COVID-19 often causes a cough, which can be a disruptive and uncomfortable symptom managed effectively with over-the-counter (OTC) medications. These products offer symptomatic relief but do not target or eliminate the SARS-CoV-2 virus itself. Selecting the proper OTC remedy depends entirely on the specific type of cough a person is experiencing. Choosing the right medication can provide comfort and improve sleep quality during recovery.
Understanding the Two Types of Cough
A cough is a protective reflex, and classifying it is the first step toward effective treatment. The two primary types are categorized as either productive or non-productive. A productive, or “wet,” cough brings up phlegm or thick mucus from the lungs or throat, attempting to clear the airways of secretions.
A non-productive, or “dry,” cough does not produce any mucus or sputum. This type is often described as hacking or tickling and can be irritating to the throat lining. Using the wrong medication—such as treating a dry cough with a wet cough remedy—can be counterproductive to symptom management.
Over-the-Counter Options for Dry Cough
The most suitable OTC choice for a persistent, dry cough is a cough suppressant, also known as an antitussive. These medications work by decreasing the activity in the central nervous system that triggers the cough reflex. The active ingredient most commonly used for this purpose is Dextromethorphan (DM).
Dextromethorphan acts on the brain area responsible for initiating a cough, raising the threshold required to provoke the reflex. This allows irritated airways to rest and provides temporary relief from the hacking associated with a dry cough. DM is widely available in many formulations, often labeled as “long-acting” or “cough relief” products.
Supplementary Relief for Dry Cough
Since a dry cough is a common presentation of COVID-19, relief is often sought to aid sleep and reduce throat irritation. Non-pharmacological methods can be used alongside antitussives to soothe the throat. Sucking on medicated lozenges or hard candies stimulates saliva production, which coats the throat and helps suppress irritation.
Honey has also been shown in some studies to be effective for temporary relief. Keeping the throat moist is recommended, as dryness often exacerbates a non-productive cough. When selecting a product containing DM, choose a single-ingredient formula to avoid unnecessary exposure to other drugs.
Over-the-Counter Options for Wet Cough
When the cough is wet and productive, the goal shifts from suppression to clearance. An expectorant is the correct medication choice to help the body expel accumulated mucus. The primary expectorant found in OTC products is Guaifenesin.
Guaifenesin works by reducing the viscosity and adhesiveness of respiratory secretions in the airways. It increases the volume of fluid in the respiratory tract, which helps to thin the thick mucus. This action makes the phlegm less tenacious and easier for the body to cough up.
The benefit of using Guaifenesin is that it makes the cough more effective, helping to clear chest congestion and improve breathing. Guaifenesin works best when combined with ample fluid intake.
Hydration and Environmental Support
Maintaining hydration is a highly effective, non-drug method that complements the expectorant’s function. Drinking plenty of water or clear liquids helps keep the mucus thin, allowing the body’s natural ciliary action to transport secretions out of the airways. Using a cool-mist humidifier in the bedroom can also introduce moisture into the air, further assisting in thinning respiratory secretions.
Safety Warnings and When to Seek Medical Help
Avoiding Combination Products and Overdose
When using OTC cough and cold medications, careful attention to active ingredients is paramount to prevent accidental overdose or harmful drug interactions. Many products are combination formulas containing multiple active ingredients, such as a cough suppressant, a decongestant, and a pain reliever like Acetaminophen. Combining a multi-symptom product with a separate Acetaminophen tablet can easily lead to exceeding the maximum recommended daily dose.
The maximum daily limit for Acetaminophen from all sources is typically 4,000 milligrams for adults; exceeding this amount risks severe liver damage. It is essential to check the label of every medication to ensure you are not doubling up on the same drug. Certain other ingredients, such as decongestants like pseudoephedrine or phenylephrine, may also be included but can cause unwanted side effects like increased blood pressure or sleeplessness.
It is generally better to select single-ingredient products that target only the specific symptom you are experiencing. Additionally, older-generation antihistamines sometimes included in nighttime formulas can cause excessive drowsiness. These may not be necessary for a simple cough and can interact with other medications or existing health conditions.
When to Seek Medical Help
There are specific warning signs that indicate a need for immediate medical consultation rather than continued self-treatment with OTC products. Seek emergency care if you experience trouble breathing or persistent pain or pressure in the chest. Other red flags include new confusion, the inability to wake or stay awake, or if the skin, lips, or nail beds appear pale, gray, or bluish.
If the cough persists for longer than seven to ten days, or if it worsens after an initial period of improvement, you should consult a healthcare provider. A cough that is accompanied by a high fever that is not responsive to medication, or one that produces blood, also warrants professional medical evaluation. These symptoms suggest the possibility of a complication that requires more than just symptomatic relief.