Medically reviewed
As uncomfortable as having a cough may be, it remains one of the body’s best defense systems.
By coughing, your body does its part to force out irritants and prevent infections of the respiratory tract.
In many cases, a cough also resolves on its own within three weeks.
The best cough medicine depends on what type of cough you have.
Knowing the cause of your cough and which medicines are available can help determine which cough medicine is right for you.
Which Cough Medicine Is Best?
OTC medications may be the best and quickest way to get your cough under control. However, it’s important to select the right type of medicine and that depends on what is causing your cough.
Wet productive cough
Use medicine with an expectorant that contains the active ingredient guaifenesin will help you get rid of the mucus.
Dry cough
Use medicine with an antitussive with the active ingredient dextromethorphan will help suppress your need to cough so you can get some rest.
Allergy cough
Use a cough medicine that is an antihistamine as that can help dry up your congestions.
Sinus congestion or postnasal drip
Use a decongestant with the active ingredient pseudoephedrine is your best option.
Ingredient importance
Some medications have a combination of active ingredients to tackle several symptoms at once. Use caution when using these medications so that you don’t get too much of one ingredient.
For example, acetaminophen, the active ingredient in Tylenol, is also a common ingredient in some OTC cough and cold medications. Too much acetaminophen causes liver damage. Read the active drug list on the label of your medications to be sure you don’t double up.
Different Types of Cough Medicine
Broadly, there are five types of medicines that can be used when you have a cough:
- Expectorants: If you’re feeling congested in your chest and want to make your coughs more productive, expectorants can work to help thin out the mucus in your lungs to make it easier to clear your congestion.
- Suppressants or antitussives: As the name suggests, suppressants work to suppress a cough from forming by halting the cough reflex in the brain.
- Decongestants: When postnasal drip is causing your cough, decongestants can work to constrict blood vessels which allows more air to pass through your nasal passages, drying out nasal tissues and reducing the amount of postnasal drip.
- Antihistamines: If your cough is in response to allergies, antihistamines can help to block histamine, the natural chemical that can cause a runny nose and postnasal drip.
- Pain relievers: Pain relievers like ibuprofen, aspirin, Tylenol, and Panadol aren’t used directly for a cough but can be used to treat other symptoms of a cold or flu, like fever or headache.
Over-the-Counter Options
Over-the-counter cough (OTC) medicine typically falls into either the expectorant or suppressant categories.
Here are some of the common OTC cough medicine ingredients available:
- Guaifenesin: The only expectorant approved by the U.S. Food and Drug Administration. It’s often combined with another ingredient and is available in several brand name medicines including Robitussin DM and Mucinex.
- Dextromethorphan: A common suppressant, dextromethorphan is available in brand names including Triaminic Cold and Cough, Robitussin Cough, and Vicks 44 Cough and Cold. Evidence on whether or not dextromethorphan actually works to suppress cough is mixed, with one study showing that it is as effective as honey in reducing cough frequency. In addition, dextromethorphan is a derivative of narcotics so it can be habit forming if taken in larger than recommended doses.
- Pseudoephedrine: The primary active decongestant ingredient in Sudafed. Though effective in short-term use, this ingredient can be habit-forming if used for more than four consecutive days.
- Phenylephrine: Another common decongestant ingredient used in the OTC product Cough Control CF. Like pseudoephedrine, it can also be habit-forming if used for more than four consecutive days.
Keep in mind that the FDA doesn’t recommend OTC medicines for cough and cold symptoms in children younger than two years old. Some sources don’t even recommend cough medications for children younger than four years of age.
If you choose to use honey (which has been shown to be as effective as dextromethorphan) as a cough suppressant instead of OTC medications, beware not to give it to children under the age of one due to the potential risk of botulism.
Zarbees and Manuka honey are two brands of honey supplements that work well against a cough.
Prescription Cough Medicine Options
Prescription cough medicines can contain stronger ingredients than those available OTC.
Here are some of the ingredients used in prescription cough medicine:
- Benzonatate: The active ingredient in Tessalon Perles is a non-narcotic cough suppressant. It acts by numbing the stretch sensors in the lungs to stop coughing. It starts to work about 15 to 20 minutes after taking the medication and relief can last up to 8 hours.
- Codeine: An opiate used in some suppressant cough medications, including Triacin C, Tuxarin ER. Though previously considered a gold standard in cough medicine, more recent studies show that it may not be as effective as previously assumed. In addition, its habit-forming risks may outweigh its cough suppressant benefits. This is a controlled medication and not often given as a first-line cough syrup.
- Hydrocodone: Another opiate used in cough medications, including FlowTuss and Hycofenix. The FDA updated their regulations in 2018 to limit the use of hydrocodone and codeine in cough medicines to adults 18 and older due to the potential for addiction and overdose. This is also a controlled cough medication
Potential Side Effects of Cough Medicine
Medical experts are divided on whether or not cough medicines actually work.
If you decide to start taking an OTC or prescription cough medicine, it’s important to speak with a health provider first about the possible side effects.
You can always try a spoonful of honey first to possibly avoid the use of cough medicines.
Possible side effects of cough medicine use include:
- Headache
- Nausea
- Vomiting
- Stomach pain
- Dizziness or lightheadedness
- Drowsiness
- Nervousness
- Restlessness
In rare cases, more severe side effects can include:
Before taking OTC or prescription cough medicine, it’s important to read the labels carefully and follow the instructions exactly as given.
What Causes a Cough?
A cough is often caused by a viral infection, like the cold or flu.
But there are additional possible causes, depending on whether you’re experiencing an acute cough (short-term) or a chronic cough (lasting longer than eight weeks):
Acute Cough Causes
- Foreign particles, including smoke and dust
- Viral infections, including the common cold, influenza, COVID-19 or respiratory syncytial virus (RSV)
- Bacterial infections, including pneumonia or whooping cough
- Acute viral bronchitis
- Acute viral sinusitis
- Croup
- Choking
- Laryngitis
Chronic Cough Causes
- Chronic bronchitis
- Allergies (including hay fever)
- Exposure to air pollution
- Asthma
- Postnasal drip
- GERD (gastroesophageal reflux disease)
- COPD (chronic obstructive pulmonary disease)
- Smoking
- Lung cancer
- Some medications, including ACE inhibitors (such as lisinopril and enalapril) used to treat high blood pressure and heart failure can cause cough months after starting the medication
When to See a Medical Provider
If it’s your first time taking cough medicine, it’s a good idea to speak with a health care professional to determine which medication, if any, is right for you—especially if you’re looking for the right option for your child or teenager.
Not all cough medicines are right for young children, while research shows teenagers are most likely to abuse cough medicine (particularly those containing dextromethorphan or codeine).
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