Fifty-one different flavors were found in the search on 60 cough medicines. Some of these fell into single flavor groups such as raspberry flavor, which consisted of four different excipients (raspberry flavor in 8 medicines, raspberry flavor 503.850/T in 2 medicines, raspberry flavor F2126 in one medicine, and raspberry juice concentrate in one medicine). This gave a total of 12 references to raspberry flavor but since one medicine had 2 raspberry flavor excipients, the total number of medicines containing a raspberry flavor excipient was 11 medicines as illustrated in Table 3. Similarly, in Table 3, aniseed flavor was a combination of 3 excipients, anise oil in 14 medicines, aniseed flavor in 6 medicines, and aniseed flavor 545008E in 2 medicines.
By grouping similar flavors together Table 3 condenses 50 excipients into 30 flavors. The most common flavor was menthol (levomenthol is commonly referred to as menthol), which was present in 34 of the 60 medicines, and in one medicine was combined with cooling flavor 539692T. One could also include peppermint oil (present in 9 medicines) as related to menthol, as this oil often contains up to 50% menthol .
Other common flavors were aniseed flavors, present in 22 medicines, caramel in 19 medicines, and capsicum and Hot mix flavor 538842T, which give a warm pepper flavor, with capsicum present in 13 medicines. Medicines formulated for children often contained a fruit flavor such as raspberry, blackcurrant, or blackberry, and honey flavor was also common in medicines for children.
Licorice extract and flavor was found in 6 medicines and this not only provided a distinct flavor but also enhanced the sweetness of the medicine as discussed under sweeteners.
The large number of flavors illustrates how cough medicines have transitioned into consumer products that more resemble foods or confectionery than medicines with flavors in cough medicines such as apple, strawberry, peach, cherry, custard, vanillin, and condensed milk all being common flavors in foods and confectionery.
The science of food flavoring has become more and more sophisticated with many new synthetic flavors and special molecules designed to enhance and modify flavors, and these synthetic flavors have found their way into use in cough medicines such as Tingling flavor 538723T, which enhances the oral sensations associated with the cough medicine, and Bitterness blocking flavor 84E260. Pharmacologically active antitussives such as dextromethorphan have a bitter taste that is unpalatable to children and most adults and this bitter taste can be masked by sweeteners but can also be blocked by excipients such as Bitterness blocking flavor 84E260. The masking of bitter taste by synthetic molecules is a well-developed field of food technology, and there is much research into this area because of its commercial significance 
Role of Flavors in Cough Medicines
Flavors provide much more than just the taste of a cough medicine as they are often declared as the active ingredient. Menthol is declared as an active ingredient in 11 cough medicines and the supporting statement in the SmPC is that “Menthol has mild local anesthetic, decongestant and antitussive properties.” Menthol is often described as a nasal decongestant but it does not decongest but provides an increased sensation of nasal airflow due to stimulation of sensory receptors such as transient receptor potential melastatin (TRPM8) [18, 19]. Menthol is a common ingredient in cough medicines and there is some support for antitussive activity from studies on healthy volunteers where cough was induced by either citric acid or capsaicin inhalation [10, 20, 21].
Capsicum tincture was found in 13 medicines and declared as an active in one medicine as a traditional herbal medicine. Capsicum tincture is derived from the pepper plant and contains capsaicin which has a strong burning taste or pungency due to stimulation of sensory receptors such as transient receptor potential cation channel subfamily V member 1(TRPV1) 
Licorice extract is declared as an active in 4 cough medicines and capsicum in one medicine and their use as an active ingredient is supported in the SmPC by reference to their use as traditional herbal medicinal products.
Honey is declared as an active in one medicine and the SmPC states that honey acts as a demulcent and provides a soothing medium for an irritated throat.
Lemon flavor in combination with citric acid monohydrate are declared as actives in one medicine and the SmPC states that “the citric acid monohydrate and the lemon oil, both add to the sharpness of the product and enhance the flavor.”
The wide range of flavors indicates how the cough medicine market has diversified to suit different consumers. Adults who prefer a traditional flavor of medicine are likely to opt for flavors such as menthol, peppermint, capsicum, treacle, aniseed, and ginger, whereas children may opt for a fruit flavor such as raspberry, blackcurrant, blackberry, peach, or more familiar food flavor such as condensed milk, custard, and vanillin. Flavors such as honey and lemon may appeal to both adults and children.
Flavors add to the sensory impact of the cough medicine and this is important to enhance any placebo effect of the medicine. The placebo effect has been proposed to contribute up to 85% of the efficacy of some cough medicines , and the sweet or medicinal taste of the medicine with other sensory signals such as cooling, heat, and tingling sensations all contributing to maximize the sensory impact and the belief in the efficacy of the medicines.