Antitussives: Uses, common brands, and safety info

Cough and cold symptoms are often managed using over-the-counter (OTC) medicines. Antitussive drugs, or cough suppressants, are medicines that are used to control and relieve a cough. While many antitussives are available OTC, a few antitussives are only available with a prescription. 

Continue reading to learn more about antitussive drugs, their uses, and their side effects.

Other antitussives

• Vicks Formula 44 (dextromethorphan)

• Zonatuss (benzonatate)

• Pediacare Children’s Long-Acting Cough (dextromethorphan)

• Hold (dextromethorphan)

• Elixsure Cough (dextromethorphan)

• DexAlone (dextromethorphan)

• Creomulsion (dextromethorphan)

• Babee Cough (dextromethorphan)

• Buckley’s Mixture (dextromethorphan)

• Codeine

What are antitussives?

Antitussives, which may also be referred to as cough suppressants, are medications that help relieve a cough. They are typically used to treat a dry cough caused by allergies, respiratory illnesses, or infections. Viral infections, like a cold or the flu, can often irritate the airways of the lungs and lead to bronchial inflammation, which can result in a cough. Antitussives can also treat post-viral cough, or a persistent cough that develops after an infection has resolved.  

Although many types of cough are best treated with supportive care methods, such as rest, hydration, and the use of a humidifier, a healthcare provider may recommend an over-the-counter or prescription antitussive. Antitussives are not recommended for treating productive, or mucous-producing, coughs due to an increased risk of mucus buildup and breathing problems. 

Antitussives are available in different types of formulations, including tablets, capsules, liquids, and syrups. Antitussives are often combined with other medications, like expectorants, analgesics, decongestants, anticholinergics, or antihistamines, and they are usually available over the counter, although certain formulations are only available with a prescription. 

How do antitussives work?

The cough reflex starts in the nerve receptors that are abundant along the lining of the throat and airways of the respiratory system. When stimulated by an irritant or allergen, these receptors send a message to the cough center in the brain. The cough center then triggers muscle contractions surrounding the vocal cords and chest, which then leads to a sudden passing of air through the airways. 

The exact mechanism of action of antitussives is unknown. However, certain antitussives are believed to inhibit the cough center in the brain. When this region is inhibited, the cough reflex arc is stopped. Other antitussives may soothe the nerve receptors around the airways to reduce the transmission of signals to the brain’s cough center. This ultimately blocks the cough reflex. 

What are antitussives used for?

Cough, which may be associated with:

• Common cold

• Flu

• Sinusitis

• Bronchitis

• Upper respiratory tract infections

Types of antitussives

Two types of antitussives are available: centrally-acting and peripherally-acting antitussives.

Centrally-acting antitussives

Centrally-acting antitussives are available in non-opioid and opioid formulas. They are believed to work by suppressing the central cough center in the brain. Non-prescription or OTC, centrally-acting antitussives include dextromethorphan products (Delsym, Robitussin, Vicks Formula 44, and Triaminic).

Peripherally-acting antitussives

Peripherally-acting antitussives work by desensitizing nerve receptors in the lungs and pleura, or lining of the lungs. Tessalon Perles (benzonatate) is a peripherally-acting antitussive.

Who can take antitussives?

Adults

Antitussives are used to relieve a nonproductive, or dry, cough in adults. An acute cough is a common symptom of respiratory conditions and infections. In most cases, a cough is self-limiting and will resolve with rest and at-home supportive care methods. However, when a cough begins to interfere with daily activities, an antitussive may be considered for temporary symptomatic relief. 

Antitussives can be safely given to adults. A non-opioid, centrally-acting antitussive, such as dextromethorphan, is the first choice option. If an OTC product is not effective, a peripherally-acting antitussive, such as benzonatate, may be recommended. An opioid antitussive, such as codeine, is reserved as a last resort. 

Antitussives are recommended for short-term treatment only. A chronic cough should be evaluated to determine the cause of the cough before starting or continuing treatment with an antitussive.

Children

The use of over-the-counter antitussive medications in children is not recommended. Both the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP) have released statements against the use of these antitussives in children. Over-the-counter antitussives may be less effective in children than in adults, and they may also carry a greater risk of adverse effects in children. 

Due to the risk of serious adverse effects, the AAP and ACEP do not recommend codeine for children under the age of 12. Adverse effects of codeine may include respiratory depression, slowed or difficult breathing, and even death. Additionally, codeine is not recommended for adolescents between 12 to 18 years of age that are obese or have sleep apnea, lung disease, or other conditions characterized by breathing problems.

The U.S. Food and Drug Administration (FDA) does not recommend over-the-counter antitussives for children younger than two years of age. The FDA also states that opioid prescription cough medicines containing codeine or hydrocodone are not recommended for children under the age of 18.  

Benzonatate is not approved by the FDA in children under the age of ten. A healthcare provider should always be consulted before administering an antitussive to children. 

Seniors

Seniors may take antitussives using the same precautions as other adults. Short-term, nonproductive coughs may be treated with an antitussive in older adults. However, chronic or productive coughs should be evaluated in order to determine treatment for the underlying condition. 

Dosing guidelines of antitussives in seniors is the same as dosing guidelines in adults. Codeine doses, however, may need to be reduced in seniors. Seniors may also experience an increased incidence of constipation after the administration of codeine antitussives. 

Can you take antitussives while pregnant or breastfeeding?

If possible, avoid antitussives during pregnancy. When an antitussive must be given, OTC dextromethorphan is generally considered acceptable for use while pregnant or breastfeeding.

There is no current data regarding benzonatate and pregnancy or breastfeeding. Therefore, the use of benzonatate should be avoided in these cases. 

Opiates are known to cross the placenta and pass into breast milk. Codeine should be avoided during pregnancy and breastfeeding. Because many OTC antitussives also contain other ingredients, such as decongestants, products should be evaluated for safety during pregnancy and breastfeeding. Consult a healthcare provider for medical advice before considering an antitussive while pregnant or breastfeeding.

Are antitussives safe?

In general, antitussives are safe. Some antitussives interact with other medications. Tell your healthcare provider about all medications and supplements you are taking, including herbal products and vitamins, before starting treatment with an antitussive. Because drug interactions can lead to serious adverse effects, a full medication review is recommended to decrease the risk of harmful drug interactions.

Do not take dextromethorphan, codeine, or other cough medicines if you are taking or have taken one of the following monoamine oxidase (MAO) inhibitor medicines within the past two weeks:

• Marplan (isocarboxazid)

• Nardil (phenelzine)

• Eldepryl, Emsam, Zelapar (selegiline)

• Parnate (tranylcypromine)

Black box warnings

Codeine carries a black box warning regarding addiction, abuse, and misuse. Risks must be evaluated before the administration of codeine-containing antitussives. Misuse or abuse of codeine may lead to overdose or death. 

Recalls

• Robitussin recall, 6/28/2020

Restrictions

Antitussives are contraindicated in those with known allergies to any antitussive ingredients. 

If you have phenylketonuria (PKU), be cautious of taking an antitussive as many brands of dextromethorphan are sweetened with aspartame. Aspartame is a source of phenylalanine and should be avoided if you have PKU. 

Codeine-containing antitussives should not be used in the pediatric population. Additionally, the following restrictions are specific to codeine-containing antitussives:

• Avoid use in coma or central nervous system (CNS) depression.

• Avoid use in gastrointestinal obstruction and ileus.

Are antitussives controlled substances?

Dextromethorphan and benzonatate are not controlled substances. However, codeine-containing products are classified as controlled substances. 

Common antitussives side effects

The most common side effects of antitussives may include:

• Dizziness

• Drowsiness

• Sedation

• Nervousness

• Confusion

• Headache

• Nausea

• Vomiting

• Stomach pain

• Constipation

• Difficulty urinating

More severe but rare side effects of antitussives may include:

• Rash or hives

• Itching

• Tightening of the throat

• Difficulty breathing or swallowing

• Numbness of the chest

• Confusion

• Hallucinations

• Respiratory distress

This list of side effects is not comprehensive. Speaking with a healthcare professional is the best way to get a complete list of side effects and determine whether taking antitussives is suitable for you.

How much do antitussives cost?

Antitussives are generally affordable medications that are available in brand names and generic formulas. Costs will vary depending on your insurance plan. Without insurance, the price can vary widely depending on the medication and quantity prescribed. However, using a prescription discount card from SingleCare may help reduce the cost of antitussives.