Best Cough Medication

Age-Specific Recommendations

Honey is the best and only recommended cough medication for children over 1 year of age. 1, 2

Honey provides more relief for cough symptoms than no treatment, diphenhydramine, or placebo 1, 2
Honey may modestly decrease frequency and severity of cough compared with dextromethorphan or no treatment 3
Never give honey to infants under 12 months due to risk of infant botulism 2

Over-the-counter cough and cold medicines should NOT be used - they have not been shown to make cough less severe or resolve sooner 1, 2
Codeine-containing medications must be avoided due to potential serious side effects including respiratory distress 1, 2
Dextromethorphan should not be used - it is no different than placebo in reducing nocturnal cough or sleep disturbance in children 2
Antihistamines have minimal to no efficacy and are associated with adverse events when combined with other OTC ingredients 1, 2

Dextromethorphan is the first-line treatment for nonproductive dry cough in adults. 4, 5

Dextromethorphan has substantial benefit and a favorable safety profile compared to other antitussives 4
Maximum cough reflex suppression occurs at 60 mg with prolonged effect 4
Dextromethorphan is more effective than codeine in controlling cough with fewer side effects 4, 6
It lowers cough intensity to a greater degree than codeine and is considered the better antitussive by the majority of patients 6

First-generation antihistamines with sedative properties can be particularly helpful for nocturnal cough 4, 7
Codeine may be used for short-term symptomatic relief in chronic bronchitis, but has limited efficacy for cough due to upper respiratory infections 4
Benzonatate can be considered for opioid-resistant cough when other options fail 4

Simple home remedies like honey and lemon mixtures can be effective first approaches 4
Adequate hydration helps manage symptoms 4
Menthol lozenges or inhalation provides short-term cough suppression 4

Antibiotics are not recommended for nonproductive cough due to viral infections, even when phlegm is present 4
Expectorants, mucolytics, and bronchodilators (like albuterol) are not recommended for acute nonproductive cough 4
Zinc preparations are not recommended for acute cough due to common cold 4
Antihistamine-decongestant combinations and guaifenesin do not provide greater relief than placebo 3

Do not use if taking MAOIs or within 2 weeks of stopping MAOI therapy 5
Contains sodium metabisulfite which may cause allergic-type reactions 5
Stop use if cough lasts more than 7 days or occurs with fever, rash, or persistent headache 5
Caution with higher doses as some preparations contain other ingredients like paracetamol 4

For unexplained chronic cough in adults that persists despite appropriate investigation:

Multimodality speech pathology therapy is suggested as first-line treatment 1
Gabapentin may be considered (300 mg once daily, escalating to maximum 1,800 mg/day in divided doses) after discussing risk-benefit profile 1
Inhaled corticosteroids should NOT be prescribed if tests for bronchial hyperresponsiveness and eosinophilia are negative 1
Proton pump inhibitors should NOT be prescribed if workup for acid reflux is negative 1

Using adult cough management approaches in pediatric patients 2
Prescribing OTC medications due to parental pressure despite lack of efficacy 2
Empirical treatment for asthma or GERD without clinical features consistent with these conditions 2
Failure to re-evaluate patients whose cough persists despite treatment 2