How to Choose the Best Cough Syrup for Your Needs?

Posted On November 13, 2022March 19, 2024

Introduction

Yes, you read it right. Here, I will review the best cough syrup for kids and adults.

You must have found cough syrup at your home. But do you think it is the right cough syrup for you? 

Selecting the ideal cough syrup is always challenging for everyone. A cough and cold can affect anyone at any time as the weather changes.

However, not all coughs are the same. So, it is evident that even cough syrups are not the same.

Before selecting the best cough syrup, it is also essential to know about the cough. 

This post will review the effective cough syrup for kids and adults. But before that, we will know some basic information about the cough. 

Are you ready to know the most popular cough syrup? Then take a deep breath, and let’s get started.

Learn about Cough 

Have you ever thought about why we cough? 

You take oxygen and expel carbon dioxide because of the lungs. Suppose something (like dust or unwanted particles) enters your lungs. In that case, your lungs try to remove foreign particles from your respiratory tract by coughing. 

The cough is not our enemy because it is a natural defence mechanism of our lungs or respiratory tract. Therefore, a normal cough is generally a healthy function of our body. 

But you need to worry if it does not go away within a few weeks. 

Cough is a common symptom of various respiratory infections like upper or lower respiratory tract infections.

Although, coughing is not a life-threatening condition. But the long-term cough may devastate your daily routine activities like –

• you are unable to sleep properly, 
• you are not able to eat, 
• you are unable to do work, 
• you are unable to do study.

Cough pathophysiology

Usually, you start to cough when your cough receptor gets stimulated via any foreign particles or chronic lung diseases.  

Cough receptors are primarily present in our pharynx, larynx, trachea, bronchi or bronchioles areas. These cough receptors are well controlled by the cough center located at the medulla oblongata. 

Cough receptors and cough centers are both connected with the autonomic nervous system.

When a foreign particle enters your respiratory tract, it binds to cough receptors. 

Then it makes a complex between the antigen (Or a foreign particle) and cough receptor that sends a signal to the cough center. Due to this reflux arc, we do cough. 

Classification of cough

You can classify the condition or severity of the cough based on duration. For example, 

• If you have a cough for less than 3 weeks, it is called acute cough.
• If you are complaining cough between 3 to 8 weeks, it is called sub-acute cough
• If your cough is not controlling or persisting more than 8 weeks, it is called chronic cough. It may be due to tuberculosis, asthma, lower respiratory infections or other chronic lung diseases. 

It is always better to consult your doctor if you have had a cough for more than 3 weeks. 

Types of coughs 

It is also important to know – what kind of cough you have?

Generally, Cough has two types – productive and non-productive cough. 

Productive cough

If you get mucus (or sputum volume > 10 mL per day) in your cough; it is considered Productive cough (also known as Wet Cough). You may feel like something is dripping down or stuck in your throat. 

You may also experience the following symptoms during a wet cough – 

• Difficulty in breathing 
• Congestion in chest
• Feeling wheeziness (or breath noisily) 
• Yellowish-green phlegm 
• Blood spot (Hemoptysis)

These symptoms also suggest chronic lung diseases; you must consult your doctor. 

Non-productive cough

If you don’t have sputum or any mucus while coughing, this indicates a non-productive cough, also called dry cough. 

During a dry cough, you may feel irritation or a tickling sensation in your throat. It may be due to the common cold, flu, GERD, irritants (like smoke, dust, pollen grains etc.), heart failure and lung diseases (like pulmonary fibrosis). 

The severe dry cough may also indicate whooping cough or other respiratory problems. 

Whooping cough is highly contagious and most commonly happens in children. This type of cough is also known as “Pertussis.” 

Causes of cough 

You may have a cough due to certain factors like – 

• Weather changes 
• Common cold or flu
• Environmental factors like smoking (active or passive), irritants, dust, etc.
• Upper respiratory tract infections (URTI) include viral pharyngitis, laryngitis, sinusitis, etc. 
• Lower respiratory tract infection (LRTI) or chronic lung diseases such as asthma, COPD, bronchitis, pneumonia, tuberculosis, etc. 
• GERD (Gastroesophageal reflux disease) 
• Taking drugs that cause cough like ACE inhibitors (most common with captopril), Beta-blockers (propranolol-induced asthma), NSAIDs (Aspirin-induced asthma) etc. 
• Certain drugs can cause pulmonary fibrosis, like Bleomycin, Busulphan, Methotrexate, Carmustine, Amiodarone, Cyclophosphamide, and Hydralazine.

Best cough syrup names 

We have grabbed enough information about the cough. Now, it’s time to know the best cough syrup for you. 

As we know, cough is a common symptom of lung infection. You need to understand the cause of the cough. 

If your cough is persisting more than 8 weeks, you should not treat the cough yourself. It could be a lung infection or chronic lung disease. You must consult your doctor. 

Your doctor may assess your cough based on intensity, severity, frequency, and sensitivity. 

Sometimes cough may disturb your daily routine activities. In that case, you can take symptomatic relief or over-the-counter (OTC) cough and cold medications. It would be best to take any syrup after consulting your doctor.

When it comes to best cough syrups, there are two types of cough syrups in the market – 

• Expectorant, and 
• Antitussives

These kinds of cough syrups are usually available in a combination of antihistaminic drugs, nasal decongestants, or bronchodilators like – 

• Expectorant + bronchodilator 
• Expectorant + antihistaminic drug 
• Antitussives + antihistaminic drug 
• Antitussives + antihistaminic drug + nasal decongestant 

You must know what type of cough you have while selecting the cough syrup.

If you have a productive cough, you should choose expectorant cough syrup, while for dry cough, you need to take antitussive cough syrup. 

Best dry cough syrup

Choosing the best dry cough syrup depends on various factors, including the underlying cause of the cough and individual preferences.

If you don’t have mucus (or sputum) or having irritation in your throat during a cough, then you should go for dry cough syrup. 

Antitussive cough syrups are always a better choice for dry cough. These antitussives suppress the coughing by inhibiting the cough center. So, antitussives are also known as cough center suppressants. 

Here are several well-known dry cough syrups that are frequently recommended:

1. Codeine Cough Syrup

Codeine is considered as gold standard medicine for dry cough. 

It belongs to a class of opioid (or narcotic) medicine because this medicine is naturally obtained from the opium poppy plant.

Codeine binds to μ (mu) opioid receptor of your brain and suppresses the cough center. 

It relieves your cough effectively, but you may have an addiction because it gives you pleasure or sedation. 

Codeine should not be used in acute cough. It is highly effective in chronic dry cough. 

Codeine is banned in many countries due to its serious side effects, but it is available in India. 

Benefits – Effective in chronic dry cough condition

Side effects – Risk of serious side effects like drowsiness (feeling sleepier), dizziness, breathing difficulty, headache, constipation (most common), nausea, vomiting, addiction, and death. 

Safety advice – Strictly avoid during pregnancy, asthma and children (less than 6 years) 

2. Codeine Phosphate and Chlorpheniramine Maleate Syrup

Codeine syrup is prepared chiefly with chlorpheniramine medicine. You can get various brands of the combination of codeine and chlorpheniramine in the market like –

• Tossex Antitussive Cough Syrup
• Codistar syrup 
• Ascoril C Syrup
• Grilinctus CD Syrup
• Wirof cough syrup

Chlorpheniramine is an antihistaminic (or antiallergic) medicine of the first generation. It stops allergic reactions by inhibiting the H1 receptor. 

Chlorpheniramine drug has the potential to cause sedation or drowsiness. Therefore, it is also known as a drowsy antihistaminic drug. 

Benefits– The combination of codeine and chlorpheniramine is best to take if you have a chronic dry cough with a common cold, runny nose, watery eyes, and sneezing.

Side effects –

• Severe drowsiness
• Confusion 
• Seizures
• Hallucination  

Safety advises –

• Avoid taking in acute or severe bronchial asthma
• Don’t take in pregnancy 
• Don’t give children unless the doctor prescribed 
• Don’t take in glaucoma condition because chlorpheniramine may increase intraocular pressure 

3. Dextromethorphan Hydrobromide Syrup IP

Dextromethorphan is the best cough syrup for dry cough. 

It is easy to remember while selecting cough syrup for non-productive cough like – 

“D for Dry cough”

“D for Dextromethorphan”

Dextromethorphan is a popular OTC (over-the-counter) cough medicine. This means you do not require a prescription while buying.  

It is a non-opioid medicine. So, you won’t feel much drowsiness, and it also does not cause addiction. 

In terms of effectiveness, the effect of Dextromethorphan is similar to those of codeine.

It is an antitussive by blocking the NMDA receptor (N-methyl D-aspartate).

The duration of action of Dextromethorphan is 6 hours. This means it gives you an antitussive effect for 6 hours. 

Dextromethorphan is famous in India with the brand name Benadryl DR dry cough syrup (Dextromethorphan bromide 15 mg/5ml). 

Benefits – 

• Effective in acute or chronic dry irritants cough
• Dextromethorphan has an equal efficacy to codeine. 
• Dextromethorphan does not cause sedation, respiratory depression, or addiction at usual doses because it has a low addicting profile.

Side effects –

You may feel drowsiness, dizziness, or mental confusion if you consume inappropriately or in high doses.

Safety advises – 

• Don’t take in asthma
• Don’t take in pregnancy
• Don’t take in liver problems 
• Avoid if you are on antidepressant drugs like selective serotonin reuptake inhibitors (SSRIs).

4. Dextromethorphan Hydrobromide and Chlorpheniramine Maleate syrup

You may take the combination if you have a dry cough with the common cold, runny nose, watery eyes, and sneezing.

We have already discussed that dextromethorphan has an antitussive effect while chlorpheniramine has an antihistaminic or antiallergic effect.

You may get this combination (chlorpheniramine maleate 4mg/5ml + dextromethorphan hydrobromide 10mg/5ml) with different brands in India, like – 

• Corex Dx 
• Codistar-DX Cough Syrup
• Cheston D Syrup Sugar Free
• Dilo-DX Syrup
• Bricarex-DX Syrup

Benefits – Effective in acute or chronic dry irritant cough with a runny nose, watery eyes, and sneezing.

Side effects – Drowsiness is a major side effect. 

Safety advises – 

• Don’t take in asthma
• Don’t take in pregnancy
• Don’t take in liver problems 
• Avoid if you are on antidepressant drugs like selective serotonin reuptake inhibitors (SSRIs)
• Don’t take in glaucoma condition because chlorpheniramine may increase intraocular pressure 

5. Dextromethorphan HBR, Phenylephrine HCL and Chlorpheniramine Maleate Syrup

You may take this entire combination if you are struggling with dry cough, runny nose, sneezing, stuffy nose and nasal congestion.

In this combination syrup – 

• Dextromethorphan HBR is an antitussive activity 
• Phenylephrine HCL is a nasal decongestant 
• Chlorpheniramine Maleate is an antiallergic medicine

The combination of these medicines is available in various brands in India. For example – 

• Ascoril D plus syrup sugar free
• Alex Syrup
• Tuscuf D syrup 
• Touxvib cough syrup
• Respilex-D XL syrup 
• Akof D syrup 
• Kozifed plus cough syrup

Benefits – This combo pack is highly effective in acute or chronic dry irritant cough + runny nose + stuffy nose + nasal congestion. 

Side effects – 

• Drowsiness
• Increase blood pressure 

Safety advises – 

• Don’t take in asthma
• Don’t take in pregnancy
• Don’t take in liver problems 
• Avoid if you are on antidepressant drugs like selective serotonin reuptake inhibitors (SSRIs)
• Don’t take in glaucoma condition because chlorpheniramine may increase intraocular pressure 
• Avoid this if you are a hypertensive patient because phenylephrine has the potential to raise blood pressure

Best wet cough syrup

For wet coughs, which are commonly characterized by the formation of mucus or phlegm, you must take medicines that help to expel or reduce mucous production. 

Expectorants are always the best cough syrup for wet cough. 

Expectorants are two types – 

• Bronchial secretion enhancers
• Mucolytics 

Bronchial secretion enhancers are those medicines that increase bronchial secretion (such as sputum) and expel out more efficiently by coughing. These drugs are – 

• Sodium citrate 
• Potassium Citrate
• Potassium iodide 
• Guaiphenesin 
• Ammonium chloride 

On the other hand, Mucolytics are those medicines that break down mucous and make sputum easier to expel from the airways. It includes – 

• Ambroxol
• Bromhexine 
• Acetylcysteine (Mucinex 600 mg tablet)
• Carbocisteine 

Here are some of the top wet cough syrups frequently recommended:

1. Guaiphenesin cough syrup

One of the most frequently used expectorants is guaifenesin. 

You can take this guaiphenesin cough syrup without a prescription because it is a component of over-the-counter (OTC) cold and flu medications.

Guaiphenesin works as a bronchial secretion enhancer. It increases bronchial secretion, reduces the thickness or viscosity of mucus and makes the sputum thin. This mechanism helps the mucus to expel out from the airways. 

It also provides a soothing effect to your throat.

Guaiphenesin comes alone in tablet form with different strengths. It is trendy in India with the brand name – 

• Barkeit Tablet (Guaiphenesin 200 mg)
• Cervclear Tablet (Guaiphenesin 200 mg)
• Mucusnil Tablet ER (Guaiphenesin 600 mg)
• Tussalyte G1 Syrup (Guaiphenesin 133 mg)

In cough syrup, Guaiphenesin is prepared with other drugs to make it more effective.

Sometimes Guaiphenesin is also combined with antitussive cough syrup like Dextromethorphan, Noscapine. 

Benefits – 

You can use guaiphenesin cough syrup under the following conditions – 

• Colds
• Minor bronchial irritation
• Bronchitis
• Influenza
• Sinusitis
• Bronchial asthma
• Emphysema.

Side effects – No serious side effects, but overdosing may cause vomiting, diarrhoea, abdominal pain, and drowsiness.

2. Ambroxol hydrochloride, Levosalbutamol and Guaiphenesin Syrup

You need to take this combination if – 

• you are feeling gasping and producing a crackling sound while coughing 
• you are having wheezing problems ((or breathing noisily) 
• you have congestion in your lungs  
• you are having shortness of breath
• you have chest tightness 

In this combination, 

• Ambroxol is a mucolytic agent that breakdown the sputum
• Levosalbutamol is a bronchodilator that dilates your bronchioles and makes breathing easier
• Guaiphenesin is a bronchial secretion enhancer that loosens your sputum

This entire composition (ambroxol hydrochloride, levosalbutamol and Guaiphenesin) comes in various brands in India. For example – 

• Ascoril Plus LS Expectorant
• Ascoril LS Syrup
• Kufril LS Syrup
• Levolin Plus Syrup
• Chericof-LS Syrup
• Ambrodil-LX Syrup

Additionally, terbutaline can be used in place of levosalbutamol as a bronchodilator. The combination also comes with ambroxol hydrochloride, terbutaline sulphate and guaiphenesin syrup. For example, 

• Tusq-X Plus Expectorant
• Cheston Plus Expectorant
• M-Solvin Syrup Lime
• Macbery-XT Expectorant

Sometimes, menthol is also used to give a cooling sensation or soothing effect to your respiratory tract. 

The composition may form like ambroxol hydrochloride, terbutaline sulphate, Guaiphenesin and menthol syrup. For example, 

• Ambrolite S syrup 
• S-Mucolite Syrup
• Axalin Expectorant
• Soventus Syrup

Benefits – Treatment for chesty cough (or cough with mucus)

Side effects – 

• Tremor because of levosalbutamol 
• Rhinorrhoea (excess discharge of mucus from the nose) because of ambroxol 

3. Benadryl cough syrup (diphenhydramine + ammonium chloride + sodium citrate)

Benadryl cough syrup is very popular in India. It is a combination of diphenhydramine, ammonium chloride and sodium citrate.

Benadryl can be the best cough syrup for you if you struggle with a wet cough and the common cold. 

In this composition, diphenhydramine is a highly sedative antihistaminic drug. It gives you symptomatic relief from runny nose, sneezing and watery eyes. 

While ammonium chloride and sodium citrate are both bronchial secretion enhancers that act like an expectorant. 

This composition is also available with other famous brand names like Cofsils Cough Syrup.

Benefits – Treatment for chesty cough and the common cold 

Side effects – Drowsiness

4. Bromhexine syrup

Bromhexine is also one of the best cough syrups if you have a chesty cough. It is only indicated if mucus plugs are present. 

Bromhexine is a mucolytic agent; it breaks down the sputum and helps to expel out by coughing. 

In India, it is very popular with the brand name Bromex Syrup and Bromhexine Elixir.

It also comes in combination with other drugs like – 

Benefits – Treatment for chesty cough (or cough with mucus)

Side effects – 

• Tremor because of terbutaline 
• Rhinorrhoea (excess discharge of mucus from the nose) because of bromhexine 

Best cough syrup for kids

When choosing a cough syrup for children, it’s crucial to prioritize safety and effectiveness.  

As per FDA, if your child has a cough due to a cold or upper respiratory cough infection, it does not need treatment. 

Still, if you want to give cough syrup to your children, you may go with OTC medicines but don’t give any cough syrup to children under 2 years.

Always consult with a pediatrician or healthcare professional before giving any medication to children, especially for those under the age of 2.

Here are some of the best cough syrups for kids that are commonly recommended:

1. Dextromethorphan used in kids

Dextromethorphan is India’s most widely prescribed and trending medicine for dry cough syrup for kids. 

Dextromethorphan is an OTC medicine for younger children. You should not give Dextromethorphan if your child is less than 2 years. 

It is very popular with a brand name of – 

• Benadryl DR kids dry cough syrup (Dextromethorphan bromide 7.5 mg/5ml)
• Benylin dry cough syrup (Dextromethorphan bromide 7.5 mg/5ml)

Dosage – 

• For children 2-6 years – Dextromethorphan 2.5 to 5 mg 
• For children 6-12 years – Dextromethorphan 5 to 10 mg

Combination – Also available with a combination of chlorpheniramine like Tixylix New cough syrup (Dextromethorphan and chlorpheniramine)

Benefit – Treatment for dry cough 

Side effects –Drowsiness

Safety alert –Overdose may cause nausea, vomiting, dizziness, ataxia, lethargy, slurred speech, nystagmus, urinary retention, hysteria, stupor, hallucination, and coma.

2. Promethazine syrup IP

Promethazine is available in OTC and prescription medicine. It can be the best cough syrup for younger children. 

You should avoid it if your child is less than 6 years old. 

In India, promethazine is sold under the brand name Phenergan syrup. 

Promethazine is an antihistaminic drug that is used for the common cold and symptomatic cough relief.

Combination – Promethazine cough syrup is usually prepared with pholcodine (antitussive drug). For example – Tedykoff LX linctus, Tiskytas Syrup, Toff Lix Syrup etc. 

Benefits – A combination of Promethazine + Pholcodine is effective in the treatment of cold symptoms like dry coughing and runny nose 

Side effects – Promethazine is a highly sedative antihistaminic drug, so your child may have drowsiness. 

Safety alert – Don’t give less than 2 years child unless a doctor prescribes it because promethazine can potentially cause fatal respiratory depression.

3. Noscapine linctus IP

Noscapine is an OTC cough syrup in many countries, but it does not recommend for acute cough. 

You may take this syrup if you have continuous dry coughing for longer than about five minutes. This type of cough is often called spasmodic cough. 

It is also a prescription drug. 

Noscapine is a non-narcotic opioid antitussive drug that works on sigma σ–receptor agonist.

It has equally potent antitussive properties as codeine.

It does not have narcotic or addictive properties. So, it does not cause respiratory depression and addiction. 

You can give noscapine to young children for symptomatic relief of cough. But it is better to avoid noscapine in less than 6 years old children. 

Combination – Noscapine cough syrup is generally prepared with other drugs. So, you might have seen the combination of medicines with different brand names – 

• Coscopin Paed Syrup (Noscapine + ammonium chloride + sodium citrate)
• Himaleate cough syrup (Noscapine + chlorpheniramine maleate + guaifenesin + sodium citrate)

Benefits – Treatment for spasmodic cough (coughing longer than 5 mins.)

Safety alert – 

• Still no safety data of noscapine below 3 years old children. 
• Don’t give in asthmatic children because it releases histamine and cause bronchoconstriction. 

4. Herbal cough syrup

Herbal cough syrups are generally safe for children. They are OTC products. 

The most popular herbal cough syrups available in India. For examples – 

• Dabur Honitus Herbal Cough Remedy
• Himalaya Koflet Syrup
• Cofsils Naturals Cough Syrup
• Zandu Ayurvedic Cough Syrup 
• Dr. Morepen Lemolate Gold Ayurvedic Cough Syrup 
• Multani Kuka Cough Syrup
• Charak Pharma Kofol Sf Syrup 

Also read – 

• How to calculate paracetamol dose for kids
• Albendazole dose for kids

Best cough syrup during pregnancy in India

Diphenhydramine and dexchlorpheniramine are the safest and best cough relief medicine for pregnant women. 

If you are pregnant and struggling with a cough, cold, runny nose, itchy skin etc.

In this case, diphenhydramine or dexchlorpheniramine medicine are better choice.

Both diphenhydramine and dexchlorpheniramine belong to an antihistaminic category. 

Diphenhydramine is a highly sedative antihistaminic drug. It is popular in India with the brand name Benadryl. 

As per medical research, diphenhydramine is most likely safe for your growing baby during pregnancy. 

As far as the concern of dexchlorpheniramine, it is a mild sedative antihistaminic drug. It is popular in India with the brand name Polaramine.  

According to a study, three drugs (chlorpheniramine, dexchlorpheniramine and hydroxyzine) are considered safe in pregnancy, especially in the first trimester. 

But you must consult your doctor before taking any medicine in pregnancy.  

Also read – 

Safe drugs in pregnancy 

Conclusion

Choosing the best cough syrup depends on various factors such as the type of cough (dry or wet), individual preferences, age, and any underlying health conditions.

In this post, we have seen the best cough syrup for adult, kids and pregnancy.  

Cough is a symptom; it is not a disease, and it can be a symptom of many lung diseases. Therefore, you should not take any cough syrup while coughing.

Always consult with a healthcare provider or pharmacist before using any cough syrup, especially if you have underlying medical conditions, are taking other medications, or have allergies to certain ingredients. They can provide guidance on the most suitable dry or wet cough syrup based on your specific needs and circumstances.

Please share this article if you found this article informative. 

FAQ

Q 1. Which cough syrup is best for dry and wet cough?

Antitussive cough syrups are generally used for dry cough, while expectorants are highly effective for wet cough. 

Q 2. Can I take dry cough medicine for a wet cough?

No. You should not take dry cough syrup for wet cough because dry cough medicines are a cough centre suppressant and can suppress your mucus, which may cause serious problems. 

Q 3. When is a cough serious?

Suppose you have had a persistent cough for more than 8 weeks. In that case, it can be a serious lung problem like asthma, tuberculosis, COPD, lung fibrosis or other respiratory infections. You must consult your doctor if you are not getting relief from a cough. 

Q 4. Which is the best cough syrup in India?

Dextromethorphan is widely used for dry cough in India, while guaifenesin is used primarily with wet cough syrup preparations. 

References –

1. KD Tripathi. Essentials of Medical Pharmacology, 7^th edition; Jaypee brothers medical publisher, 2013; Drugs for cough and bronchial asthma, Chapter 16; Page 218 to 221.
2. Lippincott Williams & Wilkins. Nursing Pharmacology, Made incredibly easy! 3^rd Edition; Respiratory drugs, Chapter 6; Page 279 to 288.
3. Linda E. McCuistion et al. Pharmacology – a patient centered nursing process approach 2018; Elsevier Edition 9; Respiratory drugs, Unit XI; Page 973 to 983.
4. Review of cough and cold medicines in children. Australian government, April 2009