Avoid Pitfalls With Cough Meds

Patients will ask how to manage acute cough due to the common cold.

There still isn't good evidence for or against using OTC or Rx meds for acute cough due to a cold.

But patients often want to take something. 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 meds in kids under age 6...to limit the risk of adverse effects (seizures, etc) or overdose.

Avoid dextromethorphan if patients are on an MAOI (selegiline, etc). And be cautious about combining it with serotonergic meds (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 combo OTC products. Consider anticholinergic effects with diphenhydramine, etc. Explain short-term pseudoephedrine is often okay in controlled hypertension...but caution if BP is UNcontrolled.

Explain menthol or camphor rubs (Vicks VapoRub, etc) are okay for adults...but just small amounts can be toxic if ingested by younger kids.

Advise saving Rx cough meds as a last resort. There's not much evidence benzonatate (Tessalon Perles, etc), codeine, or hydrocodone helps. And avoid codeine in children and pregnant or nursing women.

Listen to PL Voices to hear our team talk with an expert about the latest evidence. Get our updated chart, Treatment of Cough in Adults, for options to treat cough due to asthma, bronchitis, and more.

• PL Voices: Managing Acute Cough Due to the Common Cold
• Chart: Managing Cough and Cold Symptoms
• Guideline: Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report, 2017