Injectable Treatments for Cough Reduction
There are no injectable medications specifically recommended or approved for the treatment of cough in adults. The current evidence-based guidelines focus on oral, inhaled, and nebulized therapies rather than injectable formulations for cough management 1.
Why Injectable Treatments Are Not Standard
The Thorax guidelines for management of cough in adults do not include any injectable medications in their therapeutic algorithms 1. The recommended treatment approaches prioritize:
- Oral medications such as opioids (codeine, dextromethorphan, low-dose morphine) for antitussive effects 1
- Inhaled corticosteroids for inflammatory airway conditions 1
- Nebulized local anesthetics (lidocaine, mepivicaine) for refractory cases, though these have transient effects and significant aspiration risks 1
Experimental Injectable Agents (Not Clinically Available)
The guidelines mention several injectable compounds that have been studied in animal models but lack human clinical data 1:
- BW443C81 (peripherally acting enkephalin analogue): Showed no effect on capsaicin-induced cough in human volunteers despite animal efficacy 1
- Nociceptin (opioid peptide): Suppressed cough in guinea pigs and cats but has no human data 1
- Neurokinin receptor antagonists (SR 48968, FK224): Mixed results in animal studies with failed human trials 1
Practical Clinical Approach
For acute cough, the guidelines recommend oral dextromethorphan (60 mg for maximum effect), menthol inhalation, or sedating antihistamines rather than any injectable therapy 1.
For chronic cough, the treatment algorithm emphasizes 1:
- First-generation antihistamine/decongestant combinations orally 2
- Inhaled corticosteroids for inflammatory conditions 1, 3
- Oral baclofen (GABA-B agonist) for refractory cases 1
- Low-dose oral morphine for idiopathic chronic cough 1
Critical Pitfall to Avoid
Do not attempt to use injectable corticosteroids (such as intramuscular or intravenous steroids) for routine cough management. While oral prednisone (30-40 mg daily for short periods) may be considered for severe paroxysms of postinfectious cough after ruling out other causes 4, there is no evidence supporting injectable steroid formulations for this indication, and the guidelines specifically recommend oral or inhaled routes 1, 4.
The absence of injectable cough treatments reflects the fact that cough pathophysiology is best addressed through direct airway delivery (inhaled/nebulized) or oral systemic therapy, rather than parenteral administration 1.