What’s the Best Cough Medicine? Comparing the Effectiveness of Over the Counter vs. Prescription
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.
Examples of OTC cough medicines include the expectorant guaifenesin (Mucinex) and the cough suppressant dextromethorphan (Delsym). Antihistamines, such as diphenhydramine (Benadryl), and decongestants, such as pseudoephedrine (Sudafed), can be helpful if post-nasal drip is contributing to your cough.
Examples of prescription cough medicines include benzonatate (Tessalon Perles) 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.
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Is your cough keeping you awake or driving your coworkers crazy? If you’re looking for a cough medicine, it can be hard to know which one to choose. There are many prescription and over-the-counter (OTC) cough medicines, including expectorants and suppressants. But studies show they don’t all work. So, what should you take for your cough?
Best over-the-counter cough medicines
The most common reason for an acute (short-term) cough is a viral upper respiratory tract infection (URTI). But coughing can happen due to other reasons as well.
There are many OTC cough medicines to help manage an acute cough — from syrups and pills to lozenges. But it’s important to know that not all OTC cough medications are created equal or work the same way.
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” (non-productive) cough, which commonly results from irritation.
Expectorants
Cough expectorants, like guaifenesin (Mucinex), work by loosening up and thinning the mucus in your throat so you cough it up more easily. For this reason, they may work better for a “wet” (productive) cough.
Cough drops
Products such as menthol cough drops (Halls, Luden’s, Ricola) have a cooling effect in addition to opening your airways to help prevent coughing.
Antihistamines and decongestants
Antihistamines and decongestants work by targeting post-nasal drip that may be triggering your cough. Examples of antihistamines include diphenhydramine (Benadryl) and cetirizine (Zyrtec). A common decongestant is pseudoephedrine (Sudafed). Know that many antihistamines can make you drowsy, while decongestants can keep you awake.
Combinations
You can also find combination products that contain several different cough medications together. These include products like Zyrtec-D (cetirizine / pseudoephedrine) and Mucinex DM (guaifenesin / dextromethorphan).
But if OTC products aren’t working within a week of starting them, or your cough has you losing sleep, you may want to talk to your primary care provider (PCP) about prescription options.
Managing symptoms: Learn more about home treatments that can help soothe a dry cough and dry 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 here.
Seeking medical care: Should you see a health professional for that cough? Knowing when to seek treatment can help you avoid more serious health issues.
If you also have symptoms like fever or difficulty breathing, let your PCP know. This could mean your cough is a symptom of a more serious infection, such as the flu or pneumonia.
Take our quiz: OTC cold and cough medicines
Best prescription cough medicines
If OTC products aren’t working, prescription cough medications are sometimes needed to control a cough. Let’s take a closer look at the type of cough medications your PCP may prescribe.
Non-narcotic cough suppressants
Your PCP may consider benzonatate (Tessalon Perles) capsules. Benzonatate is a prescription, non-narcotic antitussive medication. It numbs the airways, the air sacs in the lungs, and the lining of the lungs. It’s FDA approved for adults and children 10 years and older, however, some people are more sensitive to benzonatate's side effects than others.
You can take up to 600 mg daily as needed, divided into 3 doses or as otherwise recommended by your PCP.
Inhalers
If your PCP hears wheezing with your cough, they may prescribe a rescue inhaler, such as an albuterol inhaler (Ventolin HFA). Rescue inhalers are also used for conditions like asthma and chronic obstructive pulmonary disease (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 suppressant
Codeine cough suppressants like promethazine / codeine should only be an option for short-term use — and only in adults. This type of cough syrup is available by prescription. It’s a controlled substance and habit-forming. Codeine-containing cough syrups also carry a number of serious risks, including trouble breathing and even death. These risks are greatest in children.
Best cough medicine for kids
For infants and children under 4 years old, it’s recommended to completely avoid OTC cough medicine. And for children between 4 and 6 years old, it’s a good idea to speak with their pediatrician before giving any medication for cough. Some active ingredients may still not be safe for kids in this age group.
Instead, to help loosen or remove mucus and soothe cough, considering trying:
Humidifier
Saline nose drops
Mentholated chest rub ointment, such as Vicks VapoRub
Honey (for children older than 1 year only)
For kids 4 years old and up, you can use OTC cough medicine according to the directions on the label. These may include:
Cough suppressants (like dextromethorphan)
Decongestants (like pseudoephedrine)
Expectorants (like guaifenesin)
Antihistamines (like diphenhydramine)
Combination medications (like Dimetapp Cold and 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.
So, what’s the best cough medicine?
For some people, OTC cough medications can be a convenient option to help get an acute cough under control. It’s important to select the right product, depending on the cause and type of cough you have. You’ll also want to avoid a cough medicine that interacts with other medications you’re taking. In other words, the best cough medicine will be the one that best meets your specific needs.
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 post-nasal drip.
Combination products are meant to treat multiple symptoms at once. They may also contain medications for pain, congestion, or fever. In this case, you’ll want to make sure you’re not taking something you don’t need. For example, acetaminophen (Tylenol) is found in many OTC and prescription medications, which you may not realize without reading the OTC label.
If you’re pregnant, taking other medications, or have health conditions, talk to your PCP or pharmacist first before taking an OTC cough medicine.
Remember, OTC options don’t work for everyone. If all else fails, your PCP can help you find a prescription medication that may be able to provide some relief.
Frequently asked questions
It’s hard to say for sure, as it’s trickier to track OTC medication use than prescription medications. 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 may start working within 30 minutes. Dextromethorphan may kick in about 15 to 30 minutes after taking it. Benzontate typically starts providing relief about 15 to 20 minutes after a dose. Codeine-containing cough syrups take a bit longer to start working — about 1 to 2 hours.
Taking a cough medicine shortly before bed is one tactic that can quiet a cough at night. Using a humidifier can also help. And drinking warm tea with honey added to it may also help 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 if you’ll see a benefit from taking them. Prescription products may be another option if you can’t get relief.
If your cough is lingering longer than a week, or you’re also having symptoms like fever or difficulty breathing, contact your primary care provider. They can help to make sure it isn't something more serious.
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References
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PubChem. (2024). Codeine. National Center for Biotechnology Information.
PubChem. (2024). Dextromethorphan. National Center for Biotechnology Information.
Smith, S. M., et al. (2014). Over-the-counter (OTC) medications for acute cough in children and adults in community settings. The Cochrane Database of Systematic Reviews.
U.S. Food and Drug Administration. (2023). FDA Drug Safety Communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women.
U.S. Food and Drug Administration. (2023). Should you give kids medicine for coughs and colds?
