The Best Over-the-Counter and Prescription Cough Medications (2024)

The cough reflex is your body’s natural defense against irritants and pathogens. As annoying and uncomfortable as a coughing attack can be, this is one of the most effective ways your body protects against infection and illness. Sometimes, however, enough is enough. Frequent or painful hacking can seriously affect your daily activities. For these instances, most people turn to cough medicine to stop their symptoms.

Cough Causes

Coughing is natural. It’s your body’s way of expelling irritants, germs, and other substances that it identifies as harmful. The reflex to cough comes from an impulse in your brain to push air out of your lungs and drive out whatever irritates you.

Frequent coughing, or coughing that produces yellow or bloody mucus, may signal a medical problem that requires treatment. Coughing for an extended period might irritate the lungs and lead to additional health problems such as insomnia, dizziness or fainting, migraines, and vomiting. Long-term, vigorous coughing can even lead to broken ribs.

There are two primary types of cough: acute and chronic. An acute cough is a cough that lasts for three or fewer weeks, and it often appears as a symptom of an underlying illness or infection. Chronic coughing is a cough that lasts longer than eight weeks in adults and four weeks in young children.

Potential causes of acute cough include:

• The common cold
  
• Influenza (the flu)
  
• Pneumonia
  
• Whooping cough
  
• Allergies

Potential causes of chronic cough include:

• Allergies
  
• Asthma
  
• Chronic obstructive pulmonary disease (COPD)
  
• Bronchitis
  
• Acid reflux (GERD)

Types of Cough Medicine

There are five primary types of cough medicine.

Antitussives

Antitussives, also known as cough suppressants, are a family of drugs designed to suppress coughing. They achieve this by acting on the cough reflex in the brain. The cough reflex is a natural defense mechanism that helps clear irritants from the airways. Antitussives work by directly inhibiting the brain's cough center or soothing the irritated throat and airways.

Dextromethorphan is these medicines' most common antitussive ingredient, acting on the brain's cough control center. By reducing the sensitivity of this center or by numbing the throat and airways, antitussives help relieve persistent or irritating coughs. It's vital to use antitussives as directed by a health care professional to avoid potential side effects or overuse.

Over-the-counter cough medicines that contain dextromethorphan include:

• Delsym (available as a syrup)
  
• Tussin (generic cough syrup)
  
• Robitussin Cough Gels & Syrup
  
• Vicks 44 Dry Cough Relief

Antitussives, while effective in suppressing coughs, have certain risks and considerations. One significant risk is the potential for side effects, including dizziness, drowsiness, nausea, and constipation, especially with medications containing codeine.

Prescription cough medicines contain the drug codeine, which is a controlled substance. Misuse or overuse of prescription antitussives can lead to dependency and addiction. Following your healthcare's recommended dosage and usage instructions minimizes these risks.

Furthermore, some antitussive medications may interact with other drugs or medical conditions, so you must disclose your medical history and any other medications you take to your healthcare professional. Pregnant or nursing women and individuals with certain respiratory conditions should exercise caution and consult their healthcare provider before using antitussives.

Expectorants

Expectorant medications facilitate the removal of mucus and phlegm from the respiratory system, particularly in the lungs and airways. They work by increasing mucus volume and reducing its thickness, making it easier to expel. This is accomplished by triggering the production of secretions within the respiratory tract, which serve to hydrate and loosen the mucus. Consequently, the body efficiently expels thin mucus through a wet cough, relieving congestion and improving the breathing comfort of individuals with bronchitis, persistent coughs, and chest congestion.

Guaifenesin is the most common expectorant medication available. It is commonly supplied as an oral tablet, capsule, solution, or syrup. Side effects of guaifenesin are generally mild, and most OTC cough medications that utilize it as an active ingredient are well tolerated by most older children and adults.

OTC cough medicines containing guaifenesin include:

• Mucinex
  
• Guaifenesin (generic)

Antihistamines

Antihistamines, primarily known for their role in treating allergies, can also alleviate coughing, mainly when it is triggered by histamine release. Histamine is a chemical produced by the body's immune system in response to allergens or irritants, and it can lead to coughing by irritating the airways. Antihistamines work by blocking the action of histamine, thereby reducing its effects on the respiratory system. Doing so can help mitigate coughing associated with allergic reactions, postnasal drip (runny nose), or other histamine-related factors.

However, it's important to note that antihistamines may not be as effective for coughs caused by non-histamine factors, such as viral infections (like the common cold). Therefore, their use for cough relief should be directed by a healthcare professional, taking into account the underlying cause of the cough and potential side effects of the medication.

Antihistamines are available as oral tablets, capsules, or nasal sprays.

Common OTC antihistamines include:

• Cetirizine (generic for Zyrtec)
  
• Loratadine (generic for Alavert and Claritin)
  
• Diphenhydramine (generic for Benadryl)
  
• Fexofenadine (generic for Allegra)
  
• Brompheniramine (generic for Dimetane)
  
• Chlorpheniramine (generic for Chlor-Trimeton)
  
• Clemastine (generic for Dayhist)
  
• Doxylamine (generic for Vicks NyQuil)

Antihistamine use has been shown to cause some side effects. These are generally mild, and most OTC antihistamines are well tolerated.

Side effects include:

• Dizziness
  
• Dry mouth
  
• Nausea and vomiting
  
• Difficulty with urinating
  
• Blurred vision
  
• Skin irritation (more common in topical antihistamine use)

If these side effects persist over a few days, or you begin to notice more severe symptoms such as shortness of breath, skin rash, or chest tightness, seek medical attention immediately.

Decongestants

Decongestants are medications commonly used to relieve coughing associated with nasal congestion and mucus buildup. These medications work by narrowing the blood vessels in the nasal passages and respiratory tract, which reduces swelling and congestion. By doing so, decongestants help to alleviate the blockage and allow air to flow more freely, making breathing easier. When the airways are less congested, it can reduce coughing, especially if triggered by postnasal drip or irritation from excessive mucus.

However, using decongestants as directed and for a limited duration is crucial, as prolonged use can lead to a "rebound effect," where congestion worsens when the medication wears off. Furthermore, decongestants may not be effective for coughs caused by other factors, such as allergies or irritants, so a healthcare provider should guide their use to ensure safe and appropriate treatment.

Pseudoephedrine and phenylephrine are the two most common forms of OTC decongestants on the market. Phenylephrine, however, is ineffective when taken orally, despite its continued availability. Because of this, look for OTC medication containing pseudoephedrine, like Sudafed.

Sudafed comes in both “Drowsy” and “Non-Drowsy” options. Do not drive or operate machinery after taking “Drowsy” Sudafed, as it can make you sleepy and impair your abilities. “Drowsy” or “Night-time” Sudafed should be taken before bed.

Pain Relievers

Pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil) are not typically used to treat coughing. Still, they manage symptoms associated with coughs, such as sore throat and sinus pain. Coughing can sometimes cause irritation and soreness in the throat or chest, and these medications can help alleviate that discomfort. Acetaminophen is primarily used to reduce pain and fever, while ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can also reduce pain and inflammation.

By addressing these related symptoms, acetaminophen and ibuprofen can indirectly contribute to cough relief by making it more comfortable for individuals to cope with their cough. However, they do not target the underlying cause of the cough, so their use should be combined with appropriate treatment to address the root cause, such as allergies, infections, or other triggers. It's important to follow dosing instructions and consult a healthcare provider, especially if the cough is persistent or severe.

NSAIDs have been shown to increase blood pressure in some individuals slightly. If you are managing high blood pressure or a heart condition, seek medical advice from your healthcare provider before using any NSAID.

Combination Cough and Cold Medicines

Cough and cold combination medicines are designed to provide comprehensive relief for various symptoms associated with respiratory illnesses, including coughing. These medications typically contain a combination of active ingredients such as antitussives (to suppress coughing), decongestants (to relieve nasal congestion), antihistamines (to address allergy-related symptoms), and sometimes pain relievers or expectorants. By offering this multifaceted approach, they aim to alleviate the cough and related cold symptoms like a stuffy nose, runny nose, and sore throat.

Cough and cold combination medications can help manage coughs caused by various factors, from allergies to viral infections. However, it's crucial to choose a product that aligns with your specific symptoms and to follow the dosing instructions carefully.

Prescription Cough Medicines

Prescription cough medicine is used for acute cough cases that do not go away after using OTC medicine and home remedies.

Benzonatate is the most commonly prescribed medicine for severe cough. It is an antitussive that numbs the cough reflex, reducing the urge to cough. This soothing effect can relieve severe coughing, making it easier for individuals to rest and recover.

Unlike other prescription cough medicines, benzonatate is not habit-forming or classified as a controlled substance. It has been shown to cause some side effects, including:

• Nausea
  
• Headaches
  
• Drowsiness
  
• Constipation
  
• Stuffy nose

Stick to the dosage directions given to you by your healthcare provider. Do not increase or decrease your dosage of benzonatate without consulting them first. Stick to the dosage directions given to you by your health care provider. Do not increase or decrease your dosage of benzonatate without consulting them first. Take this medication by mouth with or without food as directed by your doctor. Swallow this medication whole. Do not chew, suck, or dissolve this medication in your mouth. Doing so will cause a loss of feeling in your mouth/throat and may cause choking or a severe allergic reaction.

At-Home Cough Remedies

If you want to treat a mild cough without using drugs, you can use several home remedies to start feeling better. These are also great treatment options if your child is dealing with an acute cough, as the Food and Drug Administration (FDA) does not recommend the use of cough or cold medicine in young children.

Home remedies for cough

Honey: Honey is a natural and time-tested remedy for alleviating cough symptoms, particularly those associated with sore throats and mild irritation. Its effectiveness lies in its soothing and antimicrobial properties. Honey helps coat the throat, relieving irritation and reducing the urge to cough. Additionally, it contains antioxidants and antimicrobial compounds that can help combat infection and inflammation in the respiratory tract.

Mix honey for cough relief with warm water or herbal tea, creating a soothing drink that can be consumed before bedtime or as needed. However, it's essential to note that honey should not be given to children under one due to the risk of botulism. While honey can relieve mild coughs, it may not be sufficient for severe or chronic coughs.

Lozenges: Lozenges are a popular over-the-counter remedy for a cough. These small, medicated tablets are designed to dissolve slowly in the mouth, relieving dry and productive coughs. The active ingredients in cough lozenges typically include menthol, honey, or soothing herbal extracts such as eucalyptus or licorice root.

These ingredients work in several ways to alleviate cough symptoms. First, they help numb the throat and reduce irritation, which can help suppress the urge to cough. Second, they stimulate saliva production, which can help soothe a dry, scratchy throat. Finally, some lozenges contain expectorant ingredients to help loosen mucus and make coughing easier.

Sucking on a lozenge may be a choking hazard for young children. Do not give children under five years of age lozenges for their cough.

Hydration: Staying well-hydrated is essential because it helps maintain the moisture levels in the throat and respiratory passages. An adequate intake of fluids can help soothe a dry, irritated throat and thin mucus, making it easier to expel.

Warm liquids like herbal teas, broths, or warm water with honey and lemon are particularly beneficial, as they can help soothe the throat and provide additional relief.

Moreover, keeping the body hydrated supports the immune system's overall function, helping it combat the underlying causes of coughs, such as infections or irritants.

Gargle salt water: This simple yet effective technique involves dissolving salt in warm water and using the solution to rinse the throat. Salt water gargling helps in several ways: it can help reduce throat inflammation, alleviate irritation, and temporarily ease the discomfort associated with coughing. The saltwater solution removes excess moisture from inflamed tissues, reducing swelling and irritation. It can also help to loosen mucus and remove irritants, relieving dry and productive coughs.

While it may not directly address the underlying cause of the cough, such as an infection, it can be a helpful and natural adjunct to other treatments. Gargling with salt water is generally safe and can be done several times daily for symptomatic relief.

Humidify the air: Humidifiers work by increasing the moisture content in the air, which can help soothe an irritated throat and respiratory passages. Dry air can exacerbate coughing by drying out the throat's mucous membranes and exacerbating irritation. By adding moisture to the air, humidifiers can help maintain optimal humidity levels in indoor environments, reducing the likelihood of coughing fits. This added moisture can also help to thin and loosen mucus, making it easier to expel, especially for wet coughs.

Sources:

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• (n.d.). Cold and Cough Medicines. Medline Plus.
  
• Morice, A. H., McGarvey, L., Pavord, I., & British Thoracic Society Cough Guideline Group (2006). Recommendations for the management of cough in adults. Thorax, 61 Suppl 1(Suppl 1), i1–i24.
  
• Sharma S, Hashmi MF, Alhajjaj MS. (2023 Aug 8). Cough. National Library of Medicine.