General information
A cough syrup (antitussive) is a medicine that suppresses or dampens the irritation of the cough. Usually the basis for a cough syrup is a simple syrup (Syrupus Simplex, purified water and household sugar) or an alcoholic solution. A variety of cough syrups with many different active ingredients are available.
For some active ingredients, the cough-relieving mechanism of action is very well known, but for some the mechanism of action is also largely unknown. There are different types of cough, so it is important to choose the right cough syrup with a suitable ingredient. Cough suppressants are used to combat dry, irritable coughs, and expectorants help the body to get rid of the mucus produced by the body’s own defence system.
Most cough-relieving drugs contain opiate derivatives derived from opium poppy seeds. Opiates not only have an analgesic (analgesic) effect, but also have a cough-relieving (antitussive) effect. These opiate derivatives are available only on prescription and are used mainly for dry irritable cough without mucus formation.
For example, codeine, dihydrocodeine and noscapine fall into this group of cough syrups. The effect of these substances takes place at the central nervous system, where they have a dampening effect on the cough center in the brain stem and a slight sedative effect. Opiate derivatives should only be used for a few days as there is a risk of developing dependency.
Cough syrup with newer active ingredients contains substances that do not have this addictive potential and the attenuating (sedating) side effect. Clobutinol, levodropizine and pentoxyverine are examples of this group of cough syrups. Over-the-counter (non-vegetable) cough syrup often contains the active ingredient dextrometorphan.
Dextrometorphan inhibits the irritation of the cough, but unlike the opiate derivatives, it still allows a cleansing cough. The risk of developing dependency is also significantly lower. Other ingredients are used to treat coughs with mucus formation, which are supposed to make coughing up easier.
Cough-relieving drugs should not be used in this case, as the suppression of the coughing stimulus prevents the mucus in the airways from being coughed up, which can hinder breathing and promotes the settlement of bacteria in the stuck mucus. Cough syrup to dissolve mucus (contains expectorants) contains, for example, acetylcysteine (a mucolytic agent, reduces the toughness of the mucus) or bromhexine and ambroxol (secretolytics, stimulate the secretion of the thin bronchial secretion). Cough syrup with these ingredients is not available on prescription.
For this group of mucolytic cough syrups, the mechanisms of action are not all clear; the main focus is on normalizing the viscosity of the mucus (mucus viscosity). Cough syrup with herbal ingredients can also soothe the cough (e.g. ribwort herb, coltsfoot, Icelandic moss and marshmallow root) and have an expectorant effect like thyme, ivy, spruce, fennel, eucalyptus and aniseed. Coughing is an unpleasant symptom of a cold, but coughing also has an important cleansing function for the lungs, as mucus has to be coughed up.
Coughing in infants and babies is very distressing for the child, especially at night. Cough suppressants should only be used when the baby is one year old. Before that, a pediatrician should always be consulted when coughing.
A child over one year of age (some recommendations are even from two years of age) can be treated with cough syrup and home remedies, but if the baby coughs for longer than a week, a visit to the doctor is necessary. The same applies if the child coughs up blood, gets a fever or vomits while coughing. The cold usually has two phases, first with a dry, unproductive cough, then with a damp, phlegm-producing cough.
By the way, this applies not only to children, but also to adults. In the first stage, cough stimulants are the medication of choice, in the second phase an expectorant cough syrup is indicated. For children and babies, simple household remedies such as hot milk with honey or cough-stimulant cough syrup such as Tuscalman® often help against a dry cough.
Stronger anti-inflammatory remedies, such as those containing codeine, are available only on prescription and should be used especially if the cough prevents you from sleeping through the night.Thyme can also have a relaxing effect on the bronchial tubes due to the essential oils it contains, promoting sputum and killing bacteria. Thyme relieves cramping and irritable coughs as well as hoarseness in the case of colds in the upper airways and can be used for baby coughs from one year of age. Against the damp, productive baby cough, which usually occurs in the second phase, expectorant cough juices can support the expectoration of mucus.
Cough syrup with the active substance Clenbuterol (like Mucospas®) works slime mobilizing and can be used also already with babies. In general, it should be noted that too much alcohol (over five percent) in the cough syrup is not suitable for babies and children. Cough syrups have no effect against the symptoms of whooping cough.
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