II. Indications

  1. Dry, nonproductive cough
  2. Cough interferes with sleep or activity

III. Precautions

  1. Cough Suppressants in general lack evidence of benefit (Opioid and non-Opioid)
  2. Avoid AlbuterolInhaler unless bronchospasm
  3. Avoid Antihistamines or Decongestants unless specific allergy or sinus symptoms
  4. Avoid Corticosteroids outside Asthma (do not shorten cough duration)
  5. Intranasal Atrovent may be effective for cough in Upper Respiratory Infections
  6. (2017) Presc Lett 25(1): 3

IV. Preparations: Non-opioid Antitussives

  1. Benzonatate (Tessalon Perles)
    1. Dose: 100 to 200 mg orally three times daily

V. Preparations: Opioid Antitussives

  1. Precautions
    1. Risk of adverse effects and Opioid Abuse potential
    2. Opioids have minimal compelling evidence for use (and Dextromethorphan is as good as any)
    3. Yancy (2013) Chest 144(6):1827-38 [PubMed]
  2. Dextromethorphan (Benylin DM, Delsym)
    1. Over-the-counter
    2. Risk of Drug Interactions (Serotonin Syndrome, MAO inhibitors), Dextromethorphan Abuse
  3. Codeine
    1. Do not use in pregnancy (Teratogenic) or Lactation (Opioid Toxicity)
    2. Codeine Cough Syrup is often abused
      1. Adolescents often mix with soda or Alcohol (Lean, Sizzurp, Purple Drink)
    3. May be used for night-time cough
    4. Codeine Dose: 0.3 mg/kg up to 30 mg PO tid-qid
      1. Codeine may be used alone or in combination product
    5. Guaifenesin with Codeine (Robitussin AC)
      1. Adult: 2 tsp (10 ml) q4h
      2. Age 6 to 12 years: 1 tsp (5 ml) q4h
      3. Age 2 to 6 years: 1/2 tsp (2.5 ml) q4h
  4. Hydromorphone-Guaifenesin (Hycotuss)
    1. Adult dose: 5 ml po after meals and at bedtime prn
  5. Hydrocodone-Guaifenesin (Obredon)
  6. Hydrocodone (Hycodan)
    1. Adult dose: 5 mg q4-6 hours prn

VI. Preparations: Nebulized

  1. Nebulized Lidocaine 1-4% Lidocaine 3 cc
  2. Nebulized Morphine Sulfate 5-10 mg in 3 cc of Normal Saline

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Related Studies

Cost: Medications

Benzonatate (on 6/18/2017 at Walmart.com)
Benzonatate 100mg #14 capsules for $4.00 $0.29 each
Benzonatate 100mg #42 capsules for $10.00 $0.24 each
benzonatate (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
BENZONATATE 100 MG CAPSULE Generic $0.20 each
BENZONATATE 200 MG CAPSULE Generic $0.30 each

Ontology: Antitussive Agents (C0003449)

Definition (NCI) Any substance that is capable of relieving or suppressing coughing.
Definition (MSH) Agents that suppress cough. They act centrally on the medullary cough center. EXPECTORANTS, also used in the treatment of cough, act locally.
Concepts Pharmacologic Substance (T121)
MSH D000996
SnomedCT 372593002, 320955005, 372791003, 59751001
LNC LP31462-2
English Agents, Antitussive, Antitussive Agents, Antitussive Drugs, Antitussives, Drugs, Antitussive, Antitussive Agent [TC], Antitussive, Antitussive Agent, Suppressants, Cough, Cough Suppressants, antitussive drug, antitussive drugs, antitussive, coughing suppressants, cough suppressants, antitussives, cough suppressant, Cough Medicines, Cough suppressants (substance), Cough suppressants (product), Antitussive agents, Cough suppressants, Cough suppressant, Antitussive agent (product), Antitussive agent (substance), Antitussive agent, Antitussive, NOS
French Médicaments antitussifs, Agents antitussifs, Anti-tussifs, Médicaments contre la toux, Antitussifs
Swedish Hostdämpande medel
Czech antitusika
Finnish Antitussiivit
Italian Antitossivi, Farmaci antitossivi, Antitussivi, Sedativi della tosse
Polish Leki przeciwkaszlowe
Japanese 鎮咳剤, 咳止め, せき止め, 鎮咳薬
Spanish Antitusígenos, supresores de la tos, antitusivos (producto), antitusivos, supresores de la tos (sustancia), Agentes Antitusígenos, Agentes Antitusivos, Antitusivos, Fármacos Antitusivos, Fármacos Antitusígenos, agente antitusivo (producto), agente antitusivo (sustancia), agente antitusivo, antitusivos (sustancia)
Portuguese Fármacos Antitussígenos, Substâncias Béquicas, Agentes Béquicos, Agentes Antitussígenos, Medicamentos Béquicos, Antitussígenos
German Antitussiva, Hustenmittel

Ontology: benzonatate (C0053229)

Definition (NCI) A synthetic butylamino-benzoate derivative related to tetracaine and a peripherally acting antitussive, nonnarcotic Benzonatate reduces the cough reflex by anesthetizing and depressing mechanoreceptors in the respiratory passages, lungs, and pleura. It is recommended for cough relief in the common cold, bronchitis, pneumonia, and for chronic cough such as in asthma. (NCI04)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C029755
SnomedCT 31801005, 386030001
LNC LP18904-0, MTHU006813
English benzonatate, benzonatate (medication), BENZONATATE, benzonatate [Chemical/Ingredient], Benzonatate, Benzonatate (product), Benzonatate (substance)
Spanish benzonatato (producto), benzonatato (sustancia), benzonatato

Ontology: Cough suppression (C0522046)

Concepts Sign or Symptom (T184)
SnomedCT 102580004
Dutch hoestonderdrukking
French Sédation de la toux
German Hustenstillung
Italian Soppressione della tosse
Portuguese Supressão da tosse
Spanish Supresión de la tos, supresión de la tos (hallazgo), supresión de la tos
Japanese 咳嗽抑制, ガイソウヨクセイ
Czech Tlumení kašle
Hungarian Köhögés csillapítás
English Cough suppression, Cough suppression (finding)

Ontology: Antitussive therapy (C1096670)

Concepts Therapeutic or Preventive Procedure (T061)
Italian Terapia antitosse
Japanese 鎮咳療法, チンガイリョウホウ
Czech Léčba antitusiky
Hungarian Köhögéscsillapító kezelés
English Antitussive therapy
Portuguese Tratamento antitússico
Spanish Terapia antitusiva
Dutch antitussivumtherapie
French Traitement antitussif
German Therapie mit Hustenmittel