Specific treatment recommendations for the common symptoms associated with cough and cold

Productive cough:

Characterized by the presence of excessive sputum and may be associated with various underlying diseases e.g. chronic bronchitis, Tuberculosis, LVF etc.

Treatment of the underlying cause recommended e.g. with antibiotics.

Avoid antitussives as suppression of cough can be harmful

Expectorants may help to reduce sputum viscosity so bronchial secretions can be expectorated. There are 2 types:

• Mucolytic expectorants e.g. Ambroxol, Acetylcysteine, Carbocysteine, Bromhexine.
• Mucokinetic expectorants e.g. Sodium or potassium citrate, Ammonium chloride, Potassium iodide, Guaifenesin, Tolu balsam.

Expectorants may cause bronchospasm in patients with asthma.

Non-productive cough:

Characterized by dry, irritating cough with little or no sputum.

Suppression of cough using antitussives (e.g. Dextromethorphan, Codeine) usually indicated

May cause excessive drowsiness

Postnasal drip cough:

A combination of first-generation antihistamine (e.g. diphenhydramine, chlorphenamine) and nasal decongestant (e.g. pseudoephedrine, phenylephrine) may be indicated. Antibiotics may be added if necessary for bacterial sinusitis.

Caution when using decongestants in patients with hypertension or other cardiovascular disease.

Asthmatic cough:

Short-acting beta-agonists (SABAs e.g. Salbutamol, Terbutaline) are usually indicated. Inhaled corticosteroids may be added depending on the severity.

GERD-associated cough:

H2RA (e.g. Ranitidine, Famotidine) or PPI (e.g. Omeprazole, Pantoprazole) are the treatments of choice. Non-drug measures include elevation bedhead, light dinner, diet modification, etc.

ACE inhibitor associated cough:

Substitute ACEI with ARB (e.g. Losartan). Antitussives not useful

Nasal congestion:

Systemic decongestants (e.g. Pseudoephedrine, Phenylephrine) or nasal decongestants (e.g. Oxymetazoline, Xylometazoline) may be useful.

They act indirectly to reduce blood flow, edema and swelling in the nasal area, thereby helping to alleviate nasal congestion.

Side effects may include rebound congestion, palpitations, tachycardia, burning sensation with topical agents.

Caution in patients with cardiovascular disease especially with the systemic agents.

Saline spray or drops may be effective alternatives and should be considered first-line especially in children.

Sneezing, rhinorrhea:

First-generation antihistamines (e.g. Chlorphenamine, Diphenhydramine) can be useful in controlling runny nose due to their anticholinergic properties. Non-drowsy antihistamines (e.g. Loratadine) are also effective especially when allergy is the underlying cause

Fever, headache, sore throat:

Analgesics (e.g. Paracetamol, Ibuprofen) are generally useful.

Non-drug measures namely increased fluid intake and rest can be beneficial in most cases of cough and cold.

Therapeutic classification of compound cough & cold preparations available in Nigeria

See EMDEX Mobile App for the proprietary preparations

Analgesic-containing preparations

Analgesic with Antihistamine

• Paracetamol + Cetirizine
• Paracetamol + Chlorphenamine
• Paracetamol + Diphenhydramine

Analgesic with Antihistamine & Antitussive

• Paracetamol + Loratadine + Dextromethorphan
• Paracetamol + Doxylamine + Dextromethorphan

Analgesic with Antihistamine & Expectorant

• Paracetamol + Chlorphenamine + Ammonium chloride + Sodium citrate

Analgesic with Antihistamine & Vitamin C

• Paracetamol + Chlorphenamine + Ascorbic acid

Analgesic with Decongestant & Antihistamine

• Paracetamol + Phenylephrine + Chlorphenamine
• Paracetamol + Caffeine + Phenylephrine + Chlorphenamine
• Paracetamol + Caffeine + Phenylephrine + Pheniramine
• Paracetamol + Pseudoephedrine + Chlorphenamine
• Paracetamol + Caffeine + Pseudoephedrine + Chlorphenamine
• Paracetamol + Pseudoephedrine + Triprolidine

Analgesic with Decongestant & Antitussive

• Paracetamol + Phenylephrine + Dextromethorphan
• Paracetamol + Pseudoephedrine + Dextromethorphan

Analgesic with Decongestant, Antihistamine & Vitamin C

• Paracetamol + Caffeine + Phenylephrine + Chlorphenamine + Ascorbic acid

Analgesic with Decongestant, Antihistamine & Expectorant

• Paracetamol + Pseudoephedrine + Chlorphenamine + Ammonium chloride

Analgesic with Decongestant, Antihistamine & Antitussive

• Paracetamol + Pseudoephedrine + Chlorphenamine + Dextromethorphan

Compound decongestant preparations

See analgesic-containing preparations above.

Decongestant with Antihistamine

• Phenylephrine + Chlorphenamine
• Pseudoephedrine + Chlorphenamine

Decongestant with Antihistamine & Antitussive

• Pseudoephedrine + Chlorphenamine + Dextromethorphan
• Phenylephrine + Chlorphenamine + Dextromethorphan
• Ephedrine + Promethazine + Codeine

Decongestant with Antihistamine & Expectorant

• Ephedrine + Chlorphenamine + Ammonium chloride + Sodium citrate + Menthol
• Ephedrine + Diphenhydramine + Ammonium chloride + Sodium citrate + Menthol
• Ephedrine + Cetirizine + Ammonium chloride + Sodium citrate
• Ephedrine + Cetirizine + Ammonium chloride + Sodium citrate + Menthol
• Ephedrine + Chlorphenamine + Ammonium chloride + Sodium citrate

Decongestant with Antihistamine, Antitussive & Expectorant

• Phenylephrine + Chlorphenamine + Dextromethorphan + Guaifenesin
• Pseudoephedrine + Triprolidine + Codeine + Potassium guaiacolsulfonate

Compound antihistamine preparations

See analgesic- and decongestant-containing preparations above

Antihistamine with Expectorant

• Diphenhydramine + Ammonium chloride + Ammonium bicarbonate
• Diphenhydramine + Ammonium chloride
• Diphenhydramine + Sodium citrate
• Chlorphenamine + Ammonium chloride + Sodium citrate
• Chlorpheniramine + Ammonium chloride + Sodium citrate + Guaifenesin
• Chlorphenamine + Ammonium chloride + Sodium citrate + Ipecacuanha
• Chlorphenamine + Ammonium chloride + Sodium citrate + Ipecacuanha + Menthol
• Diphenhydramine + Ammonium chloride + Sodium citrate + Menthol
• Diphenhydramine + Ammonium chloride + Menthol
• Diphenhydramine + Sodium citrate + Menthol
• Diphenhydramine + Sodium citrate + Menthol + Tolu
• Chlorphenamine + Ammonium chloride + Sodium citrate + Menthol
• Chlorphenamine + Sodium citrate + Menthol

Antihistamine with Antitussive

• Chlorphenamine + Dextromethorphan
• Promethazine + Pholcodeine

Antihistamine with Antitussive & Expectorant

• Chlorphenamine + Dextromethorphan + Guaifenesin
• Diphenhydramine + Codeine + Sodium citrate + Menthol
• Diphenhydramine + Codeine + Ammonium chloride + Sodium citrate + Menthol
• Diphenhydramine + Codeine + Ammonium chloride + Menthol

Antihistamine with Menthol

• Diphenhydramine + Menthol
• Cetirizine + Menthol

Compound mucolytic/expectorant preparations

See also above for preparations containing analgesic, decongestant or antihistamine

Antitussive with Expectorant

• Dextromethorphan + Guaifenesin

Expectorants with Demulcents

• Thyme + Primula
• Squill oxymel + Ipecacuanha
• Ammonium chloride + Ipecacuanha + Liquorice
• Ammonium chloride + Ipecacuanha + Liquorice + Peppermint oil
• Ipecacuanha + Honey + Glycerol
• Ammonium chloride + Sodium citrate + Squill + Menthol
• Sodium citrate + Ipecacuanha + Squill oxymel + Anise water + Menthol
• Ipecacuanha + Citric acid + Honey + Glycerol

Mucolytic with Antibiotic

• Bromhexine + Co-trimoxazole

Mucolytic with Antihistamine

• Carbocisteine + Promethazine

Mucolytic with Antihistamine & Expectorant

• Bromhexine + Diphenhydramine + Ammonium chloride + Menthol

Mucolytic with Antitussive & Expectorant

• Bromhexine + Dextromethorphan + Ammonium chloride + Menthol

Mucolytic with Expectorant & Bronchodilator

• Bromhexine + Guaifenesin + Salbutamol
• Bromhexine + Guaifenesin + Salbutamol + Menthol
• Bromhexine + Guaifenesin + Terbutaline + Menthol
• Ambroxol + Guaifenesin + Salbutamol + Menthol

Other compound cough & cold mixtures

Herbal cough & cold remedies

• Thyme + Grindelia + Pimpinella + Primrose + Rose

Glycrrhiza + Terminalia + Zingiber + Curcuma + Mentha