QUESTION: Whenever I get a cold, I’ll have a cough that can last from one to several weeks. What do you recommend? Over-the-counter dextromethorphan, honey, or inhaled prescription ipratropium (generic Atrovent)? Or something else?

ANSWER: Most of the Urgent Care and Emergency healthcare professionals in our area prescribe benzonatate (generic Tessalon Perles).

Tessalon Perles are said to work by numbing the cough receptors in the airways and throat, which suppresses the cough reflex, and it is said that they usually start working within 15–20 minutes and can last for 3–8 hours.

However, a 2023 review found that there’s not enough evidence to support its effectiveness and safety.

Not to upset my “tee-totaler” readers, but when I entered practice in the Smoky Mountains of North Carolina way back in 1981, all the local doctors there recommended a “hot toddy,” a home-made warmed concoction of one-part honey, one-part lemon juice, and one-part whiskey taken every 4-5 hours as needed.

Of course, those not wanting to use alcohol just used one-part honey mixed with one-part lemon juice.

For young children over one year of age, the dose was one teaspoon, for older children and young teens, it was two teaspoons, while adults can take a tablespoon.

Although I’ve continued to recommend this for over four decades, and almost all my patients say it helps, I don’t know of any studies showing this is safe or effective.

However, to your question, another 2023 study reported there was no significant difference between people taking honey, dextromethorphan, or inhaled ipratropium.

This primary care study adds to other studies that have found these agents alone don’t help.

But one of the researchers added, I suspect tongue in cheek, “If someone wants to avoid opioids, honey seems like the safest ineffective alternative,” except be sure to remember that honey is not considered safe for children younger than 12 months.