Can I give hydroxyzine to a patient with a dry cough?

Hydroxyzine for Patients with Dry Cough

Hydroxyzine is not recommended for patients with dry cough as it is not included in evidence-based treatment algorithms for cough management. Instead, established antitussives should be used based on cough type and duration.

Evaluation and Classification of Cough

Before selecting treatment, determine cough characteristics:

• Duration: Acute (<3 weeks) vs. chronic (>8 weeks) 1
• Type: Dry/non-productive vs. productive/wet cough
• Underlying cause: Viral URI, asthma, GERD, etc.

Treatment Algorithm for Dry Cough

First-line options:

1. Over-the-counter glycerol-based cough syrups containing dextromethorphan

   • Low cost, some evidence of effect, and favorable side effect profile 1
   • Dextromethorphan 30mg has demonstrated efficacy in reducing subjective cough scores 2

2. First-generation antihistamine/decongestant combinations

   • Recommended as initial empiric treatment for chronic cough 1
   • Particularly effective when cough is related to upper airway cough syndrome

Second-line options (if first-line fails):

1. Opioid antitussives:
   • Codeine, pholcodine, hydrocodone (where available) 1
   • Can suppress cough counts by 40-60% in patients with chronic bronchitis 2
   • Codeine is less preferred due to greater side effect profile 1

Third-line options:

1. Peripherally acting antitussives like levodropropizine
   • May be equally effective to dihydrocodeine or moguisteine 1
   • Shows highest level of benefit especially in children 3

Important Considerations and Precautions

• Hydroxyzine is not mentioned in any of the clinical practice guidelines for cough management
• Avoid mucokinetic agents in dry cough as they show no consistent favorable effects 1, 2
• Use caution with antitussives in specific populations:
  • Children under 2 years: Cough medications have been associated with infant deaths 4
  • Patients with pre-existing conditions: High blood pressure, stomach problems, asthma 5
  • Patients taking multiple medications: Risk of drug interactions

When to Consider Further Evaluation

Refer for further investigation if the cough presents with:

• Hemoptysis
• Prominent systemic illness
• Suspicion of inhaled foreign body
• Suspicion of lung cancer 1
• Persistent cough despite appropriate treatment

Conclusion

For dry cough, begin with dextromethorphan-containing preparations or first-generation antihistamine/decongestant combinations. If these fail, consider opioid antitussives. Hydroxyzine is not included in evidence-based treatment algorithms for cough management and therefore should not be used for this indication.