Cough medication

Have you ever entered into a pharmacy hoping to get your cough treated without seeing a doctor? The pharmacist dispenses you a cough medication but after that only you realise that the ingredients from the cough medication are different from the cough medication you got last time. Why is that so? Basically, there are 2 major types of cough medications which are available over the counter – expectorants and suppressants.

    1. How do I know which cough medications to take?

Expectorants are used to treat productive cough by loosening and liquefying the phlegm to make it easier for the phlegm to be cough out. The active ingredients in expectorants include guaifenesin, ammonium chloride and sodium citrate. Mucolytics, such as bromhexine, carbocystein and acetylcysteine, which can be found in some cough syrups like Unizet®, Duro-Tuss Expectorant®, Mucoprom® and Rhinathiol® works by breaking down the excessive thick and viscous phlegm. The syrups mentioned above may be available in any Malaysia retail pharmacy. How about tablets? Is there any expectorant that is available in tablet form? Fortunately, there are, for example Mucinex®, bromhexine and Parbon-Cough® expectorant. However, they can only be taken in children age 12 years and above, except bromhexine.

On the other hand, cough suppressants, also known as antitussives, work by blocking the body’s cough reflex or desire to cough. Cough suppressants are used to treat dry cough only and should not be used to treat productive cough because it will promote mucus accumulation, creating a favorable environment for bacteria to grow in the airways which will worsen the cough and increase the risk of pneumonia (lung infection). Medicines that act as cough suppressants are normally containing pholcodine and dextromethorphan. Patients can also opt to take a cough suppressant in tablet form. Copastin®, which contains cloperastine hydrochloride, is used to treat unproductive cough in people who prefers tablet more than syrup.

It is a no-no to use a cough suppressant and an expectorant at the same time because both of the medications work oppositely from each other. However, it may be useful to take an expectorant during the day and an antitussive at night to aid in sleeping.

The illustration showed some cough syrups to help with productive cough (with phlegm).

Mucinex® which is available as tablet dosage form for chesty cough.

The illustration showed some medications to help with dry cough.

   2.     Does any of the cough medication containing antihistamines for treating runny nose and blocked nose or known as ‘common cold’?

   

              Cough medications, such as Bena®, Uphadyl forte® (diphenhydramine), Cough-en®, Actifed® Expectorant (tripolidine hydrochloride) and Sedilix-DM® (promethazine hydrochloride), contain antihistamine which can benefit a patient who has cough and runny nose at the same time. However, these antihistamines can make cause drowsiness. Therefore, it may impair the person’s ability to drive or operate machinery. More details on antihistamine can be viewed in our “Keep those sneezing and wheezing away!!!” article.

The illustration showed some cough syrups containing flu medication (antihistamine) and nasal decongestant (eg: pseudoephedrine) to help with flu and runny nose.

    3.     Some cough medications should be used with care in patients with severe hypertension, heart diseases and diabetes.

Most of the cough syrups contain sugar which is not suitable for diabetic patient. There are many cases of diabetic patients admitted to the hospital with high blood sugar level because of self-administering sugary cough syrup. Mucoprom® syrup is sugar-free which is particularly useful for diabetic patients with productive cough. Diabetic patients with dry cough can go for Tussidex® Forte which is non-sedating, sugar-free syrup or Copastin® which is in tablet form.

Cough medications which contain nasal decongestant such as pseudoephedrine or phenylephrine should always be used with care in patients with severe hypertension and heart diseases as these active ingredients can increase the heart rate and blood pressure of a person. Moreover, the oral nasal decongestant can temporarily increase blood glucose level of a diabetic patient. Therefore, you should always consult your physician or pharmacist before taking any medications. Further elaborations can be viewed in our “Keep those sneezing and wheezing away!!!” article.

    4.     Which medication can cause dry cough?

The most common medication which can cause dry cough in approximately 20% of the population taking it is angiotensin converting enzyme (ACE) inhibitors which is one of the classes of high blood pressure medications. Medications under this class include Enalapril, Lisinopril, Ramipril and Perindopril. The dry cough is usually self-resolving. If the cough persists for more than 2 weeks and is bothersome, please seek help from your physician and do not stop taking it without talking to pharmacist or physicians. Usually, switching to another medication class can reduce the cough.  

The illustration showed a class of high blood pressure medications known as ACE inhibitors (ended with –pril) which will cause dry cough.

    5.     What are common side effects of cough medicine?

Generally, adults do not experience serious adverse effects from cough medicine if take it at recommended dose that advised by healthcare professionals or instructed on the label of the product. However, cough medicines can cause some mild side effects such as drowsiness, rashes, stomach upset, nausea, vomiting, nervousness, blurred vision, restlessness and irregular heartbeat. Due to the drowsiness of the medicine, the people should not drive or operate machinery after taking it. Alcohol should be avoided when you are taking the medicine.The side effects of the medicines varied from people to people. To know more detailed on side effect of the cough medicine you are taking, you may read the information on the leaflet that provided with the medicine.

The illustration showed certain cough syrups may cause one of the common side effect, which is drowsiness. Please talk to your pharmacist if you need a non-drowsy medication for cough.

  

    6.     Do cough medicines lead to addiction?

Cough syrup that contains dextromethorphan, codeine or pseudoephedrine will cause addiction if taken in large dose. Addiction to drug will eventually cause the individual to abuse it and experience overdose. However, if the medicine is taken at recommended dose at a short time, it will only provide therapeutic effect and does not pose any health risk.

When people take the cough syrup that is mentioned above at large doses, the medicine will produce a feeling or state of intense excitement and happiness. At 25 to 50 fold of the recommended dose, the medicine may cause individual to have hallucinations, out-of-body experiences, changes in visual perception, loss of control with their own body and irregular heartbeat.

                If the cough syrups are taken in large quantities for long term, it will lead to organ damage especially brain, heart and lung and then death.

                 Since cough syrup is the preparation that combine cough suppressant with other ingredients, the people will also have drug abuse from other ingredients. For example, the people abusing cough syrup that contain codeine and paracetamol, the individual will have paracetamol overdose besides codeine overdose and lead to liver damage.

    7.     Which cough medication(s) is/are safe children?

Cough-en®, Sedilix-DM®, Sedilix-Rx® and Tussidex® Forte can be given for children who are more than 2 years old having dry cough. There are other brands which are safe for children more than 2 years old having cough with phlegm as well, such as Actifed® Expectorant and Parbon-Cough® expectorant. Parents should give the cough syrup by following the dosing instruction on the product label carefully or advice of healthcare professionals. And, parents should use the dosing cup that provided to make sure that the amount of medicine that give to children is exactly the same as the dose labelled.

For children under age 2, cough medicine should not be given. The reason is these medicines were mostly not studied in children. The medicines are always studied in adult population. Therefore, the benefit of cough medicine for children is not clear and the potential risk for them may be greater. 

Instead of cough medicine, parents can give one to two teaspoon(s) of honey for coughs and sore throat of kids before their bedtime and give them plenty of liquids daily to increase hydration and thin mucus. For kids that younger than age 1, honey is not recommended. However,  Prospan® syrup can be given 2.5mL three times daily for 1 week.  If your child’s nose is blocked, saline nasal drops can be used with two to three times per day to ease the removal of mucus from nose.

General tips for the public, for children with age less than 2 years old having common cold symptoms or cough symptoms, please seek help from paediatrician (child-specializing physicians).

Important tips:

1.     If you experience shortness of breath, wheezing, or cough up blood when you cough, please consult your doctor instead of self-medicating by buying over-the-counter cough medicine.

2.     Most people only need to take cough medicine for a few days to ease their cough. Please do not use it for long time.If your cough lasts more than two weeks after taking cough medicine, talk to your doctor.

3.     If you are taking other medicines, you should check with your doctor or pharmacist before buying any cough medicine.

4.     Check the ingredients in cough medicine before buying. Some cough mixtures contain other active ingredients such as paracetamol. If you are already taking paracetamol, you should consult your pharmacist and buy the preparations that do not have the medicines you are taking. This is because take too much single ingredients (overdose) will cause serious effects. For instance, paracetamol overdose can damage your liver. This is particularly important when you are helping your child to look for a cough medicine.

Authors:

1. Jamie Lim Jo Shin

          BPharm (Hons) (IMU)

2. Lau Hie Hie

    BPharm (Hons) (IMU)

Editors:

1.  Lok Ker Yee

    BPharm (Hons) (IMU)

2. Loh Pui Yee

    BPharm (Hons) (IMU)

3. Jordy Wong Der Yuan

    BPharm (Hons) (IMU)