Coughs can take days or even weeks to go away. While a stubborn cough is annoying and sometimes even painful, it is your body’s natural way of clearing out harmful irritants and secretions—but that doesn’t mean you have to be uncomfortable or lose sleep.
In this Q&A, Jacqueline O’Boyle, DO, a primary care physician at Mount Sinai Doctors-Manhasset, explains what over-the-counter cough medicines and at-home remedies can help soothe your cough, and when it’s time to see a doctor.
Jacqueline O’Boyle, DO
What over-the-counter cough syrups do you recommend?
It depends on whether you have a dry cough or a wet cough. For most patients, I typically suggest guaifenesin (Mucinex®), which can help relieve both wet and dry coughs.
Wet coughs: These are caused by excess fluid or mucus in the airways, and are often caused by a post-nasal drip that tickles your throat. Treatments that dry up the nose and nasal passages are helpful. These include nasal steroid sprays, such as fluticasone (Flonase®) or mometasone (Nasonex®), which reduce inflammation. Antihistamines, which are anti-allergy drugs, are also good for drying up the nasal passages. Some popular over-the-counter antihistamines include loratadine (Alavert® and Claritin®) and fexofenadine (Allegra® Allergy, Aller-ease®, and Aller-Fex™).
Dry coughs: These don’t produce mucus. Remedies that stimulate saliva production and moisten the dry areas are very helpful. These include nasal saline sprays (Ayr® or Simply Saline™), lozenges, tea with honey and lemon, and humidifiers.
When should I see a doctor for my cough?
If you are experiencing any shortness of breath, tightness in your chest, persistent fever, or if your cough has gone on for more than three weeks or is causing chest pain, you should see a doctor. Most coughs are caused by viruses, which antibiotics don’t treat, but your doctor may prescribe an antibiotic if your cough is more likely bacterial. If your cough is interfering with sleep or your ability to function, there are certain medications that are effective, regardless of the cause of your cough.
What cough medications might the doctor prescribe?
Your doctor may prescribe you medications like benzonatate (Tessalon Perles®), which can both suppress your cough and allow you to sleep better. Benzonatate works well when used in combination with guaifenesin (Mucinex®). If you’re experiencing wheezing or tightness in your chest, or have a history of asthma, your doctor might prescribe inhaled steroids, or inhaled beta-2 adrenergic receptor agonists such as albuterol, or an oral steroid. If your cough is very disruptive, your doctor may prescribe a cough syrup with promethazine or codeine. While there is no evidence that cough syrup with promethazine or codeine will be more effective than placebo for people with cough from acute infection, some people find it allows them to sleep better and reduces symptoms.
What at-home remedies soothe a cough?
Good remedies for a dry cough are: lozenges, a spoonful of honey, or honey stirred into tea. Honey has been proven to reduce cough symptoms more so than most medications, and contains antibacterial properties (but never give honey to an infant younger than one year old.) There are a number of other at-home remedies to try. If you have a wet cough, elevating the head of your bed and using a humidifier can help. Elevating your head will prevent irritation from postnasal drip, and the humidifier will moisturize the air as well as your throat and sinuses, so you can sleep better at night. Rest, in turn, will help boost your immune system. Additionally, nasal irrigation rinses (such as NeilMed® Sinus Rinse or Neti Pot) can reduce swelling and flush out mucus (make sure to use only clean/sterile water).
Any other suggestions?
Sitting in a steamy bathroom with a hot shower running can help clear your nasal passages and throat. You can also try chest physical therapy, an airway clearance technique in which someone you know manually performs chest percussion on your chest wall to loosen mucous and phlegm. Strengthening your immune system with good nutrition, keeping yourself hydrated, and getting lots of rest are also important.
- Mucinex, a common over-the-counter medicine, is generally good at relieving any type of cough.
- Treatments that dry up the airways (nasal steroid sprays and anti-allergy drugs) are ideal for treating wet coughs, whereas remedies that moisten the airways (nasal saline sprays, lozenges, humidifiers), help relieve dry coughs.
- If you are having trouble sleeping, elevate the head of your bed (prevents post-nasal drip) and put a humidifier in your bedroom.
- Never give medications to a child without consulting their pediatrician, or honey to a child under one year old.
- See a doctor if you are experiencing shortness of breath, tightness or pain in your chest, persistent fever, or if your cough has gone on for more than three weeks. If you have health issues, do not take over-the-counter medications without consulting your doctor.
How can I soothe a child who is too young for cough medicine?
Never give children under the age of 12 cough medications unless instructed by the child’s doctor, as they are at a much greater risk of side effects. Never give a child under one year old honey, which can cause botulism. Instead, put a humidifier in their bedroom and elevate the top of their bed to keep their airways moist and to reduce the effects of post-nasal drip. If their cough is very bad, have them sit in a steamy bathroom with a hot shower running. If they are over one year old, you can give them half to one teaspoon of honey or over-the-counter remedies containing honey that are specifically made for children. Have them drink plenty of water to help flush out mucous and secretions. If your child is over three months old, consider using Vicks® BabyRub™. Unlike the adult version (Vicks VapoRub™), Vicks BabyRub does not contain camphor (dangerous if ingested), but uses holistic ingredients like aloe, eucalyptus, and lavender oil, which are safe for kids. You can rub it on their feet and chest. Be sure to consult your child’s doctor before putting them on Vicks BabyRub or other mediations, especially if they are under 12.
Are there cough medications that people with high blood pressure, or other health issues, should avoid?
Consult a doctor before taking any over-the-counter medications if you have health problems. For most people, dextromethorphan (Robitussin®), a common cough suppressant, is fine, but can cause dizziness, restlessness or drowsiness in some. Other cough medications, such as pseudoephedrine (Sudafed® or SudoGest™), can raise blood pressure and heart rate. Always read the labels of over-the-counter cough suppressants, as many should be taken with caution if you take other medications, such as the category of antidepressants known as SSRI/SNRIs (selective serotonin reuptake inhibitors/serotonin–norepinephrine reuptake inhibitor). A lot of them have multiple ingredients, so you want to make sure you’re not doubling up on any ingredients that could potentially harm you.