From the Guidelines
For congestion, post-nasal drip (PND), and dry cough lasting 2 days, I recommend starting with an oral antihistamine like cetirizine (Zyrtec) 10mg once daily or loratadine (Claritin) 10mg once daily, as these can help reduce mucus production and alleviate symptoms, as suggested by the clinical practice guideline update on adult sinusitis 1. Combine this with an oral decongestant such as pseudoephedrine (Sudafed) 30-60mg every 4-6 hours as needed, avoiding its use if you have high blood pressure, to help shrink swollen nasal tissues. For the cough, try dextromethorphan (found in Robitussin DM) 10-20mg every 4 hours as needed, which can help block the cough reflex, although evidence of its clinical efficacy is lacking and decisions regarding its use are largely related to patient and provider preference, as noted in the guideline 1. Stay well-hydrated with at least 8 glasses of water daily and use a humidifier at night to moisten airways, which can help relieve symptoms of congestion and cough. Honey in warm tea can also soothe throat irritation from the cough. These symptoms likely result from an upper respiratory infection or allergies causing inflammation in your nasal passages and throat. If symptoms persist beyond 7-10 days, worsen significantly, or if you develop fever, shortness of breath, or colored sputum, consult a healthcare provider as you may need prescription medication, considering the guidelines for postinfectious cough management 1.
Some key points to consider:
- The use of antibiotics has no role in treating viral rhinosinusitis (VRS) or postinfectious cough, as the cause is not bacterial infection, as emphasized in the guidelines 1.
- Inhaled ipratropium may be helpful in attenuating the cough in postinfectious cough, as suggested by the ACCP evidence-based clinical practice guidelines 1.
- Inhaled corticosteroids may be considered when the cough adversely affects the patient’s quality of life and persists despite use of inhaled ipratropium, as noted in the guidelines 1.
- Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail, as recommended by the guidelines 1.
Overall, the management of VRS and postinfectious cough is primarily directed toward relief of symptoms, and the choice of treatment should be based on patient preference and the severity of symptoms, as suggested by the clinical practice guideline update on adult sinusitis 1.
From the FDA Drug Label
Purpose Cough suppressant The FDA drug label does not answer the question.
From the Research
Postnasal Drip and Cough
- Postnasal drip (PND) is a common complaint in primary care and ear-nose-throat offices, often associated with chronic cough 2.
- The pathophysiology of PND-related cough may be related to an airway sensory hypersensitivity rather than actual irritation from inflamed nasal secretions 2.
Effects of Post-nasal Drip Symptoms on Cough Duration
- A retrospective study found that patients with post-nasal drip symptoms had a significantly longer time until cough disappearance compared to those without post-nasal drip symptoms 3.
- Post-nasal drip symptoms were reported in 63.7% of patients with cough-variant or cough-predominant asthma, and multivariate analysis showed that post-nasal drip symptoms are independent prolonged factors of cough duration 3.
Treatment Options
- There is limited evidence on the efficacy of diphenhydramine against cough in humans, with only a few studies properly evaluating its effect 4.
- Crossover studies have demonstrated a significant effect of diphenhydramine in reducing cough, but active versus placebo studies did not show a significant effect 4.