It’s enough to make you dizzy—hundreds of boxes and bottles lining the drugstore shelves, all promising to eradicate your cough…and perhaps also chest congestion, postnasal drip, sneezing and other related symptoms. Americans spend billions a year on over-the-counter (OTC) respiratory medications—including cough suppressants, decongestants and antihistamines. Coughs are also one of the top reasons why we see a doctor.

Here’s a surprise…most of the time, it’s all unnecessary. Why? Most acute coughs brought on by a cold or the flu go away on their own within a few days and don’t require a doctor’s care. Sometimes, though, a cough can linger as long as two or three weeks, so you want to take something for relief.

Here’s the real bombshell: Most OTC cough remedies just don’t work! Back in 2006, the American College of Chest Physicians concluded that there’s no strong evidence of effectiveness for the vast majority of drugstore cough medications. In 2014, a Cochrane review of 29 clinical trials involving nearly 5,000 people reached the same conclusion. But they are heavily advertised, so people still buy them.

But don’t despair. There is real help out there. Some OTC remedies really do relieve coughs—though not in the way you’d expect. Even better are natural cough remedies, using readily found ingredients, which are both effective and safe.


Nine times out of 10, acute cough symptoms are triggered by postnasal drip—that annoying mucus trickling down the back of your throat. These OTCs decrease secretions to ease postnasal drip…

Antihistamines. Loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec) and diphenhydramine (Benadryl) block histamine, a naturally occurring chemical that provokes mucus production. They dry up mucus and decrease nasal secretions—even if you don’t have an allergy. Caution: They can cause water retention as a side effect. Avoid if you have glaucoma or prostate enlargement or are taking diuretics. Also, because these old-fashioned antihistamines can make you drowsy, you can become dependent on them to fall asleep. My advice: Take half the recommended dose, for no more than a week.

Saline nasal spray. Salt plus water—it doesn’t get much more natural than that! The simple act of spraying this combination into nasal passages usually alleviates the stuffiness that can trigger constant hacking. Try versions that contain only these two active ingredients, such as Ocean Nasal Spray, Ayr Saline Nasal Mist or Little Remedies Saline Spray/Drops. Caution: Avoid sprays containing oxymetazoline (Afrin), phenylephrine (Sudafed) or xylometazoline (Triaminic), which lead to “rebound congestion” when they wear off.


These natural cough relief remedies are your best bet for cough relief. They calm throat irritations, dry up mucus and boost the immune system—safely. My top picks…

Warm lemon and manukah honey “tea.” Everyone knows about the lemon/honey combo, which calms a cough while cutting mucus. But you can make it even more effective with manukah honey, a special kind from New Zealand that has strong antimicrobial properties, so it protects against the underlying cold virus. Regular raw honey also has antimicrobial properties. Blend a tablespoonful of honey with the juice from half a lemon in a cup of just-boiled water. For optimal benefit, drink it just before bedtime, when coughs typically rev up…and again in the morning.

Dark chocolate. Most people have no idea that one of their favorite treats is also a natural cough suppressant—thanks to theobromine, a chemical component in chocolate. The darker the chocolate, the more theobromine, so aim for versions containing more than 65% cocoa. Eat a small square—about one-half to one ounce—two or three times a day. Caution: Chocolate has caffeine, so don’t eat it in the evening.

Beet and/or pineapple juice. Both beet and pineapple juices have long been standbys for coughs due to bronchitis. Both help open bronchial passages and make it easier for your body to bring up excess mucus. Whichever you choose, a half cup (four ounces) is enough. It’s fine to drink it two or three times a day. (Note: If you’ve been told to limit nitrates, avoid beet juice.)

Elderberry syrup. Elderberry syrup, readily available in health-food stores, is a traditional remedy for colds, coughs and the flu. It acts as an expectorant and also has antiviral and antiflu properties. Take as directed on the package, up to three times a day. Dilute in water if that makes it easier to take.

Important: If your cough lasts beyond three weeks—or includes symptoms such as coughing up blood, significant shortness of breath, chest pain or persistent fever—see a doctor.


• Cough suppressants. A common ingredient is dextromethorphan (DXM), first introduced 60 years ago. It’s found in popular brands including NyQuil, Coricidin HBP Cough & Cold, Delsym and Dimetapp DM. Not only is there no evidence that it works, it can provoke a narcotic-like “high” when taken in large amounts, leading to potential for abuse.

• Cough expectorants. Guaifenesin, the active ingredient in Mucinex, Robitussin, Tussin and Guaifenesin LA, doesn’t have the narcotic-like downside of DXM, but there’s no evidence that it works, either.

• Combination products. Most OTC remedies combine ingredients in the same product to treat a variety of symptoms. Example: DXM, guaifenesin, an antihistamine, plus acetaminophen. This kitchen-sink approach is a bad idea—you’re treating symptoms you don’t have with drugs you don’t need. The biggest pitfall? You might be taking acetaminophen for a headache or fever and don’t realize that it’s also in your combo cough remedy…so you may exceed the safe daily limit, which increases the risk for liver damage.

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