By Brett Kappelmann, PharmD, Co-Owner of Cooper Drug
As we trudge along through cold and flu season, I am frequently asked about cough medicine. What is the best cough medicine available? What are the different types of cough medicine? Are the over-the-counter cough medicines any good? Cough medicine and cough syrups are available over-the-counter in three different types: cough suppressants, oral expectorants, and topical (externally applied) drugs.
If you were to walk into my store and ask about choosing a cough medicine, the first question I would ask you would be if the cough is productive or not. A productive cough produces mucous and secretions. A nonproductive cough is also known as a dry, hacky cough. Based upon the type of cough you have will depend on the best type of cough medicine to use.
For a productive cough, usually a medicine that contains guaifenesin is the best approach. Guaifenesin is an oral expectorant that works by thinning the mucous, making it easier to cough up. If you have a productive cough you usually do not want to suppress it, because coughing up mucous and secretions is your body's natural way to clear the airways. Guaifenesin works the best if you take it with plenty of water, because the water will work with the guaifenesin to thin the mucous. You can find guaifenesin in many cough medicines. Two of the most common guaifenesin-containing cough medicines are Robitussin and Mucinex. Robitussin comes in syrup form, is inexpensive, but is shorter acting. Mucinex comes in tablet form, is more expensive, but can last for up to twelve hours.
For a nonproductive, dry, hacky cough, a cough suppressant is usually the best choice for therapy. Cough suppressants relieve your cough by blocking the cough reflex. The most common ingredient that you will find as a cough suppressant in over-the-counter formulations is dextromethorphan, or DM. Codeine is considered the gold standard of cough suppressants, but is mostly available in prescription form due to its abuse potential. Delsym is a popular choice as an over-the-counter cough suppression therapy because it contains dextromethorphan in a long acting (twelve hour) formulation.
Many OTC cold and cough syrups and cough medicines contain a cough suppressant (dextromethorphan) plus an expectorant (guaifenesin) along with other cold medicines and pain relievers. The combination cold and cough medicine may contain an antihistamine, a decongestant, and a pain reliever in addition to the cough suppressant and/or expectorant. The combination of medicines may give optimal relief if you have multiple cold symptoms, such as body aches, coughs, and congestion. The downside of the combination cold medicines is that you may be taking medication that you don't need, depending on your symptoms.
Topical products that contain camphor and menthol are also used to relieve cough. These natural, aromatic cough medicines are rubbed on the throat and the chest. The anesthetic action of their vapors is thought to ease coughing and soothe stuffiness from a cold.
In summation, this is a simple breakdown of cough therapy. There are many other factors that must be considered when choosing the most appropriate cough therapy. Factors such as drug-drug interactions, age restrictions, and conflicting medical conditions must be considered. As always, ask your doctor or pharmacist if it unclear as to the most appropriate medication to choose.
