Every one of us has experienced a cough…that nagging cough that keeps us up at night or the panic about what to give our little ones when their coughing seems unrelenting.

ALSO READ: Wet cough vs dry cough – do you know the difference?

Desperate to find something to offer ourselves or our children relief, most of us will turn to over-the-counter (OTC) cough medication. But how many of us know what ingredients are in the cough medicine, what are the risks associated with the medicine and most importantly, whether we are taking the correct cough mixture to help relieve a wet or dry cough?

Determining what type of cough you have may be a bit confusing. Typically cough is defined as wet or dry. A dry (non-productive) cough produces no phlegm (mucus) and is usually tickling and irritating, whereas a wet cough produces mucus or phlegm.

Wet coughs typically require an expectorant to help expel mucus whereas cough suppressants are used when the cough is dry and there is no mucus or phlegm present, there is no identifiable cause and it is disruptive e.g. disturbing your sleep.

Let’s take a closer look at cough suppressants.

Cough suppressants typically contain 1 of the following ingredients; codeine, dextromethorphan or pholcodine³. Codeine is one of the most commonly used/recommended antitussives today.

It is an opiate and a derivative of morphine which means that is has the potential to cause morphine-like side effects such as constipation, excitation and can be habit forming.

Misuse of prescription and over-the-counter codeine-containing products is a global public health issue.

Despite restrictions imposed on OTC codeine-containing products made in 2015 by the South African Health Products Regulatory Authority (SAHPRA), it is still relatively easy to obtain.

Of course, one must remember that over-the-counter (OTC) cough and cold medicines are safe and effective when they are used as directed. But taking too much of them — on purpose or by accident — can lead to abuse.

Fortunately, there are over the counter cough suppressants available that have proven efficacy without codeine-like side effects. Pholcodine does not metabolise to morphine and so it has little to none of the codeine-like side effects at recommended dosages but is equally effective. Cough medicine containing pholcodine can generally be used in children from the age of two years old.

When choosing an OTC cough medication to suppress a dry cough, speak to your pharmacist about a suppressant with a favourable safety profile or go to www.knowyourcough.co.za for more information.

References:

1. What causes cough? (2017) at https://www.healthline.com/symptom/cough (Website accessed on 4 July 2019)
2. Witness Newspaper. Doctors take flu seriously (28 June 2019) athttps://www.news24.com/SouthAfrica/News/doctors-take-flu-seriously-20190628(Website accessed on 5 July 2019)
3. Truter I. Cough. Evidence Based Pharmacy Practice. SA Pharm J 2007;74(4):20-27.
4. Van Schoor J. An approach to recommending cough mixtures in pharmacy. S Afr Pharm J 2012;79(6):30-33.
5. De Blasio F, Virchow JC, Polverino M, et al. Cough management: a practical approach. Cough 2011;7(1):7.
6. Cough treatment. Specialist Forum 2017;17(6): 28-30
7. Equinozzi R, Robuschi M, on behalf of the Italian Investigational Study Group on Pholcodine in Acute Cough. Comparative efficacy and tolerability of pholcodine and dextromethorphan in the management of patients with acute, non-productive cough. A randomized, double-blind, multicenter study. Treat Respir Med 2006;5(6):509-513
8. Science Direct. Antiasthmatic and cough medication (2007) at https://www.sciencedirect.com/topics/neuroscience/antitussives (Website accessed on 4 July 2019)
9. Gibbon CJ (ed). South African Medicines Formulary, 5th ed. Cape Town, South African Medical Association, 2000. P 367, 464.
10. Dada S, Burnhams NH, van Hout MC, et al. Codeine misuse and dependence in South Africa – learning from substance abuse treatment admissions. S Afr Med J 2015;105(9):776-779. DOI:10.7196/SAMJnew.8172
11. Web MD. Teens and Cough Medicine Abuse (2019) at https://www.webmd.com/parenting/teens-cough-medicine-abuse#2 (Website accessed on 4 July 2019)
12. Girdwood RH, editor. Clinical pharmacology. 25th edition. Edinburgh: Bailliere Tindall; 1985. p. 328
13. Core pholcodine product information, Dec 2005 [Online]. Australian Government Department of Health, Therapeutic Goods Administration. [cited 23 August 2018]; Available from URL: https://search.tga.gov.au/s/search.html?collection=tga-websitesweb&query=pholcodine.
14. Findlay JWA, Fowle ASE, Butz RF, et al. Comparative disposition of codeine and pholcodine in man after single oral doses. Br J Clin Pharmacol 1986;22:61-71.
15. Approved product package insert. February 2004.

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