I agree, they seem to be helping me, too. Not as good as codeine, but very useful if I got a coughing fit in the cinema or while lecturing my students, for example.

I’m confused. Are those coughs that hang on for 2 or 3 weeks after the cold or flu, infectious coughs? I thought they were just due to general post infection irritation of the throat and airway. If it was only airway generated, then a drink of water would do nothing to sooth that dry/hacky cough I get at bedtime after a cold. But it really does and really, I’m not inhaling the water.

Also, I thought that those post infection coughs weren’t communicable…at least that’s what our pediatrician said. When you say infectious, do you mean that it still spreads virus/bacteria? Or are we only talking about coughs that one gets at the beginning of an infection?

Sorry to be a pain. but it really does seem like things that sooth the throat (hard candy, etc) cut down on that dry coughing reflex thingy.

“A taste of honey.
Tasting much sweeter than wine.
I dream of your first kiss …”

LOL! So you know what “labiate” means.

Yes. Typo. And yes. All the accounts of DM intoxication I have heard/read make it sound like it has about the same abuse potential as nutmeg.

@pmoran: while SBM is our platonic ideal, we all work in reality-based medicine, or all the limitations of our practice settings. In the specific case of cough, codeine works well, but my pts are inmates in a jail, with a propensity for drug abuse. If we started handing out codeine for coughs, everybody would have a permanent cold (except for the gangsters, who sell drugs but take pride in not using them).

Kinda o/t, but does anybody have experience with treating the coughs caused by smoking crack? I did a lit search and found nothing. Our dr treats it like asthma – steroid inhalers + short-acting beta agonist inhaler (or sometimes Symbicort).

I helped write the formulary for our organization, and we excluded dextromethorphan because of its dubious efficacy and its (tiny) potential for abuse – at high doses, it has ketamine-type effects, probably by the same mechanism as ketamine; ie, agonism @ the NMDA receptor.

While I’ve never had ketamine, I’ve tried high-dose dextromethorphan way back when it could be obtained in gelcaps. The (quite unpleasant) experience did not jibe with any accounts of ketamine use that I’ve encountered, perhaps due to activity at PCP-2 and σ-1. Ketamine and DXM’s metabolite, dextrorphan, are NMDA antagonists, BTW.

.About the only relevance of the distinction is in relation to the positive studies now appearing for unlikely CAM methods, although rarely SBM looks to soften the very strong prohibitive aspects of EBM and allow for some small practitioner discretion.

My comments referred to pharmacology where EBM can mean little else other than clinical studies. The quotation marks around “merely” were clearly intended to be ironic, allowing for the importance of clinical studies in optimising medical treatment even if they cannot, as is quite obvious but rarely stated, generate new therapeutic ideas.

The advent of of evidence-based medicine has not been all sweetness and light for medical practice. This much-lauded facet of modern medicine has no ability in and of itself to produce new and better treatments of anything. It “merely” helps test them out.

Nonsense, Peter. There’s no “merely” about it, and remember that EBM (even more so SBM) includes the whole gamut from preclinical research to randomized clinical trials to meta-analyses. We at SBM quibble about the emphasis placed on basic science considerations, but to imply that the EBM infrastructure is incapable of producing new or better treatments is just plain wrong. It is now the primary scientific framework through which new and better treatments make their way from idea to clinical trials.

“Institutional politics”? Why blame this? I suspect, since you go on to suggest “a safer placebo”, you know that these doctors are responding to the very simplest of medical pressures, the “unmet medical needs” that I have been suggesting should be contributing more to our understanding of why people (and some doctors) turn to CAM.

The advent of of evidence-based medicine has not been all sweetness and light for medical practice. This much-lauded facet of modern medicine has no ability in and of itself to produce new and better treatments of anything. It “merely” helps test them out.

Yet it has had the effect of seriously reducing prescribing options for many symptoms. It has become so strongly prohibitive of non-EBM-prescribing, that we now see fit to frown upon the use of honey for a child’s cough through it not being shown to work clearly better than placebo..

Cough is also just one of many instances where we have gone so far as to very extensively prescribe certain treatments, only to then either take them away, or made them very hard to get for one reason or another. This has happened with anxiolytics and other mood-modifying drugs (e.g. opiates and cocaine ), sleeping pills, stimulants such as amphetamines, the once ubiquitous “tonics”, and also recently a variety of appetite suppressants.

It took us most of a century to discover that there are few free lunches in pharmacology, but all the while we were unwittingly holding out the promise of much nicer and more trouble-free lives for everyone just around the corner. “All your ills will have an answer” it seemed.

So, we have limited right to get grumpy obout unreasonable public expectations when we ourselves have been permitting them to be aroused. These are one of many factors making the public receptive to less than honest medical claims .

As some other commenters have hinted, there is a desperate need for an effective cough suppressant. It does not need to work as well as a rib fracture does, and thereby increase the risk of pneumonia — if that was ever a serious concern with the usual outpatient use of cough suppressants.

I am not pretending there is an easy or correct answer to this. But it surely helps if we fully understand the terrain in which we are working.

If there are benefits to suppressing the cough associated with acute respiratory infections I can’t find any …

My wife has definitely found the benefit to suppressing my cough when she is trying to sleep next to me

windriven– Murfreesboro? Are you in Tennessee, by chance?

Also, even though I have a botany background and am over the age of twelve, I maintain no one should ever, ever call it “labiatae honey”. Because… just because.

But this current cough-cold-flu season has brought us a flurry of non-formulary drug request forms from physicians asking us to include DM syrup in the formulary. I have suggested guaeifenesin (Robitussin) syrup instead, with the rationale that at least we are giving our patients a placebo that is entirely harmless.

As the point person for drug information, I am getting innundated with requests to justify the exclusion of DM. Like Mark’s research found, the evidence for its worthlessness is solid. But some of the other pharmacists are pressuring me to cave to the physicians and include DM as the path of least resistance. After all, DM is cheap, and its risks are tiny enough to be almost theoretical.

It hasn’t been settled yet, but when evidence-based medicine comes up against institutional politics, I don’t think it’s the patients who win.

Enough codeine (I use C-3s, and a portion thereof as cough lessens) to get enough sleep at night.

C-3s (300 mg acet. and 30 mg codeine) are the cheapest and likely most effective. The syrup is mostly sugary crap.

http://www.mayoclinic.com/health/infant-botulism/HQ00854

Poor babies can’t even have a hot toddy.

Exactly so and I won’t care a bit what a well-done study says, unless it confirms my Toddy Bias. I shall also start paying serious attention to Cochrane Reviews when they get jiggy with bourbon studies.