What are the available medications for cough (antitussives)?

From the Guidelines

For the management of cough, the most effective medications include opioids such as codeine, hydrocodone, and dihydrocodeine, as well as non-opioid options like levodropropizine and dextromethorphan, with the choice of medication depending on the underlying cause of the cough and patient-specific factors. When considering the treatment of cough, it's essential to differentiate between acute and chronic coughs, as well as the underlying cause, such as upper respiratory infections, chronic bronchitis, or lung cancer 1.

• For dry, non-productive coughs, dextromethorphan (found in Robitussin DM, Delsym) is recommended at doses of 10-30mg every 4-8 hours, which works by suppressing the cough reflex in the brain 1.
• For wet, productive coughs with mucus, guaifenesin (Mucinex) at 200-400mg every 4 hours helps thin secretions and make coughs more productive.
• Opioids like codeine, hydrocodone, and dihydrocodeine are effective for cough suppression, especially in patients with lung cancer, with hydrocodone and dihydrocodeine being the most widely used 1.
• Levodropropizine, a non-opioid antitussive, has shown efficacy in reducing cough frequency and severity, with a lower risk of somnolence compared to dihydrocodeine 1.
• Other options like benzonatate and sodium cromoglycate may also be considered for cough management, although the evidence is less robust 1. It's crucial to note that the efficacy and safety of these medications can vary depending on the individual patient and the underlying cause of the cough, and therefore, treatment should be tailored to the specific needs of each patient 1. Additionally, staying hydrated, using a humidifier, and avoiding irritants like smoke can complement medication therapy and help alleviate cough symptoms. Children under 4 should not receive OTC cough medications, and those with certain conditions (high blood pressure, glaucoma, prostate issues) should consult healthcare providers before using these products as some ingredients may worsen these conditions.

From the FDA Drug Label

Drug Facts Active Ingredients Purpose (in each teaspoonful (5 mL)) Codeine Phosphate USP 10 mg ................... Antitussive Package/Label Principal Display Panel Compare to Delsym® active ingredient Dextromethorphan Polistirex Extended-Release Oral Suspension Cough Suppressant The available medications for cough (antitussives) are:

• Codeine Phosphate 2
• Dextromethorphan 3

From the Research

Available Medications for Cough

The available medications for cough, also known as antitussives, can be categorized into different types, including:

• Centrally acting opioids such as morphine, codeine, pholcodeine, and dextromethorphan 4, 5
• Peripherally acting antitussives like moguisteine and levodropropizine 5
• Centrally acting drugs such as amitriptyline, paroxetine, gabapentin, and carbamezepine, which have been reported to be successful in treating chronic cough in some cases 4, 5
• Antihistamines like chlorpheniramine, which are often used in combination with codeine or dextromethorphan for symptomatic relief of dry cough 6
• Over-the-counter (OTC) cough preparations, which may include antitussives, expectorants, mucolytics, and antihistamine-decongestant combinations, although their effectiveness is often unclear 7

Efficacy of Available Medications

The efficacy of these medications varies, and some may have significant side effects, especially at high doses 4, 5. For example:

• Codeine has been shown to be no more effective than placebo in reducing cough symptoms in some studies 4, 7
• Dextromethorphan has been shown to be effective in reducing cough symptoms in some studies, but not others 4, 7
• Slow-release morphine has been reported to be useful in controlling intractable cough with good tolerance to constipation and drowsiness 4, 5

Need for New Therapies

There is a need for new therapies for cough, particularly for chronic cough, as current treatments are often ineffective or have significant side effects 4, 8, 5. New agents, such as nociceptin or antagonists of transient receptor potential vanniloid-1, may have antitussive effects and could potentially be used to treat cough 4, 5.