniramine) can suppress cough through sedative properties 1, 2
• Particularly useful when cough disrupts sleep 3
• Trade-off: Causes drowsiness, which may be beneficial at night but problematic during the day 2

For Quick Temporary Relief

• Menthol inhalation (menthol crystals or proprietary capsules) provides acute but short-lived cough suppression 1, 2
• Effect is immediate but brief 1

For Nasal Congestion Component

• Ipratropium bromide (intranasal) relieves nasal symptoms in older children and adults 3
• Pseudoephedrine (found in Bromfed DM) for nasal decongestant effects 4

Medications NOT Recommended

Codeine and pholcodine should be avoided as they have no greater efficacy than dextromethorphan but carry significantly more adverse effects including drowsiness, nausea, constipation, and physical dependence 1, 2, 3

Practical Treatment Algorithm

1. Start with honey and lemon for all patients with benign viral cough 1, 2

2. If additional relief needed during the day:

   • Dextromethorphan 30-60 mg (Delsym or generic) 1, 2
   • Menthol inhalation for quick temporary relief 2

3. If cough disrupts sleep:

   • First-generation antihistamine-containing products (e.g., Bromfed DM) 1, 3
   • Dextromethorphan 30-60 mg at bedtime 2

4. If nasal congestion is prominent:

   • Combination products containing pseudoephedrine (Bromfed DM) 4
   • Ipratropium bromide nasal spray 3

Critical Safety Considerations

• Do not use dextromethorphan in patients requiring pneumonia assessment (tachycardia, tachypnea, fever, abnormal chest examination) until pneumonia is ruled out 1
• Dextromethorphan should not be used for productive cough where secretion clearance is beneficial 2
• Approximately 5% of persons of European ethnicity lack normal metabolism of dextromethorphan, leading to rapid toxic levels 6
• Seek medical attention for coughing up blood, prolonged fever, increasing breathlessness, or feeling significantly unwell 3

Common Pitfalls to Avoid

• Using subtherapeutic doses of dextromethorphan (standard OTC doses may be insufficient) 2
• Prescribing codeine-based products which offer no advantage but increased side effects 1, 2
• Not recognizing that most acute viral cough is self-limiting and lasts 1-3 weeks 1
• Overlooking simple home remedies in favor of immediate pharmacological intervention 1, 2