From the Guidelines
For a COPD patient on lisinopril, norvasc, gabapentin, and Advair who hasn't responded to Mucinex or benzonatate (Tessalon), I would recommend dextromethorphan (found in Delsym or Robitussin DM) at a dose of 20-30 mg every 6-8 hours, not exceeding 120 mg in 24 hours. This recommendation is based on the evidence from the American College of Chest Physicians (ACCP) guidelines, which suggest that central cough suppressants, such as dextromethorphan, are effective for short-term symptomatic relief of coughing in patients with chronic bronchitis or COPD 1. The patient's current medication regimen, including gabapentin, should be considered when initiating dextromethorphan, as both medications can cause drowsiness. It is essential to note that codeine-based suppressants are generally avoided in COPD patients due to the risk of respiratory depression. If the cough persists despite dextromethorphan, the patient should consult their healthcare provider to evaluate for COPD exacerbation, medication adjustment, or consideration of other causes for the persistent cough. Key points to consider when prescribing dextromethorphan for this patient include:
- Monitoring for increased drowsiness when combined with gabapentin
- Avoiding codeine-based suppressants due to respiratory depression risks
- Evaluating the patient for COPD exacerbation or other causes of persistent cough if symptoms persist despite treatment with dextromethorphan 1.
From the Research
Cough Suppressant Options for COPD Patients
The patient in question has COPD and is currently taking lisinopril, norvasc, vitriol, gabapentin, and advair. They have also tried musinex and tessalon, but claim they don't work.
- The studies provided do not specifically address cough suppressants for COPD patients 2, 3, 4.
- However, the studies do discuss various treatments for COPD, including bronchodilators and inhaled corticosteroids.
- One study recommends the use of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy for patients with COPD and dyspnea or exercise intolerance 3.
- Another study compares the effectiveness of two single-inhaler triple therapies, fluticasone furoate/umeclidinium/vilanterol and budesonide/glycopyrrolate/formoterol fumarate, in reducing COPD exacerbations and mortality 4.
Potential Interactions with Current Medications
- When considering a new cough suppressant, potential interactions with the patient's current medications should be taken into account.
- For example, gabapentin is known to interact with certain medications, including opioids, which are sometimes used as cough suppressants 2.
- The patient's current medications, including lisinopril, norvasc, and vitriol, should be reviewed for potential interactions with any new cough suppressant.
Next Steps
- Given the lack of specific information on cough suppressants in the provided studies, further research or consultation with a healthcare professional may be necessary to determine the best course of treatment for this patient.
- The patient's healthcare provider should be consulted to discuss potential options and determine the best treatment plan based on their individual needs and medical history.