Help for Hackers
New guidelines say which drugs really kill a cough
My dear doctor, I'm surprised to hear you say that I am coughing very badly, because I have been practicing all night," Irish orator John Philpot Curran informed his primary caregiver a couple of centuries ago. You know the feeling, as your red-rimmed eyes scan pharmacy shelves for the box that will end the hacking. Suppressants, expectorants, decongestants, pain relievers. Daytime, nighttime. Nonsedating. Elixirs, gel caps, lozenges. One company has 10 cough products. How to choose?
Last week the American College of Chest Physicians answered. For coughs caused by colds and sinus problems, asserted new guidelines, you need just two ingredients: an older antihistamine, to dry up the drip down the back of the throat, and a decongestant, to reduce swelling. Medications with other ingredients should be kept out of your shopping cart. Makers of cough products quickly took issue with the guidelines.
A sweeping literature review convinced the ACCP that cough suppressants such as dextromethorphan and codeine don't work, says Richard Irwin, a professor of medicine at the University of Massachusetts Medical School and chair of the guideline-writing panel. "About the only thing that will truly stop a cough is general anesthesia," he says. Nor are phlegm-thinning expectorants effective.
Newer, not better. Brompheniramine, chlorpheniramine, and diphenhydramine are acceptable antihistamines for ordinary coughs. Newer, nonsedating antihistamines are less likely to cause drowsiness--but they are also less effective at stopping the dripping, says Irwin. To reduce congestion, the guidelines specify pseudoephedrine. Many products, such as Dimetapp Elixir, have only the two recommended ingredients.
The guidelines, summarized at www.chestnet.org, also warn against giving over-the-counter cough medicine to children younger than 14 because of the risk of illness or death. And if you have high blood pressure, check in with your doctor before taking an OTC remedy--older antihistamines may raise it further.
This story appears in the January 23, 2006 print edition of U.S. News & World Report.