Which Is the Best Cough Medicine: Prescription vs. OTC?

Reviewed by Preeti Parikh, MD | September 10, 2022

Key takeaways:

There are many over-the-counter (OTC) and prescription cough medicines available. The best choice for you will depend on the cause and nature of your cough.
Dextromethorphan (Delsym), a cough suppressant, and guaifenesin (Mucinex), an expectorant, are two popular OTC cough medicines. Antihistamines, such as cetirizine (Zyrtec), and decongestants, such as pseudoephedrine (Sudafed), can also be helpful if postnasal drip is contributing to your cough.
Examples of prescription cough medicines include benzonatate (Tessalon) and codeine-containing cough syrups, such as promethazine / codeine. A rescue inhaler, such as albuterol (Ventolin HFA), may be helpful if your cough is causing wheezing.

Reviewed by Preeti Parikh, MD | September 10, 2022

Is your cough keeping you up at night or making it hard to get through the day? In most cases, a short-term cough is caused by a viral respiratory infection, such as the common cold, COVID-19, or the flu. But sometimes coughing can be linked to an ongoing health issue, such as chronic obstructive pulmonary disease (COPD).

If you’re looking for a cough medicine to relieve your symptoms, it can be hard to know which one to choose. There are many prescription and over-the-counter (OTC) options available. But studies show they don’t all work. So, what should you take for your cough?

Learn more with this guide to the best cough medicines to consider.

Best over-the-counter cough medicines

There are many OTC cough medicines to help manage an acute cough — from syrups and pills to lozenges. But not all OTC cough medications are created equally or work the same way. Check out options below that you can find on the shelves of your local pharmacy or supermarket.

Cough suppressants

Cough suppressants (antitussives) help by controlling your cough reflex. A common example is dextromethorphan (Delsym). Cough suppressants usually work better for a “dry” (nonproductive) cough, which commonly results from irritation.

Dextromethorphan is typically well tolerated. But it can cause potentially serious side effects if you take too much. Adults shouldn’t take more than 120 mg per day of dextromethorphan, and kids younger than age 12 should take even less. Reach out to your pharmacist with any questions about how to take dextromethorphan safely.

Expectorants

Cough expectorants, such as guaifenesin (Mucinex), work by loosening up and thinning the mucus in your throat. This allows you to cough up the mucus more easily. For this reason, they work better for a “wet” (productive) cough.

Guaifenesin products work best when you drink plenty of water. Guaifenesin and water work as a team to help break up your mucus.

Cough drops

Cough drops are a convenient option to help soothe a sore throat or cough. Products such as menthol cough drops (Halls, Ricola) have a cooling effect in addition to opening your airways to help prevent coughing. Pectin cough drops (Luden’s) are another option to soothe a sore throat.

EXPERT PICKS: WHAT TO READ NEXT

Managing symptoms: Learn more about home treatments that can help soothe a dry cough and clear up a wet cough.
Dealing with a nagging cough: Sometimes a cough lingers and won’t go away. Explore causes of and treatments for a persistent cough.
Seeking medical care: Should you see a healthcare professional for that cough? Knowing when to seek treatment can help you avoid more serious health issues.

It’s best for kids under 4 years old to avoid cough drops, though, to prevent choking.

Antihistamines and decongestants

Antihistamines and decongestants work by targeting postnasal drip that may be triggering your cough. Cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) are all go-to oral antihistamines for this use. These nondrowsy antihistamines typically last for 24 hours. Astepro Allergy (azelastine), an antihistamine nasal spray, is another option.

A common decongestant is pseudoephedrine (Sudafed). It works well, but it comes with more risks. It’s best to avoid taking it close to bedtime since it can cause problems falling asleep. Pseudoephedrine can also raise your blood pressure. If you have hypertension (high blood pressure), your healthcare professional may recommend avoiding pseudephedrine products.

Steroid nasal sprays

Corticosteroid (steroid) nasal sprays can help clear up your cough by reducing swelling in your nose and clearing up mucus. Check out these examples:

Fluticasone propionate (Flonase Allergy Relief)
Fluticasone furoate (Flonase Sensimist)
Budesonide (Rhinocort Allergy)
Mometasone (Nasonex 24HR Allergy)

Combination products

Many OTC products combine multiple cough medicines into one pill or liquid. These include products such as cetirizine / pseudoephedrine (Zyrtec-D), guaifenesin / dextromethorphan (Mucinex DM, Robitussin DM), and more.

Make sure to check out the “Drug Facts” label before purchasing a combination product. This lists all the active ingredients in the cough medicine. This is a good safety check to make sure you aren’t doubling up on any medications. You’ll also want to make sure you’re not taking something you don’t need. For example, acetaminophen (Tylenol) is found in many cough and cold medications. If you’re not in pain or don’t have a fever, acetaminophen isn’t necessary.

Take our quiz: OTC cold and cough medicines

Best prescription cough medicines

If OTC products aren’t working for you, prescription cough medications are sometimes needed to manage a cough. The best cough medicine depends on your age and symptoms, so let’s take a closer look at cough medications your healthcare professional may prescribe.

Non-narcotic cough suppressants

Your prescriber may consider benzonatate (Tessalon) capsules if you have a nagging, dry cough. Benzonatate is a prescription, non-narcotic antitussive medication. It works by numbing parts of your airways and lungs. It’s FDA-approved for adults and kids ages 10 years and older.

Good to know: Keep benzonatate out of reach of kids. The FDA has received reports of kids under age 10 accidentally ingesting benzonatate. Serious side effects include seizures, coma, and death. If your child accidentally takes benzonatate, seek emergency medical care right away.

Inhalers

If your healthcare professional hears wheezing with your cough, they may prescribe a rescue inhaler, such as an albuterol inhaler (Ventolin HFA). Rescue inhalers are also routinely used for conditions such as asthma and COPD. Keep in mind that routine use of rescue inhalers has not been shown to lessen the severity of an acute cough or shorten its duration.

Narcotic cough suppressants

Codeine-based cough suppressants, such as promethazine / codeine and hydrocodone / homatropine (Hycodan), are another option to consider. But they should only be used short term in adults. These prescription medicines are controlled substances and can be habit-forming.

Codeine and hydrocodone cough syrups also carry a number of serious risks, including trouble breathing and even death. These risks are greatest in children. That’s why they’re only approved for adults ages 18 and older.

Best cough medicine for kids

For infants and children under age 4, it’s recommended to completely avoid OTC cough medicine. And for children between ages 4 and 6, it’s a good idea to speak with their pediatrician before giving them any cough medication. Some active ingredients may not be safe for kids in this age group.

Instead, to help loosen or remove mucus and soothe cough, considering trying:

Humidifiers
Saline nose drops
Mentholated chest rub ointments, such as Vicks VapoRub
Honey (for children ages 1 year and older only)

For kids ages 6 and older, you can use OTC cough medicine according to the directions on the label. These may include:

Cough suppressants such as dextromethorphan
Decongestants such as pseudoephedrine
Expectorants such as guaifenesin
Antihistamines such as cetirizine
Combination medications such as dextromethorphan / brompheniramine (Dimetapp Cold & Cough)

What does the research say?

There’s no lack of options when it comes to choosing a cough medicine. But do they really work? According to a 2014 review, there’s not enough evidence to say for sure.

The review included 29 studies and looked at antitussives, expectorants, and antihistamines, as well as others. Less than half of them showed a benefit for acute cough. What’s more, the other studies showed that the medications weren’t any more effective than a placebo (a pill or liquid with no medication in it).

The review concluded that there’s minimal evidence for or against the effectiveness of these medications for an acute cough. More research is needed in this area.

Important safety considerations

Using the right dose of a medication is key, especially for kids who are using a liquid medication. Always use the measuring device that comes with your child’s cough medicine to make sure they get the correct dose. Never measure a dose with a household spoon, since these can vary in size.

What’s more, most OTC products are only meant for short-term use. If an OTC product isn’t working within a week of starting it, or if your cough has you losing sleep, you may want to talk to your healthcare professional about prescription options.

If you also have symptoms such as fever or difficulty breathing, let your prescriber know. This could mean your cough is a symptom of a more serious infection, such as the flu or pneumonia.

So, what’s the best cough medicine?

There’s no one best cough medicine. It’s important to select the right product based on the cause and type of cough you have.

If you have a dry cough, an antitussive might be helpful. But if you’ve got a wet cough, an expectorant can help you get the excess mucus out. You can also find antitussives and expectorants together in combination products. Some of them also contain an antihistamine or decongestant to help with postnasal drip.

If you’re pregnant, taking other medications, or have health conditions, talk to your prescriber or pharmacist first before taking an OTC cough medicine.

Remember, OTC options don’t work for everyone. If all else fails, your healthcare team can help you find a prescription medication that may provide some relief.

Frequently asked questions

It’s hard to say for sure. It’s trickier to track OTC product use than prescription medication use. But two of the most common OTC cough medicines include guaifenesin and dextromethorphan. Combination products that include both medications, such as Robitussin DM and Mucinex DM, are also popular options. Benzonatate is a popular prescription cough medicine.

Many cough medicines start working fairly quickly. Guaifenesin starts working within about 30 minutes. Dextromethorphan kicks in about 15 to 30 minutes after taking it. Benzonatate typically starts providing relief about 15 to 20 minutes after taking a dose. Codeine-containing cough syrups take a bit longer to start working — about 1 to 2 hours.

If you’re living with COPD, it’s common to experience a chronic cough. Mucolytics are prescription-only medications that help relieve COPD exacerbations. They work by breaking down mucus — making it easier to cough it up. Acetylcysteine is one mucolytic that’s inhaled through a nebulizer. Other prescription medications that can help include bronchodilators such as salmeterol (Serevent Diskus), corticosteroids, and/or antibiotics.

Bronchitis typically causes a wet cough. Cough medicine that contains guaifenesin can help ease your symptoms. Remember to also drink plenty of fluids. Honey and a humidifier may also do the trick.

Taking a cough medicine shortly before bed is one tactic that can quiet a cough at night. Using a humidifier can also help. Drinking warm tea with honey may also lessen the urge to cough. In fact, eating honey on its own may be similarly effective for cough relief as cough medicines.

The bottom line

If you’re trying to treat an acute (short-term) cough, there are several over-the-counter (OTC) cough medicines to choose from. Keep in mind that they don’t all work the same — and the evidence is mixed on whether you’ll see a benefit from taking them. The best cough medicine for you may depend on what symptoms you’re experiencing. Prescription products may be another option if you can’t get relief from OTC products.

If your cough is lingering longer than a week, or you’re also having symptoms such as fever or difficulty breathing, contact your healthcare professional. They can check to make sure it isn't something more serious.

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Written by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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