From the Guidelines
Codeine is recommended as a cough suppressant for insomnia in pneumonia.
Rationale
- The evidence suggests that central cough suppressants, such as codeine, are recommended for the short-term symptomatic relief of coughing in patients with chronic bronchitis 1.
- Although the evidence is not directly related to pneumonia, it can be applied to this context as pneumonia often presents with symptoms similar to chronic bronchitis, such as cough.
- Codeine has been shown to suppress cough counts by 40 to 60% in patients with chronic bronchitis/COPD 1.
- The use of codeine is most appropriate when the etiology of cough is unknown or when specific therapy requires a period of time before it can become effective 1.
- It is essential to note that codeine should be used with caution and under the guidance of a physician, as it can have side effects and interact with other medications.
- Other options like dextromethorphan may also be considered, but codeine is specifically mentioned in the guidelines as a recommended option for chronic bronchitis, which can be applied to pneumonia by extension 1.
From the Research
Cough Suppressants for Insomnia in Pneumonia
- There is limited evidence to recommend a specific cough suppressant for insomnia in pneumonia 2, 3.
- Studies have shown that mucolytics may be beneficial in reducing cough severity, but there is insufficient evidence to recommend them as an adjunctive treatment for acute pneumonia 2, 3.
- Antitussives such as codeine and antihistamines are not recommended for young children due to potential harm 2, 3.
- Dextromethorphan and diphenhydramine have been shown to be no more effective than placebo in providing nocturnal symptom relief for children with cough and sleep difficulty due to an upper respiratory infection 4.
- The most effective indirect antitussives are opioids such as morphine, codeine, or pholcodeine, but they produce side effects such as drowsiness, nausea, constipation, and physical dependence 5.
Considerations for Cough Suppressants
- Cough suppressants may impede airway clearance and cause harm, particularly in patients with pneumonia 2, 3.
- The measurement of cough frequency with 24-h ambulatory cough monitors in patients with chronic cough suggests that the presence or absence of nocturnal cough is not helpful in establishing the etiology 6.
- Nocturnal cough may be a useful outcome parameter for clinical trials of antitussive drugs since it is under less voluntary control than daytime cough 6.