Is naproxen (nonsteroidal anti-inflammatory drug (NSAID)) effective as a cough suppressant?

Naproxen as a Cough Suppressant

Naproxen is recommended for the short-term symptomatic relief of cough associated with the common cold, but is not effective for cough due to other conditions such as chronic bronchitis. 1

Efficacy of Naproxen for Cough

Evidence for Naproxen in Cough Management

• Naproxen is specifically recommended in the ACCP (American College of Chest Physicians) evidence-based clinical practice guidelines for treating acute cough associated with the common cold, along with first-generation antihistamine/decongestant preparations 1
• In a randomized, double-blind, controlled trial of experimental rhinovirus colds, naproxen demonstrated a significant 29% reduction in total symptom scores, including beneficial effects on cough 2
• The mechanism of action appears to be related to naproxen's inhibition of cyclooxygenase and subsequent reduction in prostaglandin production, which may play a role in the pathogenesis of cough in viral upper respiratory infections 2

Limitations of Naproxen for Cough

• Naproxen's effectiveness as a cough suppressant appears to be limited to cough associated with the common cold/upper respiratory infections 1
• There is no evidence supporting naproxen's use for cough due to chronic bronchitis, unlike other agents such as codeine and dextromethorphan which are recommended for this condition 1
• The 2006 ACCP guidelines note that while the previous guidelines had recommended naproxen for cough due to colds, the current recommendations have been revised to focus on other agents for different cough etiologies 1

Comparison with Other Cough Suppressants

First-line Agents for Different Types of Cough

• For cough due to upper respiratory infections (common cold): Naproxen and first-generation antihistamine/decongestant combinations are recommended 1
• For cough due to chronic bronchitis: Central cough suppressants like codeine and dextromethorphan are recommended for short-term symptomatic relief 1
• For cough due to URI or chronic bronchitis: Ipratropium bromide is the only recommended inhaled anticholinergic agent 1

Efficacy Considerations

• Relatively few drugs are effective as cough suppressants, and their efficacy varies depending on the underlying cause of cough 1
• Central acting cough suppressants (codeine, dextromethorphan) suppress cough counts by 40-60% in chronic bronchitis but have limited efficacy (<20% suppression) in cough due to URI 1
• NSAIDs like naproxen and ibuprofen may be effective for certain types of cough through their anti-inflammatory properties and prostaglandin inhibition 3, 2

Clinical Application and Considerations

When to Consider Naproxen for Cough

• Naproxen should be considered for patients with acute cough, post-nasal drip, and throat clearing associated with the common cold 1
• It may be particularly useful when cough is accompanied by other symptoms that respond to NSAIDs, such as headache, malaise, and myalgia 2
• Naproxen can be administered using a convenient once or twice daily regimen due to its relatively long half-life 4

Cautions and Contraindications

• As with all NSAIDs, naproxen carries risks of gastrointestinal, renal, and cardiovascular adverse effects 5
• Dosage adjustments may be prudent in elderly patients or those with mild renal or hepatic impairment 5
• For children with acute cough, evidence for over-the-counter cough medicines including NSAIDs is limited, with most studies showing they are no more effective than placebo 6

Important Clinical Pearls

• Cough suppressant therapy should be guided by the physician's specific knowledge of the disorder eliciting the cough 1
• Suppressant therapy like naproxen is most appropriate for short-term symptomatic relief rather than long-term management 1
• The use of cough suppressants is typically indicated when: (1) the etiology of cough is unknown, (2) specific therapy requires time to become effective, or (3) specific therapy will be ineffective 1
• When treating cough, it's important to recognize that the neural mechanisms responsible for cough production may differ between disorders, affecting drug efficacy 1