From the Guidelines
Lidocaine 1% inhalation is not generally recommended for treating cough. While nebulized lidocaine has been studied for refractory cough in some specialized settings, it is not an FDA-approved treatment for cough and lacks robust evidence supporting its routine use, as noted in the guidelines for cough management 1. The potential risks, including bronchospasm, throat numbness that could impair swallowing reflexes, and systemic absorption leading to cardiac effects, outweigh the limited evidence of benefit for most patients. For cough management, it's better to address the underlying cause with appropriate treatments such as antihistamines for allergic cough, proton pump inhibitors for GERD-related cough, or bronchodilators for asthma-related cough. Over-the-counter options like dextromethorphan or prescription medications such as benzonatate (Tessalon Perles) are more established treatments for symptomatic cough relief, as discussed in various guidelines and reviews 1. Lidocaine works by blocking sodium channels in nerve membranes, which can reduce cough reflex sensitivity, but this mechanism is better utilized in other formulations and clinical contexts rather than as an inhaled treatment for general cough management.
Some key points to consider in cough management include:
- Identifying and treating the underlying cause of the cough
- Using established treatments such as antihistamines, proton pump inhibitors, or bronchodilators as appropriate
- Considering over-the-counter options like dextromethorphan or prescription medications such as benzonatate for symptomatic relief
- Being aware of the potential risks and limited evidence of benefit for nebulized lidocaine in cough management.
It's also important to note that guidelines and recommendations may vary depending on the specific context and patient population, such as in cases of postinfectious cough or cough associated with lung cancer, as discussed in the guidelines 1. However, the use of lidocaine 1% inhalation for cough is not a recommended first-line treatment in most cases, due to its limited evidence of benefit and potential risks.
From the FDA Drug Label
PACKAGE DISPLAY PANEL - 5 ML AMPULE LABEL NDC 65282-1605-1 Lidocaine HCI Injection, USP 1% 50 mg/5 mL (10 mg/ml) NOT FOR INHALATION PRINCIPAL DISPLAY PANEL - 5 ML CARTON LABEL Rx only NDC 65282-1605-1 Lidocaine HCI Injection USP 1% 50mg/5 mL (10 mg/ml) For Infiltration and Nerve Block Including Caudal and Epidural Use. NOT FOR INHALATION
The FDA drug label does not answer the question.
From the Research
Effectiveness of Lidocaine 1% Inhalation for Cough
- Lidocaine 1% inhalation has been shown to be effective in treating cough in several studies 2, 3, 4, 5, 6.
- A study published in The American journal of hospice & palliative care found that nebulized lidocaine was well tolerated by patients with minimal side effects, including dysphonia, oropharyngeal numbness, and bitter taste 2.
- Another study published in Chest reported a case of a 52-year-old man with intractable cough who was treated successfully with chronic nebulized lidocaine, with no adverse effects except for occasional mild dysphonia 3.
- A review of 17 studies on the use of nebulized lidocaine for intractable cough and asthma found that the available evidence does not preclude the use of lidocaine as a treatment option for intractable cough after failure of traditional cough suppressants 4.
- A study published in The American journal of emergency medicine found that nebulized lidocaine was effective in suppressing cough in patients with intractable cough, including those with asthma, reactive airways disease, and chronic obstructive pulmonary disease (COPD) 5.
- A retrospective study published in Chest found that adults tolerated self-administration of nebulized lidocaine for difficult-to-control chronic cough, with no serious adverse effects occurring, and providing symptomatic control in 49% of patients 6.
Safety and Tolerability
- The studies found that lidocaine 1% inhalation was well tolerated by patients, with minimal side effects, including dysphonia, oropharyngeal numbness, and bitter taste 2, 3, 6.
- The review of 17 studies found that nebulized lidocaine was well tolerated, but reports of initial bronchoconstriction had occurred 4.
- The retrospective study found that 43% of patients reported an adverse event, but none of these events required an emergency visit, hospitalization, or antibiotic therapy for aspiration pneumonia 6.