Cough Syrup, Cough Drops, Menthol Rub: What’s Best?

Q: Is it best to buy cough syrup, cough drops or menthol rub?

A: A visit to the pharmacy reveals row after row of lozenges, syrups and other products for cough associated with wintertime virus. Most are helpful and reasonably safe.

When choosing cough drops or rubs, keep in mind that “medicated” products aren’t truly medicated. They usually contain menthol, an aromatic substance that opens the airways to help reduce cough and congestion.

Cough syrups can contain any combination of these over-the-counter medicines:

• Dextromethorphan, a very weak opiate, dulls the cough reflex.
• Pseudoephedrine and related chemicals are decongestants. They decrease mucus production but can raise blood pressure and cause irritation from over-drying.
• Guaifenesin, an expectorant, can loosen secretions. It’s generally the safest option.

(Parents should be aware that cough syrups and menthol rubs are not recommended for children. Cough lozenges and honey are fine after age 1.)

A couple of prescription medications can suppress cough: benzonatate (Tessalon Perles®) and promethazine cough syrup. Both are effective and non-narcotic.

But by far the simplest, safest treatment for cough and congestion is good hydration: drinking lots of fluids or rinsing the nasal passages with a saline solution.

— Family medicine physician Donald Ford, MD