Cough medicine often contains cough suppressants and expectorants.
|Other names||Cough and cold medicine, cough syrup, linctus|
While they have been used by 10% of American children in any given week, they are not recommended in Canada or the United States in children 6 years or younger because of lack of evidence showing effect and concerns of harm. One version with codeine, guaifenesin, and pseudoephedrine was the 241st most prescribed medication in 2016 in the United States with more than 2 million prescriptions.
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 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, for 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, pseudoephedrine, and oxymetazoline.
- Fever or pain medication. Examples are paracetamol (called "acetaminophen " in the US) and NSAIDs such as ibuprofen or naproxen.
- Also employed are various substances supposed to soften the coughing, like honey or supplement syrup.
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, chronic bronchitis, or the common cold. 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 for adults: antihistamines, antihistamine-decongestant combinations, benzonatate, anti asthmatic-expectorant-mucolytic combinations, expectorant-bronchodilator combinations, leukotriene inhibitors, ambroxol, and guaifenesin, sometimes with analgesics, antipyretics, anti inflammatories, and anticholinergics - and for children: antihistamines, decongestants for clearing 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 especially 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. Cold syrup overdose has been linked to visual and auditory hallucinations, rapid involuntary jaw, tongue and eye movements in children.
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 not to be true as heroin readily breaks down into morphine in the body. Morphine was already known to be addictive.
Society and culture
Sudafed is a brand manufactured by McNeil Laboratories. The original formulation contains the active ingredient pseudoephedrine, but formulations without pseudoephedrine are also being sold under the brand. In 2016 it was one of the biggest selling branded over-the-counter medications sold in Great Britain, with sales of £34.4 million. The effectiveness of phenylephrine by mouth as a nasal decongestant is questionable.
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.
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