From the Guidelines
Non-opioid prescription cough medicines include benzonatate, which numbs stretch receptors in the lungs to reduce cough reflex, typically dosed at 100-200mg three times daily, as the most effective option based on recent evidence 1. The choice of non-opioid cough medicine depends on the cause of the cough, its characteristics, and the patient's medical history. Some options include:
- Benzonatate (Tessalon Perles): numbs stretch receptors in the lungs to reduce cough reflex, typically dosed at 100-200mg three times daily
- Prescription antihistamines like azelastine or prescription-strength cetirizine: help with coughs caused by allergies or postnasal drip
- Inhaled corticosteroids such as fluticasone or budesonide: effective for inflammatory coughs, especially those associated with asthma
- Guaifenesin in prescription strengths: helps thin mucus for productive coughs
- Ipratropium bromide inhalers: reduce cough in patients with COPD or chronic bronchitis
- Dextromethorphan: a cough suppressant available for persistent dry coughs, with a typical dose of 10-15 mg tid or qid, and a maximum dose of 120 mg/d 1 These medications work through different mechanisms, and the appropriate choice depends on the individual patient's needs. Most require a 1-2 week trial to determine effectiveness, and should be used alongside treatment of any underlying condition causing the cough. It is essential to consider the patient's previous exposure to opioids, as this may dictate the initial starting dose of opioid-derived medications, and to assess the risk of aspiration before using local anesthetics like nebulized lidocaine or bupivacaine 1.
From the FDA Drug Label
Benzonatate, a non-narcotic oral antitussive agent, is 2,5,8,11,14,17,20,23,26-nonaoxaoctacosan-28-yl p(butylamino) benzoate; with a molecular weight of 603.7. BENZONATATE is indicated for the symptomatic relief of cough. A non-opioid prescription cough medicine is Benzonatate 2 and 2.
- Key characteristics: non-narcotic oral antitussive agent
- Indication: symptomatic relief of cough Note that Dextromethorphan 3 is also a cough suppressant, but the provided text does not explicitly state that it is a prescription medicine.
From the Research
Non-Opioid Prescription Cough Medicines
- Peripherally acting antitussives include moguisteine and levodropropizine, as mentioned in the study 4.
- Centrally acting non-opioid drugs such as amitryptiline, paroxetine, gabapentin, and carbamezepine have been reported to be successful in treating chronic cough, according to the study 4.
- Dextromethorphan is a non-opioid cough suppressant that has been used for several decades, as described in the studies 5 and 6.
- The efficacy of dextromethorphan for chronic cough has been demonstrated in a systematic review and meta-analysis, with effect sizes of 0.37 (95% CI, 0.19-0.56; P = .0008) and 0.40 (95% CI, 0.18-0.85; P = .0248) compared to placebo, as reported in the study 7.
Mechanisms of Action
- Dextromethorphan works by causing psychoactive effects at higher doses, making it appealing for abuse, as mentioned in the study 6.
- The major metabolic pathways of dextromethorphan include sequential O-demethylation and N-demethylation, yielding dextrorphan (DXO), the major active metabolite, as described in the study 6.
Clinical Relevance
- Non-opioid prescription cough medicines such as dextromethorphan and peripherally acting antitussives may be effective alternatives to opioid cough suppressants, as suggested by the studies 4 and 7.
- The pharmacokinetics and pharmacodynamics of dextromethorphan are important to understand in order to avoid adverse effects and optimize its use as a cough suppressant, as discussed in the study 6.