How to Choose the Best Over-the-Counter Cough Medicine

Dextromethorphan is the active ingredient in single-symptom medications such as:

12 Most Effective Cough Drops to Soothe Your Cold, Flu and COVID Hacking

Some of these lozenges will also give you temporarily relief from a sore throat.

Coughing — especially these days with new strains of COVID and who knows what else flying around — will earn you the side-eye whether you’re hacking away in a crowded elevator or quiet theater.

Other people’s reactions aside (of course, you should stay home if you’re sick!), coughing can be uncomfortable for you, even painful at times. It can also keep you from sleeping, and rest is essential for getting over a virus or bacterial infection, says Pritish K. Tosh, M.D., an infectious disease researcher and physician at the Mayo Clinic in Rochester, MN.

However much you want it to go away, though, in a way your cough is just trying to help you out. “When people are coughing, the lungs are responding to some kind of irritant,” says Dr. Tosh. The purpose of this involuntary reflex is to clear these irritants (such as smoke or pollution) and germs out of your lungs and airway, according to the American Lung Association. We also start hacking when we have a respiratory infection like a cold, COVID or bronchitis; allergies can also trigger coughing. Coughs can also be chronic, resulting from things like acid reflux, asthma, postnasal drip or a lung issue.

“For either of them, acute or chronic coughing, cough drops will help your symptoms,” says Dr. Tosh, though he adds that there is no consistent data to suggest that any of the cough drops (whether they contain vitamin C, zinc, herbs or any other particular ingredient) will actually make your illness less severe or speed your cough along.

How to Choose the Best Over-the-Counter Cough Medicine

There are many over-the-counter (OTC) medicines adults can use to treat a cough, including syrups, lozenges, sprays, and capsules. Each has a different mechanism of action. The “best” cough medicine is ultimately based on the type of cough you have.

• Cough suppressants that temper the cough reflex
• Expectorants that break up mucus so you can cough it up
• Multi-symptom formulas that may include these and other OTC drugs

This article describes how the different OTC cough medicines work, including the possible risks and side effects. It also offers tips on how to treat coughs without medicines and when it is time to see a healthcare provider.

Cough Suppressants

Cough suppressants, also known as antitussives , are a class of drugs that act on the brain to suppress the cough reflex.

There is one OTC antitussive approved for use in the United States called dextromethorphan . It is most commonly sold as a syrup but can be found as capsules and lozenges.

Dextromethorphan is the active ingredient in single-symptom medications such as:

• Delsym (syrup)
• Buckley’s Mixture Cough Suppressant (syrup)
• Vicks 44 Custom Care Dry Cough (syrup)
• Robitussin Long-Acting CoughGels (capsules)
• Sucrets DM Cough Formula (lozenges)
• Dextromethorphan (generic)

Despite their popularity, a growing body of research suggests that cough suppressants aren’t particularly effective, especially in children. Dextromethorphan can also cause significant and sometimes intolerable side effects, including:

• Drowsiness or dizziness
• Blurred vision
• Shakiness
• Restlessness and irritability
• Nausea and vomiting
• Confusion
• Slowed breathing
• Difficulty urinating

Do You Need a Cough Suppressant?

If you have a productive (‘wet”) cough, it is usually more beneficial to cough mucus out of your lungs rather than trying to suppress a cough. Speak to your healthcare provider if you have a “chesty” or “rattling” cough to ensure you are getting the right treatment.

Expectorants

An expectorant is a type of drug that breaks up and thins respiratory mucus so that it is easier to cough up. An expectorant is used when you have a productive (“wet”) cough rather than a non-productive (“dry”) cough.

Guaifenesin is the only expectorant approved for use in the United States. As a single-symptom remedy, it can be found over the counter as:

These medicines are sold as either immediate-release tablets taken every four hours or sustained-release tablets taken every 12 hours. Side effects are relatively mild and may include:

• Dizziness
• Headache
• Upset stomach
• Nausea
• Vomiting
• Rash

How Pneumonia Occurs

Multi-Symptom Cough Formulas

Dextromethorphan and guaifenesin are often combined into multi-symptom cough formulas, most often as syrups or capsules.

Additional drugs may be added to the formula to help ease accompanying symptoms, including:

• Antihistamines like Benedryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine) to ease postnasal drip that contributes to coughing
• Decongestants like Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine) to ease the swelling of blood vessels in the nose that cause nasal stuffiness. However, while phenylephrine is a common ingredient in oral decongestants, it is not considered effective at clearing up congestion
• Pain relievers like Tylenol (acetaminophen) to reduce body aches and fever

There are many multi-symptom cold and cough formulas found on pharmacy and grocery store shelves:

DXM	GUA	CLM/DPH	PSE/PE	ACT
Alka-Seltzer Plus Flu/Body	X	X	X
Alka-Seltzer Plus Severe Cold and Flu	X	X	X	X
Coricidin HBP Chest Congestion and Cough	X	X
Coricidin HBP Cold Cough and Flu Maximum Strength	X	X	X
Coricidin HBP Day and Night Multi-Symptom Cold	X	X	X	X
Mucinex DM	X	X
Mucinex Fast-Max Maximum Strength	X	X	X	X	X
Mucinex Fast-Max Severe Cold	X	X	X	X
Robitussin Cough and Allergy	X	X	X
Robitussin Cough + Chest Congestion DM	X	X
Robitussin Cough and Cold	X	X	X	X
Theraflu Flu Cold and Cough	X	X	X
Theraflu Max-D	X	X	X	X
Triaminic Cold and Couch	X	X
Triaminic Day Time Cold and Cough	X	X
Triaminic Multi-Symptom Fever	X	X	X
Tylenol Cold Multi-Symptom Nighttime	X	X	X	X
Tylenol Cold + Flu Multi-Action	X	X	X
Tylenol Cold	X	X	X	X
Tylenol Cold and Flu Severe Day and Night	X	X	X	X	X
Vicks DayQuil	X	X	X
Vicks NyQuil	X	X	X

Glossary: DXM (dextromethorphan), GUA (guaifenesin), CLM (chlorpheniramine), DPH (diphenhydramine), PSE (pseudoephedrine), PE (phenylephrine), ACT (acetaminophen)

As a general rule, find the formula that treats the symptoms that you have. Taking unnecessary drugs increases your risk of side effects. Examples include:

• Antihistamines: Drowsiness, dizziness, dry mouth, nausea, constipation, headache, nervousness, loss of appetite, vomiting
• Decongestants: Headache, dry mouth, restlessness, insomnia, shakiness, dizziness, rapid pounding heartbeat
• Acetaminophen: Nausea, stomach pain, headache, hoarseness, loss of appetite, itching

Avoid Overdosing

When taking a multi-symptom cough formula, check the product label for all the ingredients it contains. This will help you avoid overdosing if you take another OTC medicine with the same ingredient.

Risks and Considerations

Cough medicines are generally safe but aren’t appropriate for everyone. There are certain people for whom the drugs may pose certain health risks.

Dextromethorphan is generally avoided in people with severe asthma, chronic obstructive pulmonary disease (COPD), or pneumonia. Doing so can lead to a worsening of symptoms by allowing mucus to pool in the lungs rather than being coughed up.

Guaifenesin should also be used with caution in people with severe asthma or COPD unless under the supervision of a healthcare provider.

The American Academy of Family Physicians advises against OTC cough medicines for children under 6 due to the risk of accidental poisoning. These drugs have not been proven to be particularly effective in young children.

When to Call a Healthcare Provider

While most coughs associated with colds and flu can be treated at home, some can get unexpectedly worse or be caused by something far more serious than a cold or flu.

Seek immediate medical care if you have a cough and develop these signs and symptoms:

• High fever with chills
• Shortness of breath ( dyspnea )
• Coughing up greenish mucus
• Coughing up blood ( hemoptysis )
• Bluish fingers, skin, or lips ( cyanosis )
• Coughs with a whooping, barking, or wheezing sound

Other Ways to Treat a Cough

Whether you’re avoiding cough medicines or need more relief than they offer, these tips may help alleviate your cough:

• Drink a lot of fluids to thin and loosen mucus and soothe your throat.
• Use extra pillows to elevate your head when you sleep.
• Don’t smoke.
• Avoid airborne irritants such as smoke, pollution, or dust.
• If you can’t avoid irritants, wear a mask.
• Use a humidifier to help keep your airways from drying out.
• Breath in warm mist, such as from a shower.
• For a hacking cough, try hot water, tea, or lemon juice with honey.

Research suggests honey may be more effective than cough syrups.

Summary

Cough medicines for adults include cough suppressants, expectorants, and multi-symptom cough formula.

Dextromethorphan is the suppressant used in OTC remedies that acts on the brain to suppress the cough reflex. Guaifenesin is the OTC expectorant that thins mucus so you can cough it up. These drugs can be co-formulated in multi-symptom remedies along with antihistamines, decongestants, and pain relievers.

Cough medicines should not be used in children under 6 years.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. MedlinePlus. Dextromethorphan.
2. Wark P. Bronchitis (acute). BMJ Clin Evid. 2015;2015:1508.
3. MedlinePlus. Guaifenesin.
4. National Capital Poison Center: Poison Control. Cough and cold medicine safety.
5. American Academy of Family Physicians. OTC cough and cold medicines and my child.
6. American Lung Association. Learn about cough.
7. Kaiser Permanente. Relieving a cough.
8. Seattle Children’s Hospital. Coughs: Meds or home remedies?

By Kristina Duda, RN
Kristina Duda, BSN, RN, CPN, has been working in healthcare since 2002. She specializes in pediatrics and disease and infection prevention.

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