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What’s the Best Cough Medicine? Comparing the Effectiveness of Over-the-Counter vs. Prescription

October 15, 2022

Is your cough keeping you awake or driving your co-workers crazy? There are many prescription and over-the-counter (OTC) cough medicines that include expectorants and suppressants, but studies show they don’t all work. So, what should you take for your cough?

Over-the-counter cough medicines

Acute cough due to a viral upper respiratory tract infection (URI) is the most common form of cough, though coughing can happen due to other reasons as well. — and a ton of money is spent on making and marketing drugs to manage it.

There are many OTC cough medicines to help manage an acute cough — everything 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), like dextromethorphan (Robitussin, Delsym), help by controlling your cough reflex. They usually work better for a “dry” (non-productive) cough, which usually results from irritation.

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.

Products such as menthol cough drops have a cooling effect in addition to opening your airways to help prevent coughing.


Antihistamines, like chlorpheniramine and clemastine, and decongestants, like pseudoephedrine (Sudafed), work by targeting post-nasal drip that may be triggering your cough. Know that many antihistamines can make you drowsy, while decongestants can keep you awake.


You can also find combination products that contain several different cough medications together, like Dimetapp and Mucinex DM.

But if OTC products aren’t doing the trick, and if your cough is interfering with your daily activities or sleep, you may want to talk to your healthcare provider about prescription options.

And if your cough is accompanied by symptoms like fever or difficulty breathing — contact your healthcare provider since this could mean it’s something more serious.

Prescription cough medicines

Still coughing? Consider benzonatate (Tessalon) capsules. Benzonatate is a prescription, non-narcotic antitussive medication that numbs the airways, the air sacs (alveoli) in the lungs, and the lining of the lungs (pleura). It’s FDA-approved for adults and children over 10 years old.

Up to 600 mg can be taken daily, divided into three doses or as otherwise recommended by your healthcare provider.

What about adding inhalers when you have a cough? If your healthcare provider hears wheezing with your cough, they may prescribe an albuterol inhaler like Proventil or ProAir if it’s from acute bronchitis. Rescue inhalers may also be prescribed for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD). Routine use of inhalers like Proventil and ProAir, however, has not been shown to improve the severity of a cough or shorten its duration.

Codeine cough suppressants like promethazine/codeine should only be an option for short-term use — and only in adults. While the cough syrup is available by prescription from a healthcare provider, the controlled substance is habit-forming.

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