A closer look at cough syrups for a dry, irritating cough

A dry, irritating or nagging cough can keep you up at night and make you feel desperate for a good night’s rest.1,2,3

Cough suppressants or antitussives work on the cough centre of the brain to suppress a dry, irritating cough and provide day time and night time relief.1,4 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.1-5

Amongst the many cough suppressant syrups available, those containing codeine are some of the most frequently purchased.1,6,7 Although codeine is effective in relieving that nagging cough it can be associated with some side effects that you should be aware of such as constipation, habit forming behaviour, confusion, feeling dizzy and vertigo.8-11

This molecule has received a lot of lime light in the last few years because of its abuse and misuse. This problem has also been highlighted in South Africa. The Medicines Control Council of South Africa now known as SAHPRA (South African Health Products Regulatory Authority), has implemented certain measures and restrictions on the purchase of codeine to reduce the risk of abuse or misuse.11,12

Cough suppressant alternatives.

There are alternatives to codeine that are unlikely to be habit forming, have little euphoriant effects, don’t cause constipation or respiratory depression (difficulty breathing), for example pholcodine or dextromethorphan. 13-17

Pholcodine is as effective as codeine and has demonstrated no evidence of habit forming behaviour. It is not known to cause an excited state/excitement when taking the recommended dose.16-18

Before taking a cough syrup speak to your healthcare provider or pharmacist about the right cough remedies to suit your type of cough.

Speak to your pharmacist about SA’s No.1 prescribed, dry cough suppressant brand that, at recommended doses provides day time and night time relief without the morphine-like side effects. 4,16-19

DISCLAIMER: This editorial has been commissioned and brought to you by iNova Pharmaceuticals. Content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional.

Name and business address of the holder of the certificate of registration: iNova Pharmaceuticals (Pty) Ltd,. Co. Reg. No. 1952/001640/07, 15e Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. For further information, speak to your healthcare professional. Further information is available on request from iNova Pharmaceuticals. IN3088/19


  1. Truter I. Cough. Evidence Based Pharmacy Practice. SA Pharm J 2007;74(4):20-27.
  2. Cough treatment. Specialist Forum 2017;17(6): 28-30
  3. Van Schoor J. An approach to recommending cough mixtures in pharmacy. S Afr Pharm J 2012;79(6):30-33.
  4. 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.
  5. Mayo Clinic. Cough. [online] January 2018 [cited February 2019]; Available from URL: https://www.mayoclinic.org/symptoms/cough/basics/causes/sym-20050846?p=1
  6. Antitussives. [online] [cited February 2019]; Available from URL: https://www.drugs.com/drug-class/antitussives.html
  7. Padma L Current Drugs for the Treatment of Dry Cough. Supplement to Journal of the Association of Physicians of India 2013;61:9-13.
  8. IMS TPM. Total Private Market. Dry Cough Market
  9. Gardiner SJ, Chang AB, Marchant JM, et al. Codeine versus placebo for chronic cough in children (Review) Cochrane Database of Systematic Reviews 2016, Issue 7. Art. No.: CD011914.
  10. Codeine. [online] November 2018 [cited January 2019]; Available from URL: https://www.nhs.uk/medicines/codeine/
  11. American Addiction Centers. Codeine Side Effects: Is Addiction Possible? [online] November 2018 [cited January 2019]; Available from URL: https://americanaddictioncenters.org/codeine-addiction
  12. Folley M, Carney T, Rich E, et al. A study of medical professionals’ perspectives on medicines containing codeine in South Africa. South African Journal of Psychiatry ISSN: (Online) 2078-6786, (Print) 1608-9685.
  13. Matthys H, Bleicher B, Bleicher U. Dextromethorphan and codeine: objective assessment of antitussive activity in patients with chronic cough. J Int Med Res 1983;11(2):92-100.
  14. Findlay JW, Fowle ASE, Butz RF, et al. Comparative disposition of codeine and pholcodine in man after single oral doses. Br J Clin Pharmacol 1986;22(1):61-71.
  15. Blanchard E, Tunon de Lara M. New insights into the role of pholcodine in the treatment of cough in 2013? Therapie 2013;68(2):85-91.
  16. Data on file
  17. Girdwood RH, editor. Clinical pharmacology. 25th edition. Edinburgh: Bailliere Tindall; 1985. p. 328.