A cough is one of the most annoying symptoms of the common cold, and OTC cough syrups are one of the most popular purchases in pharmacies. But which ones really work?

No Combos For Children Under Four

Recent reviews have consistently shown that, unfortunately, there is no major evidence that any common OTC products help well for a cough. In fact, side effects outweigh benefits so much that last year the FDA recommended that no child under 4 years should take any OTC cough syrups. The major problem is overdosing due to the confusion of multiple pharmacy packages, and many children unwittingly receive the same medicines from different sources (for example, taking Robitussin syrup as well as a Tylenol Cold pill, both with similar medicines). Common side effects include rapid heartbeat, drowsiness, suppression of the respiratory system, seizures, and other adverse events.

Even cough drops don’t have much proven efficacy. The overall benefit seems to be simple coating of the mouth and saliva production, causing short term relief from dryness and irritation. That means that a hard candy would have the same effect as an expensive imported “medicated” cough drop. Personally, I prefer Ricola sugar-free drops, but again there is no evidence that one is better than another.

Parents can find more information from the CDC, as well as a PDF file from the American College of Chest Physicians that provide helpful tips regarding their child’s cough. Adults can find more information from the Mayo Cinic and WebMD as well as an OTC review from Familydoctor.org. There’s also a good resource from MedlinePlus.

Does Nothing Work Well?

Of course, you need to try something for a cough, right? Sure, as long as you are prudent with the dosing, you can try these medicines. But it’s important to realize, if you didn’t know it before, that many just don’t work well — so if you’re taking it and your cough is unchanged, just stop taking it. A failure of cough syrup does not automatically mean that you need antibiotics, it just means the medicines don’t work well.

So what’s the best Rx to take? In general, the cough is triggered by all the mucus in the throat, so anything to decrease that mucus would help. Sometimes, pure dextromethorphan syrup is good, especially Delsym (hard to find in China). A pure decongestant like pseudoephedrine (Sudafed) can nicely clear mucus, as well as the nasal sprays using oxymetazoline (Afrin-type sprays).

Other natural and safe ideas, especially for children under four years, can include a menthol rub on the chest; humidifiers; and nasal saline rinses/sprays. The OTC Antuss drops also work fairly well for some (they have pseudoephedrine and dexamethasone). Some feel that lemon water with honey works as well as any OTC medicine for cough, although honey is never recommended for infants due to the risk of botulism.