Cough Suppressant
Aka: Cough Suppressant, Antitussive, Cough Suppression, Antitussive Therapy, Benzonatate, Tessalon Perles
II. Indications
- Dry, nonproductive cough
- Cough interferes with sleep or activity
III. Precautions
- Cough Suppressants in general lack evidence of benefit (Opioid and non-Opioid)
- Avoid AlbuterolInhaler unless bronchospasm
- Avoid Antihistamines or Decongestants unless specific allergy or sinus symptoms
- Avoid Corticosteroids outside Asthma (do not shorten cough duration)
- Intranasal Atrovent may be effective for cough in Upper Respiratory Infections
- (2017) Presc Lett 25(1): 3
IV. Preparations: Non-opioid Antitussives
- Benzonatate (Tessalon Perles)
- Dose: 100 to 200 mg orally three times daily
V. Preparations: Opioid Antitussives
- Precautions
- Risk of adverse effects and Opioid Abuse potential
- Opioids have minimal compelling evidence for use (and Dextromethorphan is as good as any)
- Yancy (2013) Chest 144(6):1827-38 [PubMed]
- Dextromethorphan (Benylin DM, Delsym)
- Over-the-counter
- Risk of Drug Interactions (Serotonin Syndrome, MAO inhibitors), Dextromethorphan Abuse
- Codeine
- Do not use in pregnancy (Teratogenic) or Lactation (Opioid Toxicity)
- Codeine Cough Syrup is often abused
- Adolescents often mix with soda or Alcohol (Lean, Sizzurp, Purple Drink)
- May be used for night-time cough
- Codeine Dose: 0.3 mg/kg up to 30 mg PO tid-qid
- Codeine may be used alone or in combination product
- Guaifenesin with Codeine (Robitussin AC)
- Adult: 2 tsp (10 ml) q4h
- Age 6 to 12 years: 1 tsp (5 ml) q4h
- Age 2 to 6 years: 1/2 tsp (2.5 ml) q4h
- Hydromorphone–Guaifenesin (Hycotuss)
- Adult dose: 5 ml po after meals and at bedtime prn
- Hydrocodone–Guaifenesin (Obredon)
- Hydrocodone (Hycodan)
- Adult dose: 5 mg q4-6 hours prn
VI. Preparations: Nebulized
- Nebulized Lidocaine 1-4% Lidocaine 3 cc
- Nebulized Morphine Sulfate 5-10 mg in 3 cc of Normal Saline