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Which cough medicine do I need?

Posted on January 16, 2016 at 1:45 PM


Winter is the season for colds and respiratory illnesses, many of which leave us with a nagging cough for weeks afterward. The cough medicine aisle is littered with combination cold and flu medicines, all promising to stop that cough. But they are not all the same, and some medicines won’t work in some people. Here is a quick guide to the main ingredients in cough medicines and how they work, so you can pick the best preparation for your symptoms.


It is also important to note that NO over-the-counter cough medicine is safe, useful, or recommended for children who are less than 6 years old. When I say “medicine” here, I mean something that has been created in a pharmaceutical lab. And as for the age, nothing magical happens on a person’s 6th birthday; the reason age 6 is chosen is because most children at that age will have a respiratory system that is developed enough to react to medicines in a safe way. An example that helps me visualize this is having seen patients with pertussis (whooping cough). Adults who get pertussis will cough very hard, so hard they may even burst blood vessels in their eyes. Elementary-aged children will cough until they start to choke and vomit. Infants who get pertussis aren’t able to cough, so they sometimes just stop breathing. Cough suppressants affect people in these age ranges in a similar way, so please be careful when giving them to your child.


- Guaifenesin is an expectorant, meaning it helps you to cough out mucus that feels stuck in your chest or sinuses. Guaifenesin works by watering down thick mucus. If you are coughing out thick pieces of colored mucus, this is a good ingredient to have on board. In order for this medicine to be effective, a person must be able to cough with enough force to expel the mucus, and children under 6 typically can’t cough that forcefully. So that means the watery mucus stays in their lungs, and can potentially lead to pneumonia.


- Dextromethorphan (DM) is a cough suppressant that works by calming down your cough receptors. There are cough receptors in the nose, sinuses, throat, and lungs, so a “tickle” in any of these places can produce a cough. DM is great for a tickling cough that is keeping you awake, because the medicine is also sedating. Children under 6 sometimes stop breathing if they are given DM, so it should never be given to young children.


- Pseudoephedrine (Sudafed) and phenylephrine (PE) are decongestants. They work by constricting small blood vessels in the nose, thereby not allowing them to leak plasma as much into the mucus, and thickening up the mucus. They are great for congestion (I usually recommend them for sinus infections, adults with ear infections/pressure, and stuffiness). They are basically the opposite of guaifenesin, so you should not take those two together. Recent studies have shown that PE is not as effective as we once thought, and there is talk of pulling it off the market soon. Nonetheless, I will speak of the two together, because they work in the same way. These medicines don’t only constrict the blood vessels in the nose - they constrict vessels all over the body, which raises the blood pressure. They are also similar to epinephrine/adrenaline, so other side effects can include racing heart, trouble sleeping, and shakiness. These medicines are not safe in children, and tend to make them more uncomfortable.


- Antihistamines are in many cough and cold medicines. They work by blocking histamine release, and histamine is not normally released during a cold, but can contribute to your symptoms if you have underlying allergies. There are two generations of antihistamines. The first generation antihistamines (diphenhydramine/Benadryl is the most common) are able to cross from the bloodstream into the brain, and are sedating. This can be helpful if your cough is keeping you awake, which is why they are put in some cough medicines. Some children under 6 have an opposite reaction - the antihistamine makes them very agitated and hyperactive. The second generation antihistamines (loratadine/Claritin, cetirizine/Zyrtec, etc) do not cross the blood-brain barrier, so their effects are limited to only allergy symptoms. Antihistamines ARE safe for children under 6, but they are not useful during a cold, unless the child also has allergies.


- Analgesics and antipyretics are in many cold medicine preparations. Check to see if there is acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) in the preparation, so you don’t take an additional Tylenol/Advil and accidentally overdose. These medicines lower fever by resetting the thermostat in the brain to a normal body temperature. They also help with the aches and pains that come along with being sick. In addition, ibuprofen and other NSAIDs (naproxen, aspirin, etc) are anti-inflammatory. They will make you feel better, but will prolong the course of the illness by about 1-2 days, because they are slowing your body’s ability to fight the infection. Analgesics, antipyretics, and anti-inflammatory medicines should be used as needed for comfort, and should not be given preventatively. Also, NEVER give aspirin to a child/teen 18 years or younger. When a child has a viral infection (flu, cold, etc) and takes aspirin, they may have a reaction called Reye’s Syndrome, where the aspirin poisons the liver and causes liver failure, brain damage, seizures, coma, and death.


- Sugar and honey have been used for centuries for cough. Honey is the best to soothe a child’s cough. It coats the throat and calms down the cough receptors there, and most children like the taste of it. A spoonful of honey before bed, either straight or mixed into hot water/tea, can help you sleep at night if the cough has been keeping you awake. Remember that honey should NEVER be given to children less than 1 year of age, because there is a risk of botulism. Botulism is a very serious disease that attacks the muscles in the body and makes them all weak/limp, including the muscles needed to breathe, which can lead to death. The bacteria that causes botulism is found all over the place (it’s in soil) and produces a spore that is not killed by heat/cold or moisture/dryness, but is killed by stomach acid. Babies don’t produce enough stomach acid to kill the botulism spore. Sugar syrups are safe in children less than 1 year, and work in a similar way to honey, by soothing the throat. There is mixed evidence about whether sugar prolongs the course of illness or not.


- Vitamin C boosts your immune system, to fight off an infection sooner. Don’t take any more than the recommended amount; if you take too much, only some Vitamin C gets absorbed and the rest gets filtered out in your kidneys. Adults who take more than 1,000 mg in a day run the risk of the excess Vitamin C precipitating out in the kidneys and forming kidney stones. For children, the max dose is lower.


- Zinc has been shown to kill viruses on contact in laboratory studies, but it’s just not possible to take enough zinc tablets and get a high enough zinc content in your bloodstream to do that. I recommend lozenges that contain zinc, because they work locally (by slowly releasing zinc in your mouth and coating your throat as you swallow your saliva), and won’t raise the amount of zinc in your bloodstream too much.

- Foods that can help with URIs include: spicy foods such as wasabi or cayenne pepper (they act as decongestants and thin out mucus), raw ginger/garlic (they are spicy and also healing), LOTS of fluids such as herbal tea, soup, and water (staying hydrated will replace the fluid lost by coughing, sneezing, running nose, having a fever, and having a poor appetite).  

- Homeopathic remedies are safe in children, but have not been proven in large studies to be effective. That doesn’t mean they don’t work, it’s just that the results are inconsistent. They seem to help some people and not others. It’s up to you to decide if they are worth trying.


If you find a cold medicine and you aren’t sure what some of the ingredients are or if it’s safe for your child, you can always call or text me (Dr. Carole) to ask about it: 720-418-1705.


For questions about herbal preparations for cough, and for more foods to help you get over an illness, I recommend you speak with my colleague Kodiak Soled. She is a wealth of knowledge on nutrition and herbs. Her number is 513-313-3294 and her website is

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