Skip to Content

Cough Syrups Ineffective

Billions of dollars wasted? That's what the American College of Chest Physicians (ACCP) is saying about Americans' annual spend on over-the-counter cough remedies. Such medicines have little or not effect on cough symptoms, says the ACCP, who have recently issued new guidelines for cough treatment.

The guidelines were published in the January issue of Chest (journal of the American College of Chest Physicians) and an article about them was published by the Herald-Whig online on January 10, 2006.

The reason non-prescription cough syrups are not effective is that they usually contain the relevant drugs at too low a concentration, or they contain combinations of drugs whose effectiveness in treating coughs has not been proven, said Dr. Richard Irwin, chairman of the group's Cough Guidelines Committee, to the Herald-Whig.

Despite the fact that non-prescription cough syrups claim to offer fast, effective relief, "the best studies that we have to date would suggest there's not a lot of justification for using these medications because they haven't been shown to work," said Irwin, a professor of medicine at the University of Massachusetts Medical School in Worcester, Massachusetts.

And Dr Irwin is not alone in his opinion. "I agree with what the American Academy of Chest Physicians is saying about over-the-counter medications," said Dr Michael Hambrick, a family practice physician with Blessing Physician Services, to the Herald-Whig.

Codeine and dextromethorphan are two drugs that have been shown to relieve symptoms of cough caused by colds. They are often present in non-prescription cough syrups. However, the doses must be adequate to offer that relief.

"The problem is codeine is a narcotic and you don't want to use that liberally," Hambrick said. "Dextromethorphan works, but the dosages (in over-the-counter syrups) are just too small for the most part."

Robitussin is one of the largest-selling over-the-counter cough syrups, and it contains dextromethorphan - a Robitussin ingredient that the US Food and Drug Administration (FDA) has seemed safe and effective, said Francis Sullivan, a spokesman for Wyeth Consumer Healthcare, which makes Robitussin, according to the Herald-Whig.

"[Robitussin] wouldn't be a top brand if people didn't feel it was efficacious," Sullivan reportedly said.

Similarly, the Consumer Healthcare Products Association, a trade group for makers of non-prescription drugs, disputed the guidelines, saying that non-prescription cough medicines provide relief to millions of people annually.

However, the recommendations have been endorsed not only by the ACCP, but also by the American Thoracic Society and the Canadian Thoracic Society.

Risks of Over-the-Counter Cough Syrups

Delaying seeking professional treatment for coughs is one risk of using over-the-counter cough syrups for coughs caused by colds, according to Irwin. This can be particularly dangerous for more serious coughs, such as whooping cough.

The new guidelines advise that adults up to age 65 years receive a new adult vaccine for whooping cough that was approved last year.

Additional symptoms should be a warning signal. "The key is if you're having shortness of breath or fever or chest pain, those are things that should cue you in that your cough is more serious," Hambrick said. "A great number of (coughs) are serious and need to be treated with something more than cough medicines."

Another risk is drowsiness. Many popular non-prescription cough syrups claim not to cause drowsiness, but according to Irwin this is because they contain none of the older antihistamines that help relieve coughs caused by colds. Such antihistamines, including diphenhydramine, which is an active ingredient in Benadryl, are also available without a prescription, although they are not marked as cough medicines.

According to Hambrick, coughs related to colds are usually caused by postnasal drip, which would be easily alleviated by an antihistamine.

"But those [antihistamines] have significant side effects," Hambrick says, according to the Herald-Whig. "Most people get very sleepy with Benadryl."

For coughs lasting more than three weeks, Dr Edward Schulman, a representative of the American Thoracic Society on the guidelines panel, said people should consult their health professionals - similarly, the additional symptom of shortness of breath could indicate other serious conditions, such as pneumonia.

For coughs due to colds, which normally last less than three weeks, drinking fluids can help, and so can chicken soup, Schulman reportedly said.

Posted: January 2006