What medications can help relieve an itchy throat and cough?

Medications for Itchy Throat and Cough

For an itchy throat with dry cough, start with honey and lemon as first-line treatment, then use dextromethorphan 30-60 mg for pharmacological relief, reserving first-generation antihistamines specifically for nighttime cough that disrupts sleep. 1, 2

First-Line Non-Pharmacological Approach

• Simple home remedies like honey and lemon are the simplest, cheapest, and often as effective as pharmacological treatments for benign viral cough 1, 2
• Voluntary cough suppression techniques may reduce cough frequency through central modulation of the cough reflex 1, 2

Pharmacological Treatment Algorithm

Primary Option: Dextromethorphan

• Dextromethorphan is the preferred antitussive due to superior efficacy and better safety profile compared to codeine and other opioid alternatives 1, 3
• Dextromethorphan is a non-sedating opiate that suppresses the cough reflex centrally 1, 2, 4
• Standard over-the-counter dosing is often subtherapeutic—maximum cough suppression occurs at 60 mg, which is higher than typical OTC preparations 1, 2, 3
• A clear dose-response relationship exists, with 30 mg providing modest relief (19-36% reduction) and 60 mg providing maximum effect 2, 3
• FDA-approved for temporary relief of cough due to minor throat and bronchial irritation from common cold or inhaled irritants 4
• Caution: Some combination preparations contain additional ingredients like paracetamol—verify formulation before prescribing higher doses 1, 2

For Nighttime Cough: First-Generation Antihistamines

• First-generation antihistamines with sedative properties (e.g., diphenhydramine) suppress cough and are particularly useful when cough disrupts sleep 1, 2, 3
• These work through anticholinergic properties rather than antihistamine effects 5
• Diphenhydramine has been shown to inhibit cough reflex sensitivity in subjects with acute viral upper respiratory tract infection 6
• Sedation is the primary side effect but can be beneficial for nocturnal cough 5, 1

Alternative: Menthol Inhalation

• Menthol suppresses cough reflex when inhaled, providing acute but short-lived relief 1, 2
• Can be prescribed as menthol crystals or proprietary capsules 1
• Effect is immediate but temporary 1

Medications to Avoid

• Codeine and pholcodine have no greater efficacy than dextromethorphan but carry significant adverse side effect profiles including drowsiness, nausea, constipation, and physical dependence 1, 2, 3
• Second-generation (non-sedating) antihistamines are ineffective for cough associated with upper airway symptoms 5

When Upper Airway Symptoms Are Prominent

• If itchy throat is accompanied by nasal stuffiness or post-nasal drip sensation, consider a 1-month trial of topical nasal corticosteroid 5
• For allergic rhinitis causing cough, nasal corticosteroids, oral antihistamines, or leukotriene inhibitors are appropriate 5
• For post-viral upper respiratory infection, older-generation antihistamine plus decongestant combinations (e.g., dexbrompheniramine 6 mg + pseudoephedrine 120 mg twice daily) have proven efficacy 5

Critical Pitfalls to Avoid

• Using subtherapeutic doses of dextromethorphan (less than 30-60 mg) that provide inadequate relief 1, 2, 3
• Prescribing codeine-containing products which offer no advantage over dextromethorphan and have worse side effects 1, 2, 3
• Failing to recognize that newer non-sedating antihistamines are ineffective for non-allergic cough—only first-generation antihistamines work through anticholinergic effects 5
• Not verifying ingredients in combination cough preparations before recommending higher doses 1, 2

Red Flags Requiring Further Evaluation

• Cough with increasing breathlessness (assess for asthma or anaphylaxis) 1
• Cough with fever, malaise, or purulent sputum (may indicate serious lung infection) 1
• Cough lasting more than 3 weeks requires full diagnostic workup rather than continued antitussive therapy 2
• Significant hemoptysis or possible foreign body inhalation requires specialist referral 1