From the Guidelines
For persistent dry cough, a combination of Medrol Dosepak (methylprednisolone), Tessalon (benzonatate), and Atrovent nasal spray (ipratropium bromide) can be effective, though this specific combination should be prescribed by a healthcare provider. This combination addresses different aspects of cough: inflammation (Medrol), the cough reflex itself (Tessalon), and upper airway triggers (Atrovent) 1.
Key Considerations
- Medrol Dosepak is a corticosteroid that reduces inflammation in the airways, typically taken as directed in the package with decreasing doses over 6 days.
- Tessalon is a non-narcotic cough suppressant that works by numbing stretch receptors in the lungs, usually taken as 100-200mg capsules three times daily.
- Atrovent nasal spray helps reduce post-nasal drip that can trigger coughing, typically used as 2 sprays per nostril 2-3 times daily.
- Side effects may include increased blood sugar from Medrol, numbness in the mouth from Tessalon, and nasal dryness from Atrovent.
Approach to Cough Management
According to the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines, an effective approach to cough is to sequentially evaluate and treat for the common causes of cough using a combination of selected diagnostic tests and empiric therapy 2, 3, 4.
Underlying Causes
If the cough persists beyond 2 weeks despite treatment, further evaluation is recommended to identify underlying causes such as:
- Asthma
- GERD
- Chronic sinusitis It is essential to consider these potential underlying causes and adjust the treatment plan accordingly, as suggested by the guidelines 1, 2, 3, 4.
Treatment Adjustments
In patients with chronic cough, therapy should be given in sequential and additive steps because more than one cause of cough may be present 4. The guidelines recommend directing empiric treatment at the most common causes of cough, including UACS, asthma, NAEB, and GERD, and considering referral to a cough specialist if the condition remains undiagnosed after evaluation and treatment 4.
From the FDA Drug Label
The recommended dose of ipratropium bromide solution, 0.03% is two sprays (21 mcg) per nostril two or three times daily (total dose 168 to 252 mcg/day) for the symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis in adults and children age 6 years and older. The combination of Medrol Dosepak, Tessalon, and Atrovent Nasal Spray may be used for a persistent dry cough, but the specific use of Atrovent Nasal Spray is for the symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis.
- The Atrovent Nasal Spray dose is two sprays per nostril two or three times daily.
- Medrol Dosepak and Tessalon are not mentioned in the provided drug label. 5
From the Research
Medications for Persistent Dry Cough
- Medrol Dosepack is a corticosteroid used to treat various conditions, including asthma and allergic reactions, but its effectiveness for persistent dry cough is not directly mentioned in the provided studies 6, 7, 8.
- Tessalon is a cough suppressant, but there is no specific information about its use for persistent dry cough in the given studies.
- Atrovent nasal spray, which contains ipratropium bromide, is used to treat rhinorrhea and may be beneficial for upper airway cough syndrome, a common cause of chronic cough 7, 8.
Causes and Treatment of Persistent Dry Cough
- The most common causes of persistent dry cough include upper airway cough syndrome, gastroesophageal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis 7, 8.
- Treatment of the underlying cause is essential, but symptomatic relief may be necessary when the cough interferes with the patient's health and sleep 6.
- In some cases, no associated cause can be found, and treatment remains a challenge 6.
Use of Ipratropium Bromide for COPD
- Ipratropium bromide, in combination with budesonide, has been shown to improve lung function and reduce inflammation in patients with acute exacerbation of COPD 9.
- However, its effectiveness for persistent dry cough in patients without COPD is not directly addressed in the provided studies.