OTC cough medications

Suggest plain honey, up to 2 teaspoons at bedtime or as needed. Avoid dextromethorphan (Codiphan, Tossilar) if patients are on an MAOI (selegiline)...
Abdelwahab Ward, BS Pharm, PharmD

As a community pharmacist, patients will ask you how to manage acute cough due to the common cold. There still isn't good evidence for or against using OTC or prescribed medications for acute cough due to a cold. But patients often want to take something. So continue to suggest trying nondrug options first: fluids, cool-mist humidifiers, etc...

  • Suggest plain honey, up to 2 teaspoons at bedtime or as needed. There's some evidence it reduces cough in kids and it may be worth a try in adults.
    • But avoid it in kids under one year due to botulism risk.
  • Focus on safety. Weed out products some patients should avoid. For example, don't recommend OTC cough and cold medications in kids under age 6 to limit the risk of adverse effects (seizures, etc) or overdose.
  • Avoid dextromethorphan (Codiphan, Tossilar) if patients are on an MAOI (selegiline, etc). And be cautious about combining it with serotonergic medications (SSRIs, tramadol, etc), especially with multiple serotonergics or high doses.
  • There are no good data that antihistamines or decongestants reduce cough, but they're often in combination OTC products.
  • Consider anticholinergic effects with diphenhydramine (Sultan 50 mg), etc. Explain short-term pseudoephedrine (Decongess 120 mg) is often okay in controlled hypertension, but caution if blood pressure is UNcontrolled.
  • Explain menthol or camphor rubs are okay for adults, but just small amounts can be toxic if ingested by younger kids.
  • Advise saving prescribed cough medications as a last resort. There's not much evidence benzonatate, codeine, or hydrocodone helps. And avoid codeine in children and pregnant or nursing women. Get our note "Approach to acute cough".

References

  1. Malesker MA, Callahan-Lyon P, Ireland B, Irwin RS; CHEST Expert Cough Panel. Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report. Chest. 2017;152(5):1021-1037.
  2. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014;2014(11):CD001831.
  3. Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Cochrane Database Syst Rev. 2014;(12):CD007094.
Abdelwahab Ward, BS Pharm, PharmD