We all get sick; it’s inevitable, especially in the cold winter months. Just because it’s inevitable doesn’t mean we can’t be mindful of what we take to manage symptoms like a cough and sore throat. Aside from being mindful of ingredients, we also want to be sure what we’re taking actually works, and believe it or not, most over-the-counter (OTC) cough suppressant options do not.

“Recent placebo-controlled studies have shown that codeine is no more effective than placebo in suppressing cough caused by either upper respiratory disorders or chronic obstructive pulmonary disease (1).”

It doesn’t just stop there, though. Dextromethorphan, also known as DXM, is a cough suppressant approved by the Food & Drug Administration (FDA) in 1958. DMX can be found in at least 70 common over-the-counter cough and cold medicines, including “best-selling” Robitussin. Even mainstream sources like WebMD acknowledge that there’s no evidence that common over-the-counter drugs like suppressants such as DMX, which should block the cough reflex, or expectorants like guaifenesin, which should loosen up mucus in the airways, actually work (2).

What’s even worse is that the FDA knows these medications are ineffective and hasn’t taken them off the shelves despite a long list of side effects. For instance, DXM can cause lethargy, paranoia, hallucinations, and chemical psychosis. Dextromethorphan is advised not to be given to children under four years old and has other known adverse effects, including (3):

• Abdominal pain
• Angioedema
• Confusion
• Constipation
• Convulsions
• Diarrhea
• Dizziness (mild)
• Drowsiness (mild)
• Excitation
• Fixed-drug eruptions
• Gastrointestinal disturbance
• Headache
• Insomnia
• Nausea or vomiting (mild)
• Pruritus
• Rash
• Respiratory depression
• Stomach pain
• Urticaria

Additionally, DMX is often used as a street drug, and abusing it can cause effects like (4):

• Hot flashes
• Nausea, vomiting, and dizziness
• Lack of coordination
• Panic attacks or seizures
• Impaired judgment
• Sweating
• Lethargy or drowsiness—or hyperactivity
• Slurred speech
• High blood pressure
• Rapid eye movement
• Rash
• Racing or pounding heartbeat
• Regular abuse of DXM at high doses can lead to chemical psychosis

It’s also important to know the signs of an overdose, which include (3):

• Blurred vision
• Confusion
• Difficulty in urination
• Drowsiness or dizziness
• Nausea or vomiting (severe)
• Shakiness and unsteady walk
• Slowed breathing
• Unusual excitement, nervousness, restlessness, or irritability (severe

The scariest part is how the common side effects and signs of an overdose overlap, which would make it difficult to determine if you’re having an adverse event or a potentially life-threatening overdose. Even worse, DMX-free options also have harmful ingredients and fillers, so it’s important to be aware and informed of what you’re taking. With that said, let’s discuss some common cough medicine ingredients and their risks.

Concerning Ingredients In Cough Medicine

While codeine and DMX are ineffective and pose their own set of risks, they’re not the only alarming ingredients. Many cough suppressants and expectorants also contain acetaminophen. If you read my post, The Truth About Acetaminophen, you know this medication, commonly known as Tylenol, is a pain killer that has been linked to an increased risk of health problems when used in larger doses or long-term. Some risks of acetaminophen include damaging the liver and kidneys, depleting levels of glutathione, cardiometabolic risk, linked to cancer, affecting emotional processing, may have neurodevelopment consequences during pregnancy linked to Steven’s-Johnson Syndrome and asthma, and endocrine disruption. Aside from acetaminophen, many other ingredients should raise concern, including, but not limited to:

Ascorbic Acid

Ascorbic acid is another name for vitamin C. Some may find this shocking, but most ascorbic acid is synthetically derived from genetically modified (GMO) corn and should be avoided, especially in high doses (5). Of course, L-ascorbic acid comes from natural sources and can be found in citrus fruits and their peels (especially orange peel), berries (like amla), peppers, green vegetables, and even in animals and human skin (6,7). Due to the varying sources of ascorbic acid, I recommend looking for organic or GMO-free food-sourced vitamin C instead of blanket terms like ascorbic acid.

Carboxymethylcellulose Sodium

Carboxymethylcellulose sodium is an active ingredient in common eye lubricants but is also used in cough syrups (8). Carboxymethylcellulose (CMC) is an anionic gum made from cellulose composed of glucose derivatives and can be used as a thickening agent in cough syrup (9). CMC sodium, or cellulose gum, is indigestible, but the stomach and intestines cannot break it down or absorb it. Evidence shows that consuming emulsifiers like CMC can impact the gut microbiota, promoting colitis and metabolic syndrome (10).

Citric Acid

Naturally occurring citric acid can be found in oranges, lemons, and other citrus fruits and are perfectly safe. Unfortunately, like most things found in nature, the pharmaceutical industry has synthesized citric acid from Aspergillus niger (black mold), which is where most citric acid on the market comes from (11). Health problems associated with mold include respiratory infections, allergic reactions, inflamed lungs, and more (12).

Corn Syrup

Most people think that only high fructose corn syrup is a cause for concern, but plain corn syrup is 100 percent glucose and should be avoided by people with diabetes or prediabetes (13). As for high fructose corn syrup, it’s sweeter than sugar, and the body absorbs it much more quickly. Fructose is a simple sugar that makes up 50% of table sugar (sucrose). According to Healthline:

“Many scientists believe that excess fructose consumption may be a key driver of many of the most serious diseases of today. These include obesity, type II diabetes, heart disease and even cancer (14).”

Overeating high fructose corn syrup can lead to insulin resistance, obesity, type 2 diabetes, and high blood pressure (15).

Food Coloring

Food coloring (dye) has been linked to neurological disorders like ADHD, cancer, allergies, learning disabilities, irritability, and aggressiveness (16). According to Michael Greger M.D. FACLM:

“Due to cancer concerns, Red dye #1 was banned in 1961. Red #2 was banned in 1976, and Red #4 was banned soon after. But what about Red No. 3, used today in everything from sausage to maraschino cherries? It was found to cause DNA damage in human liver cells in vitro, comparable to the damage caused by a chemotherapy drug whose whole purpose is to break down DNA, but Red No. 3 was also found to influence children’s behavior over 30 years ago and to interfere with thyroid function over 40 years ago (17).”

To learn more about the risks of consuming food coloring, check out my blog, The Truth About Food Coloring.

Gelatin

Gelatin is a protein sourced from boiling cow, pig, fish skin, cartilage, tendons, ligaments, and/or bones in water (18). This ingredient isn’t an issue for most, but vegans, vegetarians, and those who keep a kosher or halal household may want to avoid this ingredient! According to WebMD, gelatin supplements (or supplements containing gelatin) can cause upset stomach, burping, bloating, and allergic reactions. Additionally, some experts worry that gelatin risks being contaminated with certain animal diseases, leaving them uncertain of its safety for pregnant or breastfeeding women and children (19).

Guaifenesin

As briefly mentioned earlier, guaifenesin (GGE) is an expectorant used to help loosen congestion in the chest and throat for cough relief (20). Like DMX and other cough medications, GGE has side effects, including, but not limited to, diarrhea, dizziness, headache, hives, nausea or vomiting, skin rash, stomach pain, and upset stomach (21). Interestingly, much like DMX, GGE is also ineffective. One study concluded that the recommended dose of two 600-mg extended-release GGE tablets twice daily for 1 week had no measurable expectorant or mucolytic effect on participants with respiratory tract infections (22).

Polyethylene Glycol

Polyethylene glycol (PEG) is a biocompatible, synthetic, hydrophilic polyether compound used as a binding and dispersing agent; it can improve the separation of particles while preventing clumping (23). PEG is an active ingredient in laxatives like MiraLAX, with a long list of side effects like severe or bloody diarrhea, rectal bleeding, blood in your stool, painful or worsening stomach pains, and more (24). Side effects aside, according to MADE SAFE, the process of ethoxylation can cause ethylene oxide contamination, which can cause cancer (25).

Sodium Benzoate

Sodium Benzoate is a synthetically manufactured preservative added to some sodas, packaged foods, and personal care products to prolong shelf life (26). This ingredient is used to extend the shelf life of cough syrup and was also reported to alter sperm quality and function in a 2018 study (27). A significant concern regarding sodium benzoate is its ability to convert to benzene, a known carcinogen when exposed to vitamin C (28).

Talc

Talc, in its natural form, often contains asbestos, a substance known to cause cancers in and around the lungs when inhaled (29). Did you know in 1976, the Cosmetic, Toiletry, and Fragrances Association (CTFA), now known as the Personal Care Products Council, which is the trade association representing the cosmetic and personal care products industry, issued voluntary guidelines stating that all talc used in cosmetic products in the United States should be free from detectable amounts of asbestos according to their standards? This doesn’t mean that asbestos-free talc is safe, though! Studies that exposed lab animals (rats, mice, and hamsters) to asbestos-free talc in various ways have had mixed results, with some showing tumor formation and others not finding any (30).

Toxin-Free Cough Relief Recommendations

• ADANIM Eucalyptus Thyme & Mullein Leaf Tea is a unique medicinal tea blend that makes a massive difference in the lungs and helps improve respiratory functions. Since this tea is loaded with antioxidants, it can help relax a congested chest when feeling under the weather.
• Gaia Herbs Kids Cough Syrup is formulated with respiratory and immune-supporting herbs for holistic support for your little ones. Made with honey, black elderberry, and ivy leaf, this all-natural, essential oil-free remedy (I do not recommend their adult version as it contains essential oils) provides soothing care to help kids breathe easily and relieve dry coughs.
• Gaia Herbs Mighty Lungs is a respiratory support supplement formulated to help maintain lung health and function. This formula combines adaptogens and respiratory-supporting herbs like mullein leaf, plantain leaf, marshmallow root, Schisandra, and more in an easy-to-take capsule.
• Herb Pharm Cough Crusader effectively quiets a persistent cough. This alcohol-free tincture is a tasty blend of wild cherry, mullein, and other respiratory-supporting herbal extracts that can ease respiratory distress and get you back to feeling like you.
• Herb Pharm Lung Expectorant supports normal lung expectoration and respiratory immune response. This alcohol-based tincture is expertly formulated with Yerba Santa, osha root, and other rapidly absorbed liquid herb extracts.
• Herb Pharm Soothing Throat Spray supports healthy immune system function. This alcohol-based tincture is expertly formulated with echinacea, propolis, and other rapidly absorbed liquid herb extracts and is gluten—and GMO-free.
• MaryRuth’s Organic Respiratory Health Liquid Extract is a specially formulated blend of herbs that may support your respiratory system and immune function, aiding overall health. If your respiratory system is occasionally irritated by dry air or other minor nuisances, reach for this blend.
• Ollois Hepar Sulphuris Calcareum is a homeopathic remedy traditionally used for acne, abscesses, and dry/harsh coughs. This organic, natural, and mineral-based remedy is made from calcium sulfide, making it vegan-friendly.
• The Brother’s Apothecary Breathe Well is a respiratory-inspired tea featuring 30mg of CBD per bag. This delicious and smooth drinking tea combines powerful herbs, including Siberian ginseng, eucalyptus, malva, mullein, and peppermint, with antioxidant-rich rooibos and delicately sweet vanilla beans.

Product Disclaimer

Product recommendations are affiliate links. I do not own or make these products. Recommendations are selected according to ingredients at the time article was written and can change at any time. I encourage you to double-check ingredients and research each company to ensure they’re suitable for your journey.

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