Cough Remedies for Adults

Cough in adults due to the common cold can often become a nuisance especially when it begins to affect your sleep. Unfortunately, cough medications are really hit or miss because the evidence that they work is not very strong. In this article, we shall discuss which cough medications have the most medical evidence in adults. If your cough lasts longer than 3 weeks, please consult your physician. Also, if you have a child who is coughing, please consult the child’s Pediatrician.

WHAT I USE FOR A COUGH DUE TO A COLD

As a pharmacist, I have personally tried most of the cough medications described in the next section. Here are my top picks:

• Promethazine with codeine: Personally, I find this syrup to be the most effective, but it can cause drowsiness and requires a prescription. Do NOT combine this medication with other over-the-counter cough medications.
• Robitussin-DM (guaifenesin/ dextromethorphan) with Chlor-Trimeton Allergy D (chlorpheniramine/ pseudoephedrine). For over-the-counter products, I prefer using both of these medications. These medications can be used together. Chlor-Trimeton Allergy D can be found behind the pharmacy counter so you will need ask the pharmacy staff if they have it available. An alternative to Chlor-Trimeton Allergy D that is available over-the-counter is chlorpheniramine/phenylephrine but it is not as effective.
• HALLS Sugar Free Honey Lemon Flavor Cough Drops: I find these cough drops to be helpful, and they can be used with the cough medications above.

THERAPIES THAT MAY OR MAY NOT HELP

• Antihistamine/decongestant combinations: Cough due to a cold can often be caused by postnasal drip. Postnasal drip happens when secretions that drain from your nose into your throat causes you to cough. Antihistamines (such as chlorpheniramine or diphenhydramine) are used to dry up these secretions, where as decongestants (such as pseudoephedrine or phenylephrine) are used to relieve a stuffy nose and congestion. The combination of an antihistamine and a decongestant is thought to work better together than either ingredient alone to treat coughs due to the common cold. Chlor-Trimeton Allergy D (chlorpheniramine/pseudoephedrine) is one example of an antihistamine/decongestant combination that is available over-the-counter. This medication has restricted access since it contains pseudoephedrine so you will need to ask the pharmacist if they carry it behind the counter. An alternative that is not as effective but is more readily available over-the-counter is chlorpheniramine/phenylephrine. Side effects to be aware about are that antihistamines may cause drowsiness and dry mouth and decongestants should not be used if you have uncontrolled high blood pressure.
• Cromolyn sodium nasal spray: Cromolyn sodium nasal spray is an over-the-counter medication called Nasalcrom that is usually used for allergies. One clinical trial showed that it was well tolerated and effective for runny nose, throat pain, or cough due to an upper lung infection (Clin Exp Allergy 1996). For more information on Nasalcrom, click here.
• Honey (for older than 1 years old): Just 2 teaspoons as needed may help with cough. Do NOT use honey in children less than 1 years of age. Honey can cause a toxic reaction called botulism in children less than 1 years old. Here is a video that goes over how to make a mixture of warm water with honey.

• Dextromethrophan: Dextromethorphan is a popular cough suppressant found in many common over-the-counter cough medications (Nyquil, Robitussin DM, Delsym, etc.). This medication is used alone or is combined with other medications in cough/cold preps. However, medical studies have shown that this medication only reduces cough by a small percentage. However, it might be worth a shot to try if you have never used this medication before to treat your cough. Ask your doctor first before taking dextromethorphan if you are already taking tramadol, an antidepressant, or a special class of medications called monoamine oxidase inhibitors (such as selegiline). These drugs are known to interact with dextromethorphan.
• Guaifenesin: Guaifenesin is another popular cough suppressant that works by breaking up the mucous that can trigger a cough. Guaifenesin is found in many common over-the-counter cough medications (Nyquil, Robitussin DM, Delsym, etc.). This medication is used alone or is combined with other medications in cough/cold preps. However, medical studies have shown this this medication has very small benefit for treating coughs (Cochrane 2014). However, it might be worth a shot to try this medication, especially if you have a wet cough with a lot of phlegm.
• Codeine: Codeine is a narcotic opioid medication that is found in prescription cough medications. Codeine works well to suppress cough due to a chronic condition, but it does not work well to suppress cough due to the common cold. However, if you do wish to try this drug, you can ask your doctor to prescribe you a cough medication such as Promethazine with Codeine. This prescription cough syrup contains both an antihistamine to dry up your nasal secretions as well as codeine to suppress your cough.
• Menthol cough drops: Menthol cough drops or lozenges are found in many products such as Halls. If you have a cough due to a cold, menthol cough drops are definitely worth a try. Cough drops are also usually available in a sugar-free form.
• Zinc lozenges: Zinc lozenges such as Zicam (lozenges only) or Cold-EEZE will not suppress your cough directly, but they have been shown to reduce the duration of cold symptoms (Open Respir Med J 2011). Zinc lozenges are worth a try but be aware they can cause nausea and bad taste. Also, do NOT use zinc-containing nasal products (Zicam) that you insert into your nose since they may cause a PERMANENT loss of smell.
• Elderberry: Elderberry is a popular herbal product that has has been used in folk medicine for centuries to treat influenza, colds and sinusitis. You can now find it combined with many zinc lozenge products such as Zicam (lozenge only) or Cold-EEZE. One small Norway clinical trial showed that elderberry shortened the duration of the flu by 4 days if given within the first 48 hours of flu-like symptoms (J Int Med Res 2004). Do not expect miracles, but it may be worth a try, especially if it is already found in combination with your zinc lozenge. Do NOT make elderberry syrup at home since the plant can produce cyanide if not cooked properly. See the video below about elderberry tea from Dr Oz:

THERAPIES WE DO NOT RECOMMEND

• Pelargonium sidoides (EPs 7630 or Umckaloabo Extract): This popular herbal root has been known to shorten the duration of the cold. However, it may cause liver injury, so we DO NOT recommend using it (Int J Mol Sci. 2016).
• Albuterol: Albuterol is a prescription inhaler that is used to treat asthma. We do not recommend albuterol for cough due to a cold unless you also have wheezing or breathing problems.
• Nasal Steroids: We do not recommend nasal steroids such as Flonase to treat cough due to the common cold. Nasal steroids are more useful if you have cough due to allergies. If you have cough due to allergies, nasal steroids can reduce cough within the first few days, but it may take up to two weeks to see maximal effect.