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Cough suppressants (antitussives) are popular cough remedies — but who should use them, when are they pointless, who should steer clear, and what are the alternatives?

If you're nursing a common cold or a flu and your cough is bothering you, over-the-counter drugs can help you out. Three kinds of drugs are commonly used to try to help you with a cough. These are expectorants, cough suppressants, and topical skin medications. Should you try a suppressant? 

Cough Suppressants: What are they and what can they do?

Cough suppressants, or antitussives in medical terms, are meant to help you suppress the urge to cough, something that can be useful if your cough is keeping you up at night. Unlike expectorants, which can help get rid of mucus in your lungs, suppressants are said to be more useful for dry and unproductive coughs. 

Dextromethorphan — the most frequently used active ingredient in over-the-counter suppressants — is a mild narcotic that will be labelled “DM” on the product’s packaging. You will find it in Robitussin DM, Benylin DM, and many more products, both generic and brand name medications. They include:

  • Delsym
  • Vicks
  • TheraFlu
  • NyQuil
  • Dimetapp
  • Robitussin
  • Coricidin
If you decide to use one of these products, you should take your cough medication for the smallest amount of time — stop taking it when your symptoms become bearable. Make sure to measure it using a dose-measuring spoon from a pharmacist rather than a normal spoon, and to let lozenges dissolve inside your mouth.

Dextromethorphan can come in many different forms:

  • Syrup
  • Tablet
  • Liquids
  • Extended-release capsules
  • Elixir
  • Solution
  • Lozenge

Codeine is a more powerful cough suppressant that is only available with a prescription — if dextromethorphan does not help your cough, you can ask your physician about it.

Which people can’t use dextromethorphan?

Dextromethorphan isn't for everyone:

  • Dextromethorphan should not ever be given to children who are under four years old.
  • It can also lead to the release of histamine release, which is why people with known allergies should not take it.
  • You need to stay away from dextromethorphan (which could have phenylalanine) if you suffer from phenylketonuria (PKU).
  • Pregnant women should not use dextromethorphan.
  • Don't take it if you are nursing either; this medication can enter breast milk which means it might be unsafe to a nursing baby.
  • Don’t use dextromethorphan if you’re also taking Procarbazine (Matulane), Rasagiline (Azilect), Isocarboxazid (Marplan), Manerix (Moclobemide), Tranylcypromine (Parnate), Selegiline (Emsam), or Phenelzine (Nardil).
In addition, consult your physician before using dextromethorphan if you have used an MAO inhibitor in the last two weeks, if you have depression, high blood pressure, asthma, chronic bronchitis, emphysema, liver disease, heart disease, mucus with cough, slowed breathing, or diabetes. Dextromethorphan doesn’t work for a cough that’s the result of smoking, emphysema, or asthma — so if this applies to you, you will want to ask your doctor about other possible treatment options.

Also, don’t drink grapefruit juice or eat grapefruit while using dextromethorphan as this can raise the level of dextromethorphan inside your body.

The side effects of dextromethorphan

Some people who take dextromethorphan will experience diarrhea, nausea, constipation, nervousness, dizziness, drowsiness, and restlessness as annoying but fairly harmless side effects. More severe side effects which could require a trip to the hospital are respiratory depression, vomiting, blackouts, double vision, low blood pressure, hypertension, and hallucinations.

What situations call for the use of a cough suppressant?

You may decide to try a cough suppressant is if a serious cough is stopping you from sleeping or from completing your daily tasks. If you’re not in this situation, it’s good let your lungs get rid of the mucus — and coughing helps you achieve this. Using an expectorant is better unless you suffer from a dry cough. Despite their popularity, there's actually no clear proof that suppressants help at all, so you can only try.

What about some natural alternatives that I can use instead of taking suppressant drugs?

You can use honey in a bid to suppress coughs instead. One study revealed it to be a more effective cough suppressant than dextromethorphan, at least in children suffering from coughs during the night. Using honey as a treatment for a cough is easy. If you want to give this a try, all you have to do is combine two teaspoons with some herbal tea or warm water. Then you just have one or two cups every day. Honey should not be used for kids younger than one year old because of the risk of botulism.

In addition:

  • Elevate your pillow while you sleep if your cough was the result of a post-nasal drip, which is pretty likely if you suspect you have a cold or flu.
  • You could use herbal remedies such as extracts of pine or spruce shoots to deal with tickly coughs. Some plant remedies that can be used as antitussives are Glycyrrhiza (licorice), Bupuleurum, Lactuca (wild lettuce), and Prunus serotina (wild cherry bark).
  • Keep an eye on the humidity in your room. You can use a humidifier to help your cough when the air is dry but if you have a lot of moisture in your room it can make you carry on coughing. Damp air is like a home to dust mites and mold (which are both typical allergies). The humidity in your living space shouldn’t exceed 50 percent. You can measure your humidity levels with a cheep device like a hygrometer, which you can find at a hardware store.

Scientists, who are still exploring the many aspects that control the urge to cough, are still looking for a drug that can really suppress coughs. In the meantime, you can only do what you can to keep yourself as comfortable as possible while waiting for that nasty cough to come to an end.