Nobody enjoys cold and flu season — but if all that hacking is uncomfortable, cough medicine might make it a bit more bearable.
Still, not all cough meds are created equal. Different symptoms call for different active ingredients to treat the underlying cause of your cough, and causes can range from allergies to asthma. Even then, when it comes to over-the-counter meds for cough symptoms, the jury is still out on their effectiveness.
We talked to experts to learn how coughing works in the body and which medications to consider if your cough is getting in the way of sleep and daily life.
How does coughing work?
Coughing is the body’s way of clearing an airway, says Dr. Alin K. Abraham, a pediatrician and internist at Northwestern Medicine Central DuPage Hospital outside Chicago.
The cough reflex “is triggered in our body by activation of cough receptors, which we have in several places,” she says, including the respiratory tract, heart lining, esophagus, stomach and diaphragm.
Some common cough causes include allergies, postnasal drip, colds, medications, pneumonia, asthma, acid reflux, cigarette smoke and conditions like chronic obstructive pulmonary disease.
More serious conditions, like lung cancer, can also cause coughing. Ultimately, it’s one of the body’s built-in protective mechanisms, but it’s possible to have too much of a good thing.
“Coughing too much can cause muscle spasms, rib pain — even rib fracture, lightheadedness, passing out, disrupted sleep and urine leakage,” Abraham says.
When to see a doctor
Hacking from a cold usually won’t fracture your ribs, but it can become quite uncomfortable. You might consider medicine for a cough if it’s getting in the way of sleep, breathing or daily functioning.
If your cough comes with a fever that lasts more than a few days or other symptoms like shortness of breath, coughing up blood, rash or weight loss, or if your cough lasts more than a week, make an appointment with your doctor.
Cough medicines
There are several over-the-counter and prescription options for a short-term, acute cough. To start, it helps to understand that doctors often refer to coughs as either productive (coughing up mucus) or nonproductive (a dry, crackly cough).
Cough suppressants
For a dry, irritating cough, you might find relief from dextromethorphan, a cough suppressant and the active ingredient in medicines like Delsym.
“Suppressants like dextromethorphan block the cough reflex and can help with sleep by decreasing frequency and intensity of cough,” Abraham says.
Although researchers haven’t been able to prove the efficacy of dextromethorphan, they also haven’t proven that it doesn’t work. Other studies have shown dextromethorphan to be more effective than a placebo treatment.
Just be sure to avoid dextromethorphan if you’re having a wet, productive cough.
“You don’t want to suppress a productive cough,” says Jenny Hetzel, a clinical pharmacist and outpatient pharmacy coordinator at UW Health in Madison, Wisconsin. “When your body is clearing things out, you don’t want to stop that clearing.”
Cough expectorants
For a productive cough with chest congestion, expectorants like guaifenesin can help thin the mucus so you can cough it up more easily. It’s the active ingredient in brands like Mucinex.
“Guaifenesin is going to work to loosen and thin some of that congestion,” Hetzel says. “It’s going to help thin those secretions to help clear them.”
Although guaifenesin can loosen mucus, so can staying hydrated, Hetzel says: “If you’re sick, sometimes drinking lots of water is not easy to do, but drinking fluids can also help with expectorating.”
Antihistamines
When allergies or hay fever are causing your cough, antihistamines can help.
Antihistamines have a drying effect on the drainage that can cause coughing. Older-generation antihistamines like Benadryl tend to be more effective for a cough than newer medications like Claritin or Zyrtec.
“But [Benadryl] also makes you drowsy, so it’s not one you’re going to take during the day,” Hetzel says. On the flipside, that drowsiness might be a welcome side effect if you’re trying to sleep better at night.
Decongestants
Is your stuffy nose and sinus pressure causing your cough? In that case, a decongestant like pseudoephedrine or phenylephrine, taken as nasal sprays, might help.
“When you have nasal congestion and it’s draining, sometimes your goal is to clear out the sinuses to get that congestion out the nose so it’s not draining into the throat,” Hetzel says. By clearing congestion and promoting better drainage, you can potentially alleviate some of the irritation causing your cough.
Just be careful with decongestants if you have high blood pressure.
“Decongestants can cause elevated blood pressure; adults with high blood pressure should avoid decongestants,” Abraham says. “Be aware that this is an ingredient in several combination cold medications, so be sure to check the label or ask a pharmacist or doctor.”
Combination medications
If you’re experiencing a combination of symptoms, you might reach for a product like DayQuil, NyQuil or Robitussin DM that combines multiple active ingredients.
These products may combine decongestants, antihistamines, expectorants and/or cough suppressants to treat multiple symptoms. It’s a good idea to check with your doctor or the pharmacist before purchasing a combination product.
“I always caution against using the combo products, because if a person isn’t having one of the symptoms, then you’re adding extra things in and possibly extra side effects,” Hetzel says.
Prescription cough medicine
In some cases, doctors might prescribe a narcotic cough syrup, like codeine, if you’re having a lot of trouble sleeping at night. Codeine is more likely to cause drowsiness than dextromethorphan, Hetzel says. Another prescription option is benzonatate, which helps numb the tickle in your throat that can cause a cough.
Doctors also sometimes prescribe albuterol inhalers to alleviate a cough caused by asthma or lung issues.
Nonmedical treatments
If you’re not sold on cough meds, there are other remedies you can try, including nonmedicated cough drops, saline nasal sprays, nasal rinses and neti pots, and topical treatments like Vicks VapoRub. These options won’t address the root cause of your cough, but they can provide relief.
“Sometimes I go with the nasal saline before the decongestants,” Hetzel says. “When you’re doing neti pots and sinus rinses, it’s just kind of flushing all of that out, hopefully decreasing what’s up there to drain out and decrease the cough.”
As for cough drops: “They help trigger salivation, which can help out with a dry throat,” Hetzel says.
Cough meds and safety
Cough medications are safe in general, as long as you’re using them as directed. But they’re not appropriate for everyone. A doctor or pharmacist can help you determine if you should avoid any particular medications. For example, people taking MAOI drugs (a certain class of antidepressants) should avoid dextromethorphan.
In most cases, doctors also don’t recommend cough meds for young kids.
“There’s just no evidence showing that there’s benefits” for kids, says Hetzel.
Ultimately, many coughs can be treated without medication. As for whether meds help make your symptoms more tolerable in the short term, your mileage may vary.
“There is no end-all be-all,” Hetzel says. “Situationally, some people see a difference.”