A cough medicine or cough and cold medicine, also known as cough syrup or linctus when in syrup form, is a medicinal drug used in those with coughing and related conditions. There is no good evidence for or against the use of over-the-counter cough medications in those with a cough. While they are used by 10% of American children weekly, 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 combinations of:
- expectorants: substances claimed to make coughing easier while enhancing the production of mucous, for example acetylcysteine.
- antitussives: substances which suppress the coughing itself (cough suppressants). Examples are codeine, dextromethorphan and noscapine.
- antihistamines, which might sedate a person a bit and reduce other associated symptoms, like a runny nose and watery eyes; for example diphenhydramine.
- decongestants, which relieve nasal congestion, such as ephedrine
- antipyretics, substances that reduce fever, such as paracetamol
- various substances supposed to soften the coughing, like honey or sugar 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 states 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. There is not enough evidence to make recommendations for those who have a cough and cancer. They are not recommended in those who have COPD or chronic bronchitis.
- 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 however that it may be no better than 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 regarding the treatment of acute cough does not recommend its use.
- 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, and guaifenesin; and in children: antihistamines, decongestants for clearing up the nose, or combinations of these.
Honey may be a minimally effective cough treatment. A Cochrane systematic review found the evidence to recommend for or against its use 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 as such should not be used in children less than one year old.
Many alternative treatments are used to treat the common cold. However, a 2007 review states that, "Complementary and 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 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." Nasally applied zinc gel may lead to long-term or permanent loss of smell. The FDA therefore discourages its use.
While a number of plants and Chinese herbs have been purported to ease cold symptoms, including ginger, garlic, hyssop, mullein, and others, studies have either not been done or have been found inconclusive.
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, already known to be addictive at the time, in the body.
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, substituting inexpensive diethylene glycol in place of glycerin. In May 2007, 365 deaths were reported in Panama, which were associated with cough syrup containing diethylene glycol.
- Smith, SM; Schroeder, K; Fahey, T (Aug 15, 2012). "Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings.". The Cochrane database of systematic reviews 8: CD001831. doi:10.1002/14651858.CD001831.pub4. PMID 22895922.
- 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 2776795. PMID 19910592.
- "FDA panel: No cold medicines to children under 6". CNN (Washington). Retrieved 2009-11-27.
- 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.
- "Children's cough and cold medicines – Lists of products" (PDF). Medicines and Healthcare products Regulatory Agency. Retrieved 18 December 2013.
- Medsafe cough and cold group http://www.medsafe.govt.nz/hot/alerts/CoughandCold/Minutes2CoughandCold.asp
- Knut Schroeder and 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 65295. 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 (2012). "Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults". Cochrane Database Syst Rev 2: CD006088. doi:10.1002/14651858.CD006088.pub3. PMID 22336815.
- 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.
- 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.
- 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 2921574. PMID 17218808.
- Goldman, RD (Dec 2010). "Codeine for acute cough in children". Canadian Family Physician 56 (12): 1293–4. PMC 3001921. PMID 21156892.
- 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.
- "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.
- 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:10.1331/1544-3188.8.131.524.Hulisz. PMID 15496046.
- "Zicam Cold Remedy Nasal Products (Cold Remedy Nasal Gel, Cold Remedy Nasal Swabs, and Cold Remedy Swabs, Kids Size)".
- Linde K, Barrett B, Wölkart K, Bauer R, Melchart D (2006). Linde, Klaus, ed. "Echinacea for preventing and treating the common cold". Cochrane Database Syst Rev (1): CD000530. doi:10.1002/14651858.CD000530.pub2. PMID 16437427.
- 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.
- 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.