Cough Medicine: DM is JUNK?

It’s about that time again! Covid cases, although not more severe, are rising. And with school starting, upper respiratory illness are taking flight and coughing illnesses are in full effect! The question though is do those over the counter cough medicines actually work?!

Coughing is a common reflex action that helps clear the airways of irritants and mucus, safeguarding our respiratory health. However, persistent or severe coughing can be distressing and disruptive, leading you to seek over-the-counter remedies for relief. One such remedy that has gained widespread attention is dextromethorphan (labeled DM on your standard over the counter medicines) - a cough suppressant found in various cold and cough medications. Despite its popularity, the efficacy of dextromethorphan in effectively stopping cough remains a contentious topic.

What is Dextromethorphan?:

Dextromethorphan is an antitussive (cough suppressant) commonly found in non-prescription cough and cold medications. Often it’s labeled with a “DM” after the name of the medicine on the shelf. It purportedly works by affecting the cough reflex in the brain, reducing the urge to cough. It is chemically related to opioids but lacks the pain-relieving and addictive properties of its counterparts. As such, it is often considered a safer alternative for managing cough.

The Limited Scientific Support:

While dextromethorphan is widely used and available over the counter, the scientific evidence supporting its efficacy in stopping cough is far from conclusive. Research on its effectiveness has yielded mixed results, leaving medical professionals and researchers divided on its true benefits.

More than several studies have shown that dextromethorphan may offer minimal to moderate relief from acute coughs, such as those associated with the common cold. However, the magnitude of the effect appears to be modest at best, with some studies suggesting that its impact is no greater than that of a placebo. (Translation: giving an empty pill to a coughing patient and telling them it’s cough medicine had a similar effect to giving the actual medicine itself). This lack of consistency in findings makes it difficult to confidently assert its efficacy.

Moreover, the effectiveness of dextromethorphan seems to vary depending on the type of cough. It might be more effective for dry coughs as opposed to productive (mucus producing) coughs. This suggests that dextromethorphan's mechanisms might not be suitable for all types of cough.

Placebo Effect and Challenges in Assessment:

The challenge of objectively measuring cough severity and the potential influence of the placebo effect further complicate matters. Cough is a subjective symptom, and its severity can be influenced by psychological factors, which might explain why some individuals report relief after taking dextromethorphan. This could contribute to the perception that the medication is effective, even if its pharmacological action in stopping cough is limited.

Safety and Risk Factors:

While dextromethorphan is generally considered safe when used as directed, it is not without its risks. High doses (which frequently happens with mixing and matching over the counter meds), or misuse of the medication can lead to adverse effects, including dizziness, nausea, vomiting, and even more severe reactions like hallucinations or serotonin syndrome. This raises concerns about the balance between potential benefits and risks, particularly when considering its relatively modest efficacy in cough suppression.

The Call for Alternatives:

Given the uncertainty surrounding dextromethorphan's efficacy in stopping cough and the potential risks associated with its use, there is a growing interest in exploring alternative cough management strategies. These alternatives might include traditional remedies, steam inhalation, honey-based treatments, and maintaining proper hydration.

Additionally, addressing the underlying cause of the cough, such as treating an underlying respiratory infection or managing allergies, is often a more effective approach than relying solely on cough suppressants like dextromethorphan.

And lastly but probably most importantly, how about preventive measures? No, I am not implying that you mask everywhere. In fact, exposure to bacteria and viruses is necessary to help build the immune system. However I am suggesting that yes, food and mindfulness be your number 1 medicine. This means 85% of the time eating foods the universe intended for us to eat… eating “from the earth” foods that are rich in micronutrients… and reducing your stress hormone levels with yoga, mindfulness or other self care techniques. This will put your body in an optimal position to effectively encounter and fight off pathogens.

In the realm of cough suppression however, dextromethorphan remains a significant subject of debate. While it is widely available and frequently used, its effectiveness in stopping cough lacks strong scientific support. I personally think it’s junk… that’s latin for: if I, as a physician, tried to market and sell the product, I’d probably have my medical license stripped of me… but somehow the pharmaceutical companies get away with it…

And if you are seeking relief from persistent cough, you should consider other consult a healthcare professional that you trust for guidance.

In peace & love,

Dr. Dana