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Cough can be referred to as a reflex action of the body to clear the throat and the air passages of the respiratory tract. However, excessive coughing needs the administration of medications or medical attention. Acute cough (lasts for 2–3 weeks) is usually associated with common conditions such as cold, flu or sinusitis, while chronic cough (more than 2–3 weeks) may result due to a variety of causes such as asthma, lung infections, lung disorders, exposure to pollutants, smoking, etc.1,2

OTC Medications

The common over-the-counter (OTC) medications for cough have been grouped as:

  • Expectorants
  • Mucolytics
  • Antitussives
  • Decongestants
  • Antihistamines

These medications should not be given to children under 2 years of age and young children unless advised by a physician. 1, 3


These drugs help in increasing the volume of the sputum thereby facilitating the removal secretions from the respiratory tract. Guaifenesin (glyceryl guiaiacolate) is the only expectorant that has been approved for OTC use.


Productive cough.


  • Known allergy to the drug
  • Persistent cough due to asthma
  • Children below 2 years


  • Gastric irritation
  • Dizziness
  • Headache
  • Rashes


The thick sputum is broken down by these drugs, which help in easier removal of the sputum thereby clearing the airway. Some of the commonly available OTC mucolytic agents include:

  • Acetylcysteine (fluimucil and ACC syrup)
  • Carbocisteine (rhinathiol 2% syrup)
  • Bromhexine hydrochloride (vasican, bisolvan)
  • Ambroxol  hydrochloride (mucosolvan)


Productive cough with thick phlegm.


  • Known allergy to the drug
  • Individuals with peptic ulcers


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The antitussives moderate the cough reflex either locally (in the throat or mouth) or centrally (act on the nerves that carry the cough sensation). Drugs that are categorized as centrally acting antitussives include:

  • Codeine phosphate (procodin, phensedyl, fedac compound, dhasedyl)
  • Pholcodine
  • Dextromethorphan

Further codeine and pholcodine are grouped as narcotic antitussives while dextromethorphan falls under non-narcotic antitussives.


Cough, which is associated with allergy or common cold.


  • Known allergy to the drug
  • Individuals suffering from disorders such as asthma
  • Individuals who are receiving other similar drugs
  • Pregnant women and breast-feeding women


  • Constipation
  • Dependency on the drug (especially codeine)


Decongestants are primarily used to relieve nasal congestion, but may be available as a combination with the other cough medications for nasal congestion associated with cough. The main drugs under this category include:

  • Ephedrine
  • Pseudoephedrine


Nasal congestion associated with cough.


  • Unwanted stimulation of the nerves of the heart and central nervous system (effect more prominent in elders and children)
  • Interact with other drugs such as furazolidine, tricyclic antidepressants, urinary acidifiers and urinary alkalinizers
  • Can exacerbate underlying conditions such as hypertension, diabetes, hyperthyroidism, heart disease


Antihistamines are primarily advised to counter inflammatory or allergic conditions. These are sometimes included in cough medications for their antitussive action. Some of the common antihistamines include:

  • Chlorpheniramine
  • Dexchlorpheniramine
  • Diphenhydramine
  • Cetirizine


Nasal congestion associated with cough.


  • Dose dependent action on the central nervous system
  • Sensitivity to light

OTC Cough Medications

The OTC cough medications generally include a combination of the different drugs given above. These medications can be used for acute cough, which is not associated with any other underlying disorder. Prompt medical advice should be obtained for chronic cough.4,5

The commonly available OTC cough medications have the following combinations:

  • Expectorant combinations
  • Antitussive combinations
  • Narcotic antitussives with expectorants
  • Nonnarcotic antitussives with expectorants
  • Antitussive and expectorant combinations

When to Seek Medical Help for Cough

Prompt medical care should be sought in the following instances:

  • Cough in babies younger than 3 months
  • Cough that lasts longer than 2–3 weeks
  • Shortness of breath or difficulty in breathing
  • Cough associated with high-pitched sound (stridor)
  • Coughing out blood
  • Cough associated with fever or yellowish-green, thick and foul-smelling phlegm
  • History of heart disorders, swelling in legs, or cough that worsens while lying down
  • Cough associated with unintentional weight loss or night sweats


  1. Rubin BK. Mucolytics, expectorants, and mucokinetic medications. Respir Care. 2007; 52(7): 859–865.
  2. Chang AB. Cough: are children really different to adults? Cough. 2005, 1: 7.
  3. American Academy of Pediatrics. Use of codeine- and dextromethorphan-containing cough remedies. Pediatrics. 1997; 99: 918–920...
  4. Kutcher ML.  Cold, cough and allergy medications: Uses and abuses. Pediatr Rev. 1996; 17: 12–17..
  5. Gunn VL, Taha SH, et al. Toxicity of Over-the-Counter Cough and Cold Medications. Pediatrics. 2001; 108(3): E52.

Written by: team
Date last updated: May 10, 2015