From the Guidelines
For inpatient cough management, opioids such as hydrocodone 5mg bid or dihydrocodeine 10mg tid are recommended as the most effective options, as they have been shown to be effective in reducing cough frequency in patients with lung cancer, according to the most recent and highest quality study 1. When considering cough management in inpatients, it's essential to identify and treat the underlying cause of cough rather than just symptoms. The following options can be considered:
- For productive coughs, guaifenesin (Mucinex) 600-1200mg every 12 hours can be effective by thinning mucus secretions.
- For dry, irritating coughs, dextromethorphan (Robitussin DM) 10-30mg every 4-6 hours can suppress the cough reflex in the brain.
- Benzonatate (Tessalon Perles) 100-200mg three times daily can work well for persistent coughs by numbing stretch receptors in the lungs.
- In cases of severe cough disrupting sleep or recovery, codeine 10-20mg every 4-6 hours or hydrocodone-containing medications may be appropriate for short-term use under close monitoring due to their respiratory depression risks.
- Nebulized treatments with albuterol or ipratropium can help when cough is associated with bronchospasm. Adequate hydration and elevation of the head of the bed can complement medication therapy. For patients with COVID-19 or other respiratory infections, isolation precautions should be maintained while managing cough symptoms. It's crucial to note that the choice of treatment may be dictated primarily by availability rather than pharmacologic parameters, as stated in the study 1.
From the FDA Drug Label
BENZONATATE is indicated for the symptomatic relief of cough. BENZONATATE acts peripherally by anesthetizing the stretch receptors located in the respiratory passages, lungs, and pleura by dampening their activity and thereby reducing the cough reflex at its source.
Great cough medications used inpatient include benzonatate (PO), as it is indicated for the symptomatic relief of cough 2. It acts peripherally to reduce the cough reflex at its source and has a duration of action of 3 to 8 hours 2.
- Benzonatate (PO) is a viable option for inpatient cough medication.
- Dextromethorphan (PO) may also be considered, but the provided label does not contain direct information about its use in an inpatient setting 3.
From the Research
Great Cough Medications Used Inpatient
- The most common symptoms for which patients seek medical attention from primary care physicians and pulmonologists is cough 4.
- Therapeutic suppression of cough may be either disease-specific or symptom related, and the potential benefits of an early treatment of cough could include the prevention of the vicious cycle of cough 4.
- Among drugs used for the symptomatic treatment of cough, peripherally acting anti-tussives such as levodropropizine and moguisteine show the highest level of benefit and should be recommended especially in children 4.
- Cough is a common symptom often confronted in the clinical setting, and one characteristic of cough that likely contributes to this is the multifactorial nature of cough 5.
- The Guideline "Acute and chronic cough" of the German College of General Practitioners and Family Physicians (DEGAM) was updated in 2021 and contains recommendations for an evidence-based approach for the management of acute cough in primary care 6.
- There is inadequate evidence for the efficacy of antitussive or expectorant drugs against acute cough, and the state of the evidence for phytotherapeutic agents is heterogeneous; clinical importance is minimal 6.
- Some studies have focused on the analysis of cough medications, such as the simultaneous determination of acetaminophen, guaifenesin, pseudoephedrine, pholcodine, and paraben preservatives in cough mixture by high-performance liquid chromatography 7.
- Robust chromatographic methods have been developed for the analysis of quaternary mixtures containing paracetamol, codeine, guaifenesin, and pseudoephedrine or phenylephrine in their dosage forms 8.