Cough Treatment and Support: Medicines and Alternative Options
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Jan 15
- 14 min read
Updated: May 20
IF IT IS ONLY A COUGH AND YOU HAVE HAD IT FOR LESS THAN ONE TO TWO WEEKS, MOST PRACTITIONERS WILL NOT PRESCRIBE ANTIBIOTICS BECAUSE COUGHS ARE MOST OFTEN DUE TO VIRUSES AND ANTIBIOTICS DO NOT KILL OR INACTIVATE VIRUSES
After many studies, the National Institute of Health and many other research organizations have determined that 90-95% of the cases of acute bronchitis are viral. They warn people not to jump to antibiotics early on unless necessary because overuse of antibiotics not only leads to personal but also to community antibiotic resistance (a sad state of affairs where antibiotics will not work at all!). So don't be too surprised if your healthcare provider does not give you one and offers other treatments and remedies, some of which will be far more effective! Stop it in its tracks early by other means if possible.
Viral bronchitis is typically self-limiting but can become bacterial and evolve into pneumonia, in which case, an antibiotic may be justified. To complicate things, sometimes you can have both!
Cough medicines and supplements available for a cough
At the clinic, we get plenty of visits and calls from people worried because, three weeks after the initial onset of their illness, they still have a hacky cough after all their other symptoms have gone away. A viral cough can take anywhere from three to eight weeks to go away (depending on what resource you read but typically lasts three to four)
Treatment and Support for A Cough
Choosing a Cough Medicine
It is important to decide what type of cough you have before taking an over-the-counter medicine. Do you have no mucus, thin/watery mucus, or thick mucus? Also, know this: There are NO perfect one-size-fits-all cough medicines: Prescription, over-the-counter (OTC). or herbal remedies.
Because antibiotics do not usually work, early symptomatic treatment is the key.
Most patients with bronchitis present with different symptoms. Most say they grabbed the first thing they found in their medicine cabinet - often take a multi-symptom cold and flu medicine like Dayquil or Nyquil. Still, unless you have ALL the symptoms listed on the label, it makes more sense to treat each symptom separately instead. Bronchitis almost always starts with lung congestion followed by a persistent, irritating cough, which tends to be the worst and most annoying symptom. Some people also have sinus drainage; others have a sore throat, headache, fever, body aches, and maybe ear pain/congestion. So, it only makes sense that a person takes medications tailored to particular symptoms. Why take something in a multi-symptom medicine that you do not need or should not be taking? (i.e., some cold medications cause high blood pressure).
People also tend to duplicate medicines. They take too much of one thing when they take a multi-symptom medicine plus a dose of either acetaminophen (common: Tylenol) or ibuprofen (common: Advil, Motrin). This occurs all too often. Almost all multi-symptom medicines contain either acetaminophen or ibuprofen, so those taking those medications in addition to multi-symptom medications cause a potential "overdose" - a bit of a kidney or liver overload.
Should you be taking a multi-symptom cold medicine? Ask yourself a few things before taking one of these conglomerations. READ the ingredients
1) Read the ingredients on the label: Do you have an intolerance or contraindication to a particular component of that medication? (for example, high blood pressure can be affected by some over-the-counter cold medicines like ibuprofen or pseudoephedrine, otherwise known as medicines with a "D").
2) Have you been taking Acetaminophen (common: Tylenol) or Ibuprofen (common: Advil, Motrin) in addition to the cold and flu medicine? If so, you may be taking too much.
3) Ask yourself: Do I really need all of this? An expectorant to water down your mucus; a cough suppressant? A decongestant to open your sinus, an antihistamine (to dry "stuff" up), a pain medicine (to help with pain and body aches), and an antipyretic (to lower a fever)? If so, the multi-symptom medication may be right for you.
4) Ask yourself: Are any of the components of the multi-symptom medicine - be counterproductive for my symptoms (will it dry out the mucus in my lungs and sinus too much and cause it to fester? (i.e., an antihistamine)
If you decide that a multi-symptom medication is suitable for your symptoms, below is a list of some popular ones with a brief description of what they are and what they do.
If you choose to treat just one or two symptoms, there is also a list of single and double-symptom over-the-counter and herbal remedies.
Over-the-Counter/Multi-symptom Cold and Flu Medicines
About Ingredients:
In efforts to compete over the last few years, many, many over-the-counter (OTC) cough/cold and flu products have been added to pharmacy shelves. It's mind-boggling. Interestingly, most contain similar, if not the same, ingredients. Many contain two or three of the following:
1) A fever reducer and pain killer - Tylenol (acetaminophen) or Motrin/Advil (ibuprofen).
2) An antihistamine (chlorpheniramine, doxylamine, or diphenhydramine) for a runny nose/congestion (These may help decrease watery and itchy eyes, runny nose, postnasal drip - and sneezing. They also tend to dry a person out too much!
3) A cough suppressant (dextromethorphan or "DM"). This works on cough centers in the brain).
4) An expectorant - Mucinex (guaifenesin) (only in a few cold preparations) - An "expectorant" that helps break up very thick mucus so you can cough it up or blow it out of your sinus.
5) A decongestant - Pseudoephedrine and Phenylephrine. Pseudoephedrine: Often, these products have a "D" on the label. It has a lot of potential side effects, like high blood pressure, palpitations, insomnia, and jitteriness. And while some people like that "energy," others do not at all. In fact, in some states, you need to buy this directly through the pharmacy and sign for it in the pharmacy because people were making meth with it. Phenylephrine (also called "PE"): This is also considered, by pharmaceutical companies, a "decongestant." Interestingly, recent reports state that phenylephrine does NOT work for anything (which is consistent with what many of my patients have told me). Anyway, that is very odd because it has been on the market for so long and is in so many over-the-counter medications (still on the shelves!). What are these drug companies going to do with all of the excesses?? Maybe sell it until it is gone?
If you use a decongestant or antihistamine, they tend to dry out mucus, so stay well hydrated.
Again, most of the time, you do not need all of the components in multi-symptom medications. consulting the pharmacist if you have questions about the best over-the-counter medicine. Tell them your symptoms. They know their over-the-counter medication well, and they can help.
Some of the more popular ones I hear about from patients include the following:
Dayquil - Tylenol/acetaminophen (pain killers and fever reducer), dextromethorphan (cough medicine), and phenylephrine (?nasal decongestant)
Nyquil - For nighttime use. Tylenol/acetaminophen (pain killers and fever reducer), dextromethorphan (cough suppressant), and doxylamine (antihistamine). (for nighttime use). This is a patient favorite: "It helps me sleep through my symptoms." Again, this may dry you out—possibly too much—so stay well-hydrated.
Advil Cold and Flu - Motrin/ibuprofen (pain killer, anti-inflammatory and fever reducer), phenylephrine (?nasal decongestant), chlorpheniramine (antihistamine)
Coricidin - Tylenol/acetaminophen (pain killer, fever reducer), chlorpheniramine (nasal antihistamine). Mixed reviews.
Coricidan HBP: Tylenol/acetaminophen (pain killer, fever reducer), chlorpheniramine (nasal antihistamine), dextromethorphan (cough suppressant). Patients give very mixed reviews on this.
Mucinex MAX: Tylenol/acetaminophen (pain killer, fever reducer), guaifenesin (expectorant), phenylephrine (?nasal decongestant)
Alka Seltzer Cold and Flu (Day): Tylenol/acetaminophen (pain killer/fever reducer), dextromethorphan (cough suppressant), phenylephrine (?nasal decongestant)
Theraflu: Tylenol/acetaminophen (painkiller/fever reducer), dextromethorphan (cough suppressant), and phenylephrine (nasal decongestant).
If you choose not to take a multi-symptom medication, you can specifically target your symptoms with the following over-the-counter medications, herbal remedies, and prescriptive treatments. Click on one of the following to learn more.
Over-the-Counter Cough Medicines for Dry or Wet/Watery Cough
Over-the-Counter Cough Medicines
Note: Some herbal remedies are contained in over-the-counter medicines
Dextromethorphan ("DM" or Delsym) is reputed to be the best over-the-counter cough medicine. It generally takes the edge off your cough and can be taken during the day—usually without making you sleepy. It works on cough centers of the brain.
Cough Lozenges - Ricola Natural Herb (contains many herbs reputed to help cough and sore throat)-somewhat effective directly after taking them
Fisherman's Friend - This lozenge also contains several reputed herbals and has very good reviews as a cough suppressant.
Diphenhydramine (Benadryl) also inhibits coughs (it works on cough centers in the brain) and may be good to take at night because it also makes you sleepy. Sometimes, patients complain of being tired in the morning when taking it at bedtime (also called the "hangover effect"). This antihistamine will dry you out, so stay hydrated if you take it.
Vicks VapoRub is an over-the-counter herbal preparation that has existed for a long time. It is a cough suppressant and topical analgesic containing camphor and some interesting "herbal" components: eucalyptus oil (also a cough suppressant), menthol (also a cough suppressant), cedar leaf oil, nutmeg oil, petrolatum, thymol, and turpentine oil. Many people feel this works well when applied to the chest and sometimes the neck.
Question: Does Vicks VapoRub work for a cough when you put It on the bottom of your feet?
Patients tell me (and ask me) about putting Vicks VapoRub on the bottom of their feet when at rest to stop a cough. Some tell me it works well. There is no good study on this, little explanation as to why it would work, and no hardcore evidence for or against it except patient testimonies. If all else fails, some patients say it works so it may be worth a try—even if it's just a placebo effect (if nothing else, it may get rid of athlete's foot!).
Natural/Herbal Cough Remedies
Cocoa and Dark Chocolate - Studies show that theobromine, an ingredient found in cocoa and dark chocolates, may be an effective cough suppressant - particularly with an ongoing cough. However, do be careful if you take this route because theobromine also has several potential interactions with your regular medications and causes side effects
Ginko Biloba - Claims to be an effective cough suppressant
**Most herbal remedies for cough are a combination antitussive (cough suppressant) and expectorant (thins mucus) - see below for more
Prescriptive Cough Medicines
Benzonatate—Tessalon Perles—Is a frequently used prescription cough medicine in the form of a gel-type capsules. Benzonatate works on the airways and may work on the cough centers of the brain. It works reasonably well for a mild to moderate cough but generally gets pretty fair reviews for a severe cough. It is often prescribed in 100—to 200 mg capsules. From what my patients say, the 200 mg capsules are generally more efficacious, judging from what my patients say.
Promethazine DM (common: Phenergan DM) - According to our patients, this works well for coughs. It is especially good at night because it contains a sedating antihistamine and dextromethorphan (a cough suppressant).
Bromphed DM—This is also a prescription medicine. It contains a sedating antihistamine, antitussive (DM), and decongestant. It has high levels of Sudafed, so the person who uses this drug may be subject to potential side effects of Sudafed, such as insomnia, palpitations, and transiently increased blood pressure. Because two of the agents in this medication are drying agents, the user must stay hydrated.
Codeine - Codeine is a narcotic medication that works on cough centers of the brain and for pain. It has a sedating effect as well. There are several cough preparations with codeine in them, including codeine and guaifenesin (expectorant to loosen up your mucus), codeine and promethazine (an antihistamine to help dry out your mucus), and codeine with pseudoephedrine (decongestant) with guaifenesin (expectorant). Other non-narcotic preparations tend to work just as well and codeine may be a bit overrated. Because it is a narcotic (a scheduled drug), it is not prescribed a lot, and there may be limitations on provider prescribing.
Albuterol - An albuterol inhaler is sometimes suitable for a cough accompanied by "tight" inflamed airways, wheezing, or mild shortness of breath. It can provide some immediate relief.
Prednisone and Dexamethasone - These are corticosteroids. They are some of the best medications for treating a cough, especially if accompanied by shortness of breath, wheezing, or chest discomfort. Often, a cough is, at least in part, due to inflammation in the airways and lungs. Prednisone helps to decrease inflammation in the respiratory tract, so it helps reduce the cough. The biggest problem with this medication is that it increases blood pressure, blood sugar, "rage," and psychosis, so it cannot easily be given to people with those problems.
Mild Cough with Thick Mucus-Expectorant Only
Over-the-Counter
Mucinex Plain (guaifenesin only)—Expectorant only. This may help if your mucus is thick: It helps loosen thick, stubborn mucus so you can clear it up by coughing and blowing it out. You need to drink plenty of water while taking this so that it will work. If you have a sinus issue, the best time to use this is in the morning to prevent postnasal drainage from going down your throat at night.
OR
Mucinex DM - The guaifenesin in this loosens mucus, AND the dextromethorphan helps suppress a cough. So, it is an expectorant/cough suppressant preparation. Like their competitors, Mucinex's makers have created a plethora of combination cold and flu preparations, many of which contain a "DM" (dextromethorphan)component—again, dextromethorphan.
Guaifenesin is a component of many over-the-counter combination medicines and is often unnecessary unless you have thick mucus. There are also generic forms of both Mucinex and Mucinex DM (guaifenesin products) that are usually less expensive.
Frequent Cough - Thick Mucus - Expectorant AND Cough Suppressant
Over-the-Counter Cough Medicines
Guaifenesin and dextromethorphan (common: Mucinex DM) - Again, this contains the expectorant (guaifenesin) and a cough suppressant (dextromethorphan). Sometimes, this combination seems a little contradictory. One wonders how you loosen up mucus and get it out of your chest if your cough is suppressed. All I can figure out is that it modifies your cough to a more tolerable level - still there but less often and more effective. Some people report stomach problems and diarrhea with the high dose Mucinex MAX.
Zarbees Cough Syrup + Mucus is another cough suppressant/expectorant sold over the counter. It is primarily herbal, containing ivy leaf (see below), honey, thyme, grapefruit seed, mallow, vitamins C and D, and minerals (zinc). If you are looking for a natural product, you might try this.
Natural and Herbal Cough Remedies
A lot of alternative herbal products claim to help a cough (antitussives) and to loosen up your mucus (expectorant). Many of these have been used for years. In fact, the over-the-counter expectorant Mucinex (guaifenesin) originated from a plant. Some of the better-known cough suppressant/expectorant herbs (in the United States) are listed below. The list is far from inclusive of all herbal remedies.
Below is a list of links to different herbs, most of which claim to have cough suppressant and expectorant properties (some claim to have several other beneficial actions as well). Some of these alternatives are reputed to be as good - if not better - than some of the other over-the-counter brands of cough medicines. However, efficacy, standardization, and purity are difficult to determine because the FDA does not test or approve them. While I have given the reader a link to each herb, I recommend that you also do some personal research into the efficacy of the alternatives you may be interested in (check German Commission E, Drugs.com, Web MD, National Institute of Health, and ConsumerLabs, among others).
Typically, herbal remedies are taken in capsule, tea, powder, or extract forms (also see "oils" below). If you choose to use any, check for side effects, medication interactions, dosage, and preparation details.
Anise- Germany Commission E approved- expectorant and cough suppressant.
Acacia Catechu - Expectorant and cough suppressant
Adhadtoda Vasica - Expectorant and cough suppressant
Andrograhis - Expectorant and antitussive
Coltsfoot - Antitussive and expectorant
Comfrey - Antitussive and expectorants
Elecampane is an antitussive and expectorant. It is claimed to have antibacterial, antiseptic, antitussive, and expectorant properties.
Garlic - Antitussive and expectorant
Ginger - Antitussive and expectorant properties.
Goldenseal - Antitussive and expectorant
Holy Basil - (Tulsi )- expectorant, antitussive.
Honey is a mild expectorant and antitussive with some antibiotic properties. However, not all honeys are created equal in their medicinal properties.
Horehound - An expectorant to break up mucus and antitussive to stop cough. It is also reputed as an antispasmodic (reduces muscle spasms) and analgesic (pain killer). Horehound is claimed to be one of the most commonly used and effective herbs for a cough and has been cited as beneficial by the German Commission.
Hyssop - Antitussive and expectorant. Anti-inflammatory.
Ivy Leaf - This herb is an expectorant and antitussive. (ALSO has possible antispasmodic, anti-inflammatory, bronchodilator ["opens airways"], antimicrobial, and possible antiviral effects). It can help with a wet or dry cough.
Ivy Leaf—This herb reportedly helps decrease a cough and is an expectorant, anti-inflammatory, antispasmodic, antibiotic, and antiviral, among other properties. It works with both wet and dry coughs. German Commission e approved.
Licorice - Antitussive and expectorant
Lobelia - Antitussive and expectorant
Marshmallow (Mallow) coats the throat, decreasing the irritation that causes cough. It is also an expectorant. German Commission e approved.
Menthol/Peppermint - Cough suppressant and expectorant
Mullein - Cough suppressant and expectorant. Coats the throat, decreasing the irritation that causes cough.
Plantain - Cough suppressant and expectorant. It coats the throat, decreasing the irritation that causes the cough.
Sage - An expectorant and antitussive
Slippery Elm is an antitussive (helps stop cough) and an expectorant. It soothes the throat by coating it, decreasing the irritation that causes coughs and helping mobilize mucus so it can be coughed up.
Thyme - Antitussive and expectorant (antiviral, antibacterial, and antifungal).
Tumeric - Cough suppressant, possible expectorant, and bronchodilator. It is also claimed to be an anti-inflammatory.
White Pine - Antitussive and expectorant
Wild Cherry Bark - Cough suppressant and expectorant with some possible sedating effects
Yerba Santa - This is reportedly a good antitussive and claims to be an excellent expectorant - suitable for many respiratory illnesses.
Essential Oils for Coughs-
The best methods to deliver these oils for cough are by using a few drops in a steam preparation or via a diffuser:
Eucalyptus - Expectorant and a cough suppressant with claimed antimicrobial properties (1)
Peppermint - Decongestant and expectorant, anti-inflammatory
Lavender- This oil acts as an expectorant and suppresses lung inflammation, which helps decrease coughing (3).
Thyme - An antitussive and expectorant, and possibly antispasmodic (decreases coughing spasms)
If you are interested in using oils, there are also a few essential oils producers who make well-known combination products like DoTerra (Breathe) and Thieves Oil (Young Living)
Prescriptive Treatment of a Bacterial Cough
Conventional treatment prescribed by your primary care provider for bacterial bronchitis may include:
A bronchodilator inhaler/beta-agonist (often albuterol) or nebulizer which helps relax constricted airway
Possibly oral corticosteroids
An antibiotic
A more potent, prescription cough medicine - especially so you can sleep at night.
The practitioner may recommend a chest x-ray if they feel there may be complications like pneumonia. But, as mentioned, it is essential to understand that a viral cough can linger...and linger and linger and is often NOT pneumonia, especially in the absence of other symptoms. We do not want you to be in denial, but please don't join this bandwagon too quickly. Plenty of coughing patients feel they need chest X-rays. Often, these are negative, and while there is a minimal chance of a chest X-ray causing cancer (4), you don't want to be radiated too much unless you really have to be.
If you have underlying problems—especially lung problems like asthma and COPD (chronic bronchitis, emphysema)—if you are a senior, if you have immune-compromising illnesses, insulin-dependent diabetes, or heart problems, or if you are at risk for pneumonia, it may be wise to see a medical practitioner early on to discuss prescriptive treatments.
If your illness has lasted more than seven to ten days (some sources say 14 to 21 days) and does not seem to be getting better (or is getting worse), If you have a pulse ox to measure your oxygen level and it is consistently hovering around 90-92%; if you have a consistently higher heart rate (90-100's or more), or if you have an ongoing fever you may be wise to see a healthcare provider for further evaluation. You may need testing and more aggressive prescription treatment. In that case, you may have developed a secondary bacterial infection.
Not sure what’s causing your cough? Is it going on eight weeks or more? It is important to consider other possible causes and take different approaches.
