Antitussives

Antitussives are medications that suppress coughing. They are used to relieve nonproductive or disruptive coughs and are often chosen when coughing interferes with sleep or rest. Coughs that are productive, aimed at clearing mucus, are generally not treated with antitussives, since coughing helps remove secretions.

Antitussives fall into two broad categories. Opioid antitussives, such as codeine and hydrocodone, act on the cough center in the brain (medulla) to reduce the urge to cough. They can be effective but carry risks of sedation, dizziness, constipation, and, at higher doses, respiratory depression. Their use is restricted in many countries, especially for children and in situations with potential for misuse or drug interactions. Non-opioid antitussives include dextromethorphan, which is widely used in over-the-counter preparations. Dextromethorphan acts centrally, likely via NMDA receptor antagonism and related mechanisms, to dampen the cough reflex. It has a potential for abuse and interactions with serotonergic drugs. Another non-opioid option is benzonatate, a peripherally acting agent that anesthetizes airway cough receptors, reducing cough without strong central effects. Diphenhydramine or other antihistamines may be included in combination products for their antitussive effects, particularly at night, though they bring sedative risks.

Safety and considerations include avoiding use in certain populations (such as young children, pregnant or lactating individuals, or those with certain chronic diseases) and watching for drug interactions. Dextromethorphan and, to a lesser extent, codeine-containing products can interact with monoamine oxidase inhibitors and other serotonergic drugs, increasing the risk of serious adverse effects. Providers tailor antitussive use to the cough cause, patient age, comorbidities, and potential adverse effects.