What is the recommended dose and dosing frequency of levodropropizine for a healthy adult with an isolated dry cough?

Levodropropizine Dosing for Isolated Dry Cough

For a healthy adult with isolated dry cough, administer levodropropizine 75 mg three times daily (every 8 hours) for 7 days. 1

Standard Dosing Regimen

• The recommended dose is 75 mg administered three times daily in adults with dry, non-productive cough 1
• This dosing schedule (every 8 hours) has been validated in clinical trials and achieves approximately 75% cough suppression 1, 2
• The typical treatment duration is 7 days, which represents the timeframe evaluated in clinical efficacy studies 1

Alternative Formulations and Dosing

• 60 mg three times daily is an alternative effective dose, particularly when using immediate-release formulations 3, 4
• Controlled-release formulations exist: 90 mg twice daily (every 12 hours) provides equivalent steady-state exposure to the standard 60 mg three times daily regimen, with the added benefit of reduced interindividual plasma concentration variability by approximately 37-83% 5
• Both immediate-release tablets, syrups, and capsules demonstrate equivalent pharmacokinetics with no clinically significant differences among formulations 5

Clinical Positioning in Treatment Algorithm

• The American College of Chest Physicians positions levodropropizine as a third-line peripherally-acting antitussive, after demulcents (first-line) and opioid derivatives (second-line) 6
• However, given its superior safety profile compared to opioids—with only 8% somnolence versus 22% with dihydrocodeine, and no risk of respiratory depression, constipation, or dependence—many clinicians use it earlier in the treatment sequence 1

Efficacy Evidence

• Meta-analysis of 1,178 patients demonstrates statistically significant superiority (p = 0.0015) over central antitussives including codeine, cloperastine, and dextromethorphan for reducing cough intensity, frequency, and nocturnal awakenings 7
• Clinical trials show levodropropizine is effective in approximately 80% of patients, with cough frequency reduced by 33-51% in responders 2
• Head-to-head comparison with dextromethorphan shows similar antitussive efficacy but significantly better tolerability, with adverse events in only 3.6% versus 12.1% of patients 3

Important Caveats

• Levodropropizine is not approved in the United States but is widely available in Europe and other regions 1
• The medication is generally very well tolerated, with mild adverse effects reported in only 3% of patients 1, 2
• No food restrictions are required (unlike nebulized lidocaine), though high-fat meals may delay absorption of controlled-release formulations without affecting overall exposure 5
• If no improvement occurs after the 7-day course, discontinue and consider alternative approaches rather than prolonging ineffective therapy 6