cough season

of all the cold symptoms, cough is, in my opinion, the worst of them. how it lingers. how it interrupts sleep - yours and your bedmate’s. how it can be so severe and so persistent that you end up with muscle spasms or - and this happened to my husband - tearing your vocal cords. and the underlying causes can be many. so it’s important to know what kind of cough and the underlying cause of it. in this post, i discuss OTC treatments for “dry: and “wet” cough. importantly, there is coughing related to other causes (e.g., asthma) that cannot be treated by OTC medicines and requires a prescription medication.

there are two OTC medications for cough:

• dextromethorphan - for adults i recommend the liqugels; for kids i like the 12-hour suspension* (DO NOT USE BRAND NAME DELSYM(R) - SEE NOTE)

  this is a cough suppressant. it works by suppressing the cough reflex. it works well for a nagging dry cough, in the beginning. dextromethorphan is chemically related to opioids, but it is not an opioid. like individuals using opioids develop tolerance, tolerance to the cough suppressant effects quickly develops, after which it effectively stops working. (note: dextromethorphan is increasingly abused by consuming large doses. this is dangerous and any doses in excess of the labeled dose are NOT recommended.)

  *IMPORTANT: i have found brand name Delsym to have the incorrect markings on the dosing cup where what is marked 2.5 mL is actually 3.75 mL - this is 1.5 times the recommended dose for a child ages 4 to 6 years (READ: OVERDOSE). i have reported this issue to the FDA and the manufacturer, without adequate remediation. this product should have been recalled but has not been.

• guaifenesin - if someone wants this ingredient, i recommend the high-dose, extended-release product (i.e., Mucinex(R) or the generic).

  this is an expectorant. it (theoretcially) works by breaking up mucus making it easier to cough up. in my learnings, it does not work. anecdotally, many individuals report Mucinex (high-dose, extended-release guaifenesin) does work. i’ve even heard these reports from other pharmacists who are admittedly skeptical about the effectiveness of guaifenesin. i have to wonder if the effectiveness is attributable to marketing. Mucinex has been heavily marketed since its introduction to the market. it’s worth noting that Mucinex is quite expensive.

TAKEAWAYS

i like dextromethorphan. it works, but i use it SPARINGLY to prevent tolerance/to ensure it continues to work. if i give it to my children, i try to avoid giving it during the day and reserve it for night so they can sleep. DO NOT USE BRAND NAME DELSYM; THE MARKINGS ON THE DOSE CUPS HAVE BEEN FOUND TO BE INCORRECT.

i do not like or use guaifenesin. i do not think it works. personally, i especially do not use Mucinex(R) due to the high cost. however, if an individual strongly desires a guaifenesin product and has a “wet” cough, i recommend high-dose, extended-release guaifenesin (i.e., Mucinex) based on anecdotal evidence.