Cough medicine often contains cough suppressants and expectorants.
|Synonyms||Cough and cold medicine, cough syrup, linctus|
Cough medicines are medications used in those with coughing and related conditions. It is not known whether over-the-counter cough medications reduce coughing. While they are used by 10% of American children in any given week, they are not recommended in Canada and the United States in children 6 years or younger because of lack of evidence showing effect and concerns of harm.
There are a number of different cough and cold medications, which may be used for various coughing symptoms. The commercially available products may include various combinations of any one or more of the following five types of substances:
- Mucokinetics, or mucolytics, are a class of drugs which aid in the clearance of mucus from the airways, lungs, bronchi, and trachea. Examples are carbocisteine, ambroxol, and bromhexine.
- Expectorants are substances claimed to make coughing easier while enhancing the production of mucus and phlegm. Two examples are acetylcysteine and guaifenesin.
- Antitussives, or cough suppressants, are substances which suppress the coughing itself. Examples are codeine, pholcodine, dextromethorphan, noscapine, and butamirate.
- Antihistamines, or allergic rhinitis may produce mild sedation and reduce other associated symptoms, like a runny nose and watery eyes. Examples are diphenhydramine, chlorpheniramine, brompheniramine, loratadine, and cetirizine.
- Decongestants relieve nasal congestion and sinus infection. Examples are ephedrine, phenylephrine, and oxymetazoline.
- Also employed are various substances supposed to soften the coughing, like honey or supplement syrup.
There is no good evidence supporting the effectiveness of over-the-counter cough medicines to reduce coughing.
The efficacy of cough medication is questionable, particularly in children. A 2014 Cochrane review concluded that "There is no good evidence for or against the effectiveness of OTC medicines in acute cough". Some cough medicines may be no more effective than placebos for acute coughs in adults, including coughs related to upper respiratory tract infections. The American College of Chest Physicians emphasizes that cough medicines are not designed to treat whooping cough, a cough that is caused by bacteria and can last for months. No over-the-counter cough medicines have been found to be effective in cases of pneumonia. They are not recommended in those who have COPD or chronic bronchitis. There is not enough evidence to make recommendations for those who have a cough and cancer.
- Dextromethorphan (DXM) may be modestly effective in decreasing cough in adults with viral upper respiratory infections. However, in children it has not been found to be effective.
- Codeine was once viewed as the "gold standard" in cough suppressants, but this position is now questioned. Some recent placebo-controlled trials have found that it may be no better than a placebo for some causes including acute cough in children. It is thus not recommended for children. Additionally, there is no evidence that hydrocodone is useful in children. Similarly, a 2012 Dutch guideline does not recommend its use to treat acute cough.
- A number of other commercially available cough treatments have not been shown to be effective in viral upper respiratory infections. These include in adults: antihistamines, antihistamine-decongestant combinations, benzonatate, anti asthmatic-expectorant-mucolytic combinations, expectorant-bronchodilator combinations, leukotriene inhibitors, ambroxol, and guaifenesin. Sometimes with analgesic, antipyretic, anti inflammatories, and anticholinergic; and in children: antihistamines, decongestants for clearing up the nose, or combinations of these and leukotriene inhibitors for allergy and asthma. However, antihistamines cannot be used as an empirical therapy in case of chronic, or non specific cough specially in very young children. Long term diphenhydramine use is associated with negative outcomes in older people.
Honey may be a minimally effective cough treatment. A Cochrane review found the evidence to recommend for or against its use in children to be weak. In light of this they found it was better than no treatment, placebo, and diphenhydramine but not better than dextromethorphan for relieving cough symptoms. Honey's use as a cough treatment has been linked on several occasions to infantile botulism and accordingly should not be used in children less than one year old.
Many alternative treatments are used to treat the common cold. A 2007 review states that, "alternative therapies (i.e., Echinacea, vitamin C, and zinc) are not recommended for treating common cold symptoms; however, ... Vitamin C prophylaxis may modestly reduce the duration and severity of the common cold in the general population and may reduce the incidence of the illness in persons exposed to physical and environmental stresses." A 2014 review also found insufficient evidence for Echinacea.
A 2009 review found that the evidence supporting the effectiveness of zinc is mixed with respect to cough, and a 2011 Cochrane review concluded that zinc "administered within 24 hours of onset of symptoms reduces the duration and severity of the common cold in healthy people". A 2003 review concluded: "Clinical trial data support the value of zinc in reducing the duration and severity of symptoms of the common cold when administered within 24 hours of the onset of common cold symptoms." Zinc gel in the nose may lead to long-term or permanent loss of smell. The FDA therefore discourages its use.
A number of accidental overdoses and well-documented adverse effects suggested caution in children. The FDA in 2015 warned that the use of codeine-containing cough medication in children may cause breathing problems.
Heroin was originally marketed as a cough suppressant in 1898. It was, at the time, believed to be a non-addictive alternative to other opiate-containing cough syrups. This was quickly realized to be not true as heroin readily breaks down into morphine in the body. Morphine was already known to be addictive.
Society and culture
In the United States several billion dollars were spent on over-the-counter products per year.
According to The New York Times, at least eight mass poisonings have occurred as a result of counterfeit cough syrup, accidentally substituting medical-grade glycerin with diethylene glycol, an inexpensive, yet toxic, glycerin substitute marketed for industrial use. In May 2007, 365 deaths were reported in Panama, which were associated with cough syrup containing diethylene glycol.
- Smith, SM; Schroeder, K; Fahey, T (24 November 2014). "Over-the-counter (OTC) medications for acute cough in children and adults in community settings". The Cochrane Database of Systematic Reviews. 11: CD001831. doi:10.1002/14651858.CD001831.pub5. PMID 25420096.
- Shefrin and Goldman; Goldman, RD (November 2009). "Use of over-the-counter cough and cold medications in children". Canadian Family Physician. 55 (11): 1081–1083. PMC . PMID 19910592.
- "FDA panel: No cold medicines to children under 6". CNN. Washington. Retrieved 2009-11-27.
- Medsafe cough and cold group "Archived copy". Archived from the original on 2010-05-25. Retrieved 2009-11-27.
- Knut Schroeder; Tom Fahey (2002). "Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults". British Medical Journal. 324 (7333): 329–331. doi:10.1136/bmj.324.7333.329. PMC . PMID 11834560.
- "New Cough Guidelines Urge Adult Whooping Cough Vaccine; Many OTC Medications Not Recommended for Cough Treatment" (Press release). American College of Chest Physicians. January 9, 2006.
- Chang, CC; Cheng, AC; Chang, AB (10 March 2014). "Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults". The Cochrane Database of Systematic Reviews. 3: CD006088. doi:10.1002/14651858.CD006088.pub4. PMID 24615334.
- Vestbo, Jørgen (2013). "Therapeutic Options" (PDF). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease. pp. 19–30.
- Molassiotis, A; Bailey, C; Caress, A; Brunton, L; Smith, J (Sep 8, 2010). "Interventions for cough in cancer". The Cochrane Database of Systematic Reviews (9): CD007881. doi:10.1002/14651858.CD007881.pub2. PMID 20824870.
- Dealleaume L, Tweed B, Neher JO (October 2009). "Do OTC remedies relieve cough in acute upper respiratory infections?". J Fam Pract. 58 (10): 559a–c. PMID 19874728.
- ed, Kian Fan Chung ... (2008). Pharmacology and therapeutics of cough. Berlin: Springer. p. 248. ISBN 9783540798422.
- Bolser DC, Davenport PW (February 2007). "Codeine and cough: an ineffective gold standard". Current Opinion in Allergy and Clinical Immunology. 7 (1): 32–6. doi:10.1097/ACI.0b013e3280115145. PMC . PMID 17218808.
- Goldman, RD (Dec 2010). "Codeine for acute cough in children". Canadian Family Physician. 56 (12): 1293–4. PMC . PMID 21156892.
- "Press Announcements - FDA acts to protect kids from serious risks of opioid ingredients contained in some prescription cough and cold products by revising labeling to limit pediatric use". FDA. Retrieved 2 February 2018.
- Paul, IM (Feb 2012). "Therapeutic options for acute cough due to upper respiratory infections in children". Lung. 190 (1): 41–4. doi:10.1007/s00408-011-9319-y. PMID 21892785.
- Verlee, L; Verheij, TJ; Hopstaken, RM; Prins, JM; Salomé, PL; Bindels, PJ (2012). "[Summary of NHG practice guideline 'Acute cough']". Nederlands tijdschrift voor geneeskunde. 156 (0): A4188. PMID 22917039.
- Chang, AB; Peake, J; McElrea, MS (16 April 2008). "Anti-histamines for prolonged non-specific cough in children". The Cochrane database of systematic reviews (2): CD005604. doi:10.1002/14651858.CD005604.pub3. PMID 18425925.
- Ruxton, K; Woodman, RJ; Mangoni, AA (August 2015). "Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis". British Journal of Clinical Pharmacology. 80 (2): 209–20. doi:10.1111/bcp.12617. PMC . PMID 25735839.
- "Honey A Better Option For Childhood Cough Than Over The Counter Medications". 2007-12-04. Retrieved 2009-11-27.
- Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE (2014). "Honey for acute cough in children". Cochrane Database Syst Rev (Systematic review). 12 (12): CD007094. doi:10.1002/14651858.CD007094.pub4. PMID 25536086.
- Sung, Valerie; Cranswick, Noel. "Cough and cold remedies for children". Australian Prescriber (32): 122–4. Retrieved 27 August 2010.
- Simasek M, Blandino DA (February 2007). "Treatment of the common cold". Am Fam Physician. 75 (4): 515–20. PMID 17323712.
- Karsch-Völk, M; Barrett, B; Kiefer, D; Bauer, R; Ardjomand-Woelkart, K; Linde, K (20 February 2014). "Echinacea for preventing and treating the common cold". The Cochrane Database of Systematic Reviews. 2: CD000530. doi:10.1002/14651858.CD000530.pub3. PMC . PMID 24554461.
- Singh M, Das RR (2011). "Zinc for the common cold". Cochrane Database Syst Rev (2): CD001364. doi:10.1002/14651858.CD001364.pub3. PMID 21328251.
- Hulisz D (2004). "Efficacy of zinc against common cold viruses: an overview". J Am Pharm Assoc (2003). 44 (5): 594–603. doi:10.1331/1544-318.104.22.1684.Hulisz. PMID 15496046.
- "Zicam Cold Remedy Nasal Products (Cold Remedy Nasal Gel, Cold Remedy Nasal Swabs, and Cold Remedy Swabs, Kids Size)".
- Sung, Valerie and Cranswick, Noel (2009). "Cough and cold remedies for children". Australian Prescriber, Vol. 32. pp 122-124. Available athttp://www.australianprescriber.com/magazine/32/5/122/4/.
- "Codeine Cough-and-Cold Medicines in Children: Drug Safety Communication - FDA Evaluating Potential Risk of Serious Side Effects". 1 July 2015. Retrieved 2 July 2015.
- Reeves, Roy R.; Ladner, Mark E.; Perry, Candace L.; Burke, Randy S.; Laizer, Janet T. (Mar 2015). "Abuse of Medications That Theoretically Are Without Abuse Potential". Southern Medical Journal. 108 (3): 151–157. doi:10.14423/SMJ.0000000000000256. ISSN 1541-8243. PMID 25772048.
- Burch, Druin (2009). Taking the Medicine: A Short History of Medicine's Beautiful Idea, and Our Difficulty Swallowing It. Random House. p. 118. ISBN 9781407021225.
- "Children's cough and cold medicines – Lists of products" (PDF). Medicines and Healthcare products Regulatory Agency. Retrieved 18 December 2013.
- Chung, Kian Fan (2008). Pharmacology and therapeutics of cough. Berlin: Springer. p. 188. ISBN 9783540798422.
- Bogdanich, Walt; Hooker, Jake (2007-05-06). "From China to Panama, a Trail of Poisoned Medicine". The New York Times. Retrieved 2010-04-30.
- "Cough and Cold Medicine Abuse". National Institute on Drug Abuse. May 2014. Retrieved 19 April 2016.