How Many Menthol Cough Drops Can You Take A Day?

abby asked

How many menthol cough drops can you take in a day? Can you take too many?

Answer

Menthol cough drops are generally considered to be safe and effective over the counter treatment of cough and sore throat.

Toxicity from menthol is extremely uncommon and cases of overdose are nearly non-existent. However, like any medication, there are limits when it comes to safe dosages.

What Is Menthol?

Menthol is a terpenoid alcohol, occurring naturally in various mint oils and can also be made synthetically. Menthol has a peppermint-like odor and is one of the primary active constituents in peppermint oil, with reported concentrations ranging from 10-70%.

Menthol is used medically in a variety of ways, including topically for pain relief and via cough drops to reduce cough and symptoms of a sore throat.

Menthol products (both topical and oral) are marketed and sold over-the-counter in the United States. As an "essential oil" and "natural extract", menthol is generally recognized as safe (GRAS) by the FDA.

How Does Menthol Work?

The exact mechanism of action of menthol when it comes to reducing cough and symptoms of a sore throat isn't completely understood. However, it is thought to work by:

• Interactions with kappa-opioid receptors or via nociceptor activation, producing a "counter-irritant" effect.
• Activation of cold thermoreceptors in the skin/throat area.
• Inhibition of voltage-dependent sodium channels, which may be partly responsible for the analgesic and anesthetic effects.

Menthol Safety

There is no FDA defined "limit" in regard to the number of menthol cough drops that may safely be consumed in one day, as dosages and strengths vary per product.

Nevertheless, when talking about the toxicity of menthol, it takes extremely large dosages to produce toxic effects. Sources vary but reported lethal doses of menthol range from 50 mg/kg to 1,000 mg/kg.

To put even the low range of reported lethal doses of menthol in perspective, 50 mg/kg equates to over 2,200 mg of menthol for a 100-pound individual. Considering that cough drops generally contain between 2 and 15 mg of menthol, overdoses are near impossible if taken as directed.

There are few published case reports of menthol overdoses.

One case report (which claims to be the 1st case report of a fatal menthol overdose) discussed a 21-year-old worker who died, not from over-consumption of menthol, but from excessive inhalation of fumes after cleaning a tank at a peppermint factory (peppermint extracts can contain up to 70% menthol).

Another published case study discussed an individual presenting to the emergency department in a coma, who then developed seizures and blood in the urine. The individual's condition was determined to be from excess menthol containing cough drop consumption, two "bags" a day for 20 years.

How Many Menthol Cough Drops Per Day?

Studies detailing significant adverse events from menthol cough drop consumption are extremely uncommon, especially at directed dosages.

They are well-tolerated and you shouldn't need to consider an "upper limit" of menthol containing cough drops when taken as per the product directions.

Nevertheless, most menthol containing cough drop products recommend taking one to two cough drops every two hours. Therefore, for most products, the recommendation is between 12 and 24 cough drops in a 24 hour time period.

Even with products containing up to 20 mg of menthol per cough drop, 24 cough drops per day will provide far less menthol than is considered dangerous or toxic.

Menthol Side Effects

Although menthol is generally considered safe, high, or consistent excessive doses are associated with certain adverse effects, including:

• Vertigo
• Dizziness
• Agitation
• Nausea
• Vomiting
• Changes in coordination
• Lethargy
• Involuntary eye movement
• Dermatitis
• Mouth ulceration
• Abdominal pain

If you experience side effects of menthol containing cough drop products, it is important to discuss them with your doctor. If you suspect an overdose, contact the Poison Control Center immediately at 1-800-222-1222.

Final Words

Menthol and related products containing menthol (e.g. peppermint oil) are considered well-tolerated.

Significant side effects are uncommon at recommended dosages. Be sure to follow the package directions for your particular menthol cough drop product.