From the Guidelines
Nebulizing bupivacaine or lidocaine for cough suppression is not generally recommended for routine use outside of controlled clinical settings. While lidocaine nebulization (typically at 1-2% concentration, 2-5 mL per treatment) has been used in some hospital settings for refractory cough, particularly in palliative care situations, it carries risks of bronchospasm, cardiac arrhythmias, and potential airway anesthesia that could impair protective reflexes and increase aspiration risk 1. Bupivacaine nebulization carries even greater risks due to its higher potency and longer duration of action, making it particularly unsafe for home use. These medications can cause systemic absorption when nebulized, potentially leading to serious cardiovascular and neurological side effects including seizures and cardiac arrest. For cough management, safer alternatives include over-the-counter cough suppressants, prescribed medications like benzonatate or low-dose opioids for severe cases, and addressing underlying causes such as asthma, GERD, or postnasal drip. Any nebulized therapy should only be administered under direct medical supervision with appropriate monitoring capabilities.
Some key points to consider:
- Nebulized lidocaine or bupivacaine should only be used in a controlled clinical setting with proper monitoring due to the risks of serious side effects 1.
- The use of local anesthetics like lidocaine or bupivacaine for cough suppression is generally reserved for cases where other treatments have failed, particularly in palliative care situations 1.
- Safer alternatives for cough management should be considered first, including over-the-counter cough suppressants, prescribed medications, and addressing underlying causes of cough 1.
- The potential benefits of nebulized lidocaine or bupivacaine must be weighed against the risks, and patients should be closely monitored for any adverse effects 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Safety of Nebulized Bupivacaine or Lidocaine for Cough Suppression
- There are no studies available on the use of nebulized bupivacaine for cough suppression.
- However, several studies have investigated the use of nebulized lidocaine for cough suppression, including:
- A case study from 1994 that reported successful treatment of refractory cough with chronic nebulized lidocaine 2.
- A study from 2013 that demonstrated the effectiveness of nebulized lidocaine in suppressing cough, with minimal side effects 3.
- A review of 17 studies on the use of nebulized lidocaine for intractable cough and asthma, which found that it may be a safe and effective treatment option for patients who cannot tolerate or are unresponsive to other treatments 4.
- A study from 2001 that found nebulized lidocaine to be effective in suppressing cough in patients with intractable cough, including those with asthma, reactive airways disease, and chronic obstructive pulmonary disease (COPD) 5.
- A case series from 2013 that reported the long-term safety of nebulized lidocaine for adults with difficult-to-control chronic cough, with no serious adverse effects occurring in 99 patients who responded to a survey 6.
Efficacy of Nebulized Lidocaine for Cough Suppression
- The available evidence suggests that nebulized lidocaine may be an effective treatment option for cough suppression, particularly for patients with intractable cough who have not responded to other treatments 2, 3, 4, 5, 6.
- The efficacy of nebulized lidocaine for cough suppression has been demonstrated in several studies, with reported response rates ranging from 43% to 80% 3, 6.
Side Effects of Nebulized Lidocaine
- The available evidence suggests that nebulized lidocaine is generally well-tolerated, with minimal side effects reported, including dysphonia, oropharyngeal numbness, and bitter taste 3, 4, 6.
- However, reports of initial bronchoconstriction have occurred, and patients should be monitored for this potential side effect 4.