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Cough Suppressant

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Cough Suppressant, Antitussive, Cough Suppression, Antitussive Therapy, Benzonatate, Tessalon Perles

  • Indications
  1. Dry, nonproductive cough
  2. Cough interferes with sleep or activity
  • 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
  • Preparations
  • Non-opioid Antitussives
  1. Benzonatate (Tessalon Perles)
    1. Dose: 100 to 200 mg orally three times daily
  • 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
  • Preparations
  • Nebulized
  1. Nebulized Lidocaine 1-4% Lidocaine 3 cc
  2. Nebulized Morphine Sulfate 5-10 mg in 3 cc of Normal Saline