What are the medications for cough?

From the Guidelines

For children with cough, honey may be the most effective over-the-counter option, as it has been shown to offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo, according to the most recent guidelines 1. When considering medications for cough, it's essential to weigh the potential benefits against the risks, particularly in children. The 2020 CHEST guidelines highlight the lack of efficacy and potential morbidity and mortality of over-the-counter (OTC) medications for young children 1. Some key points to consider when managing cough in children include:

• Avoiding the use of codeine-containing medications due to the potential for serious side effects, including respiratory distress 1
• Being cautious with OTC cough medications, as they have been associated with adverse events, including reported deaths from toxicity in young children 1
• Considering honey as a potential option for relieving cough symptoms, as it has been shown to be more effective than no treatment, diphenhydramine, or placebo 1 It's crucial to prioritize the safety and well-being of children when managing cough, and to seek medical attention if the cough persists, is severe, or is accompanied by concerning symptoms such as fever, shortness of breath, or bloody mucus. The use of OTC medications should be approached with caution, and alternative options, such as honey, should be considered, as recommended by the most recent guidelines 1.

From the FDA Drug Label

Warnings Do not use if you are now taking a prescription monoamine oxidase inhibitor (MAOI) (certain drugs for depression, psychiatric or emotional conditions, or Parkinson’s disease), or for 2 weeks after stopping the MAOI drug. If you do not know if your prescription drug contains an MAOI, ask a doctor or pharmacist before taking this product Allergy Alert: Contains sodium metabisulfite, a sulfite that may cause allergic-type reactions. Ask a doctor before use if you have • chronic cough that lasts as occurs with smoking, asthma or emphysema • cough that occurs with too much phlegm (mucus) Stop use and ask a doctor if • side effects occur. You may report side effects to FDA at 1-800-FDA-1088 • cough lasts more than 7 days, cough comes back, or occurs with fever, rash or headache that lasts. These could be signs of a serious condition. If pregnant or breast-feeding, ask a health professional before use. Drug Facts Active Ingredients Purpose (in each teaspoonful (5 mL)) Codeine Phosphate USP 10 mg ................... Antitussive Guaifenesin USP 100 mg ........................... Expectorant Package/Label Principal Display Panel Compare to Delsym® active ingredient Dextromethorphan Polistirex Extended-Release Oral Suspension Cough Suppressant Contains sodium metabisulfite, a sulfite that may cause allergic-type reactions 12 Hour Cough Relief Day or Night Alcohol-free Dosing Cup Included 3 FL OZ (89 mL) Orange Flavored Liquid

Medications for Cough

• Dextromethorphan: is used as a cough suppressant 2, 2
• Codeine: is used as an antitussive (cough suppressant) 3 Key Considerations:
• Ask a doctor before use if you have a chronic cough or cough with too much phlegm (mucus) 2
• Stop use and ask a doctor if side effects occur or if cough lasts more than 7 days 2

From the Research

Medications for Cough

• Dextromethorphan is one of the most widely used antitussives for the treatment of cough associated with acute upper respiratory tract infection, however, a study 4 found that a single 30 mg dose of dextromethorphan provides very little support for clinically significant antitussive activity in patients with cough associated with acute upper respiratory tract infection.
• A combination of first-generation antihistamine plus decongestant is considered the most effective treatment for cough due to the common cold 5.
• Some herbal compounds, the antitussive dextromethorphan, and ambroxol are effective for symptom relief in acute and subacute cough 6.
• Treatments with proven effectiveness for cold symptoms in adults include over-the-counter analgesics, zinc, nasal decongestants with or without antihistamines, and ipratropium for cough 7.
• For children, established safe and effective treatments include acetylcysteine, honey (for children one year and older), nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils 7.

Treatment Approach

• A practical approach to treatment and management of cough emphasizes identifying and treating all contributing factors together 8.
• Informing patients about the self-limited nature of the common cold can help manage expectations, limit antibiotic use, and avoid over-the-counter purchases that may not help 7.
• Counseling patients about the importance of good hand hygiene is the best way to prevent transmission of cold viruses 7.