What is a non-codeine liquid cough suppressant?

From the Guidelines

Dextromethorphan is the most effective non-codeine liquid cough suppressant available over-the-counter, with a recommended dosage of 10-30 mg per dose, taken every 4-6 hours as needed, not exceeding 120 mg in 24 hours. For adults, look for products containing this dosage of dextromethorphan, such as Robitussin DM, Delsym, and store-brand equivalents 1. It is essential to follow the package instructions carefully and be aware that many cough products contain additional ingredients like antihistamines, decongestants, or pain relievers, so choose one that matches your symptoms.

Key Considerations

• Dextromethorphan works by acting on the cough center in the brain stem to reduce the cough reflex 1.
• Other non-codeine options include menthol-based cough drops and honey (for those over 1 year old).
• If your cough persists beyond 7 days, is severe, or is accompanied by fever or difficulty breathing, consult a healthcare provider as these may indicate a condition requiring medical attention.

Dosage and Administration

• The recommended dosage of dextromethorphan is 10-30 mg per dose, taken every 4-6 hours as needed, not exceeding 120 mg in 24 hours 1.
• It is crucial to follow the package instructions carefully and not exceed the maximum recommended dose.

Alternative Options

• Levodropropizine is probably equally effective to dihydrocodeine or moguisteine and with possible earlier cough reductions than with dextromethorphan 1.
• Local anesthetics, such as nebulized lidocaine, have been suggested to be helpful in case studies and are commonly used in palliative care for intractable cough that has not responded to any other approaches 1.

From the FDA Drug Label

Purpose Cough suppressant Package/Label Principal Display Panel Compare to Delsym® active ingredient Dextromethorphan Polistirex Extended-Release Oral Suspension Cough Suppressant

• Dextromethorphan is a non-codeine liquid cough suppressant, as indicated by its purpose as a cough suppressant 2 and its packaging as an oral suspension 2.
• The liquid formulation is further confirmed by the description of the product as an orange flavored liquid 2.

From the Research

Non-Codeine Liquid Cough Suppressant Options

• Dextromethorphan is a commonly used non-codeine liquid cough suppressant, however, studies have shown mixed results regarding its efficacy 3, 4, 5.
• A study published in 2000 found that a single dose of 30 mg dextromethorphan had little effect on cough associated with acute upper respiratory tract infection 3.
• Another study published in 2004 found that dextromethorphan was not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection 4.
• A 2010 study compared the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents, and found that honey was more effective than dextromethorphan in alleviating cough 5.
• Dextromethorphan has also been repurposed as an antidepressant, with a uniquely rapid action and safety profile when combined with bupropion 6.

Alternative Options

• Honey has been shown to be an effective alternative to dextromethorphan in alleviating cough in children with upper respiratory infections 5.
• Other non-codeine liquid cough suppressants, such as moguisteine and levodropropizine, are available, but their efficacy and safety profiles may vary 7.