What is an effective antitussive (cough suppressant) medication to trial in the Emergency Room (ER) for a patient with a dry cough?

From the Guidelines

Dextromethorphan is a great cough medicine to trial in the ER for patients with dry cough. The typical adult dose is 10-15 mg orally every 4-6 hours as needed, not exceeding 120 mg in 24 hours 1. For immediate use in the ER, dextromethorphan can be administered as a single dose, with a prescription for continued use at home if needed. This medication works by suppressing the cough reflex by acting on the cough center in the medulla of the brain. It's particularly effective for non-productive coughs where the goal is to reduce the cough frequency rather than promote expectoration. Some key points to consider when prescribing dextromethorphan include:

• The medication should be used cautiously in elderly patients or those with certain medical conditions like glaucoma, urinary retention, or respiratory depression.
• Other options like benzonatate (100-200 mg three times daily) can be considered, which works by anesthetizing stretch receptors in the lungs 1.
• For patients with allergic components to their cough, first-generation antihistamines like diphenhydramine (25 mg) may help due to their anticholinergic properties.
• Opioids like codeine, hydrocodone, and dihydrocodeine can also be effective for cough suppression, especially in patients with lung cancer, but their use should be carefully considered due to potential side effects and risks 1. It's essential to note that the choice of treatment may be dictated primarily by availability rather than pharmacologic parameters, and local anesthetics like nebulized lidocaine can be tried when other pharmacologic approaches have failed to manage cough 1.

From the FDA Drug Label

Purpose Cough suppressant Drug Facts Active Ingredients Purpose (in each teaspoonful (5 mL)) Codeine Phosphate USP 10 mg ................... Antitussive The best option for a cough medicine to trial in the ER for a patient with a dry cough is dextromethorphan (PO), as it is a cough suppressant 2. Another option could be codeine (PO), which has an antitussive effect 3.

• Dextromethorphan (PO) is a direct cough suppressant.
• Codeine (PO) has an antitussive effect, which can help with cough suppression.

From the Research

Cough Medicines for Dry Cough

• Codeine is a commonly used antitussive for the treatment of dry cough, and it has been shown to be effective in providing symptomatic relief 4, 5.
• Codeine can be used in combination with other medicines, such as antihistamines and decongestants, to provide additional relief from cough symptoms 4.
• Dextromethorphan is another antitussive that has been shown to be effective in relieving cough symptoms, and it can be used as an alternative to codeine 6, 7, 8.
• Other cough suppressants, such as morphine and noscapine, are also available, but their use may be limited by side effects and the need for careful dosing 6, 7.

Considerations for Use in the ER

• When selecting a cough medicine for a patient with dry cough in the ER, it is essential to consider the patient's medical history, current medications, and potential side effects of the medication 5, 6.
• Codeine and dextromethorphan can be effective options for short-term symptomatic relief of dry cough, but their use should be limited to the minimum duration necessary to avoid dependence and side effects 5, 8.
• The choice of cough medicine should be based on the patient's individual needs and medical status, and the patient should be monitored closely for any adverse effects or interactions with other medications 4, 6.