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Choosing the Best Over-the-Counter Cough Treatment

There are many over-the-counter (OTC) medicines adults can use to treat a cough, including syrups, lozenges, sprays, and capsules. Each has a different mechanism of action. The “best” cough medicine is ultimately based on the type of cough you have.


  • Cough suppressants, which mitigate the urge to cough
  • Expectorants, aiding in the breakdown of mucus for productive expulsion
  • Multi-symptom formulas, potentially incorporating these and other OTC components

This piece delves into the functioning of varied OTC cough treatments, elucidating potential hazards and side effects. Furthermore, it offers insights into managing coughs without medicinal interventions and recognizing the appropriate juncture for consulting a healthcare professional.

Cough Suppressants

Cough suppressants, or antitussives, constitute a medication category targeting the brain to repress the reflex to cough.

In the United States, dextromethorphan represents the lone OTC antitussive. Predominantly available as a syrup, it can also be found in capsule and lozenge formats.

Dextromethorphan serves as the active agent in single-symptom preparations, including: Delsym (syrup)

  • Delsym (syrup)
  • Buckley’s Mixture Cough Suppressant (syrup)
  • Vicks 44 Custom Care Dry Cough (syrup)
  • Robitussin Long-Acting CoughGels (capsules)
  • Sucrets DM Cough Formula (lozenges)
  • Dextromethorphan (generic)

While widely used, emerging research indicates that cough suppressants may offer limited effectiveness, especially in children. Dextromethorphan might also trigger notable and occasionally intolerable side effects such as:

  • Drowsiness or vertigo
  • Blurred eyesight
  • Tremors
  • Restlessness and irritability
  • Nausea and vomiting
  • Confusion
  • Slowed breathing
  • Urination challenges

Assessing the Need for a Cough Suppressant

For a productive (“wet”) cough, the more favorable approach usually involves expelling mucus from the lungs rather than suppressing the cough. Consultation with a healthcare provider is advised if faced with a “chesty” or “rattling” cough to ensure proper treatment.


Expectorants, a category of medications, are designed to thin and disperse respiratory mucus, thereby rendering it easier to expel via coughing. Expectorants are best suited for productive (“wet”) coughs, as opposed to non-productive (“dry”) ones.

Guaifenesin holds the distinction of being the sole expectorant approved for use in the United States. Available as a standalone solution, it can be found over-the-counter as:

These treatments are accessible as immediate-release tablets taken every four hours or sustained-release tablets ingested every 12 hours. Side effects are generally mild and may encompass:

  • Dizziness
  • Headaches
  • Upset stomach
  • Nausea
  • Vomiting
  • Rashes

Multi-Symptom Cough Formulas

Frequently, multi-symptom cough formulations amalgamate dextromethorphan and guaifenesin, often in syrup or capsule forms.

These formulations might be augmented with supplementary medications to alleviate accompanying symptoms, including:

  • Antihistamines such as Benedryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine), mitigating postnasal drip exacerbating coughing
  • Decongestants like Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine), alleviating nasal stuffiness stemming from blood vessel inflammation
  • Pain relievers such as Tylenol (acetaminophen), quelling body aches and fever

A general rule of thumb is to identify the formulation aligning with your specific symptoms, minimizing the risk of unnecessary drug ingestion. Notable side effects include:

  • Antihistamines: Drowsiness, dizziness, dry mouth, nausea, constipation, headaches, nervousness, appetite loss, vomiting
  • Decongestants: Headaches, dry mouth, restlessness, insomnia, tremors, dizziness, rapid heartbeat
  • Acetaminophen: Nausea, stomach discomfort, headaches, hoarseness, appetite loss, itching

Avoid Overdosing

When contemplating the consumption of a multi-symptom cough remedy, meticulous scrutiny of the product label is advised to ascertain the ingredient composition. This practice averts potential overdosing if another OTC medication with identical constituents is ingested.

Risk Evaluation and Contemplations

Cough treatments generally pose minimal risk but may not be universally suitable. Certain demographic groups could face particular health hazards associated with these medications.

In individuals afflicted with severe asthma, chronic obstructive pulmonary disease (COPD), or pneumonia, dextromethorphan usage is often discouraged. Such action prevents symptoms from exacerbating by halting mucus expulsion, potentially leading to pooling in the lungs.

Guaifenesin warrants caution among individuals with severe asthma or COPD, unless under the supervision of a healthcare professional.

For children below six years of age, the American Academy of Family Physicians advises against OTC cough medications due to the risk of inadvertent poisoning. Moreover, these medications have demonstrated limited efficacy among young children.

Indicators for Healthcare Consultation

Though the majority of coughs stemming from colds and flu can be addressed at home, certain cases may take an unexpected turn or signify an underlying condition surpassing the scope of a common cold or flu.

Immediate medical attention is recommended if a cough is accompanied by the following manifestations:

  • Elevated fever coupled with chills
  • Breathing difficulties (dyspnea)
  • Expectoration of greenish mucus
  • Coughing up blood (hemoptysis)
  • Bluish discoloration of fingers, skin, or lips (cyanosis)
  • Cough characterized by a whooping, barking, or wheezing sound

Other Ways to Treat a Cough

For those opting to eschew cough medicines or necessitating more robust relief, the following strategies may offer respite:

  • Hydration to dilute and alleviate mucus, as well as soothe the throat
  • Elevating the head with additional pillows during sleep
  • Abstaining from smoking
  • Minimizing exposure to airborne irritants like smoke, pollution, or dust
  • In instances where irritants are unavoidable, donning a mask
  • Employing a humidifier to prevent airway dryness
  • Inhaling warm mist, such as from a shower
  • Exploring options like hot water, tea, or lemon juice with honey for a persistent cough

Research indicates that honey might offer more efficacy than conventional cough syrups.


The realm of adult cough treatments encompasses suppressants, expectorants, and multi-symptom formulas.

Dextromethorphan, the pivotal suppressant in OTC solutions, influences the brain to quell the cough reflex. Guaifenesin, an OTC expectorant, thins mucus for productive elimination. These agents can be amalgamated into multi-symptom treatments alongside antihistamines, de congestants, and pain relievers.

It’s noteworthy that cough treatments are not recommended for children below six years of age.

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