What’s the Best Cough Medicine?

tissue box, thermometer, and flu medication
Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Is your cough keeping you awake or driving your co-workers crazy? Read on—you are sick with a viral upper respiratory infection and the cough is bugging you all day. Yes, there are many opiate/narcotic prescription cough suppressants like promethazine/codeine (aka Sizzurp) that work well at night to suppress cough. But we can’t use those all the time for many reasons: you can’t afford to feel dopey during the day, codeine makes many folks nauseated, and it’s habit forming. So what should you take for your cough?

Acute cough due to viral upper respiratory tract infection (URI) is the most common form of cough and a ton of money is spent on prescription and non-prescription cough medications. However, you will be surprised to know that studies show over-the-counter cough suppressants like Robitussin aren’t any more effective than placebo.

Benzonatate, the generic for Tessalon Perles, does work. In fact, in combination with guaifenesin, it works even better. One study showed the prescription benzonatate capsule together with over the counter Mucinex (guaifenesin 600 mg) is a great combination. Benzonatate 200 mg capsule plus Mucinex 600 mg tablet suppresses cough to a greater degree than one alone.

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How do they work? Benzonatate is a non-narcotic cough medicine that acts by numbing the stretch receptors of nerves located in the alveoli of the lungs, the airways and the pleura (lining of the lung). Mucinex, on the other hand, acts as an expectorant by irritating the stomach lining and stimulating respiratory tract secretions. In doing so, Mucinex increases respiratory fluid volumes and decreases mucous viscosity (thickness or stickiness). With a full glass of water, Mucinex is used to help loosen phlegm and thin bronchial secretions to make coughs more productive.

Dr O.

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