Drugs used in the
treatment of
cough
Cough
Cough is a protective reflex, intended to remove irritants and
accumulated secretions from the respiratory passages.
Cough may be:
1. Productive cough:
Helps to clear the airway. Suppression of productive cough is harmful
as it may lead to infections.
Treatment includes antibiotics for infection, expectorants and
mucolytics for cough.
2. Nonproductive cough: It is useless and should be suppressed.
Drugs Used in Treatment
of Cough
Drugs used in the symptomatic treatment of cough are:
1. Antitussives (cough centre suppressants)
Codeine, pholcodine, noscapine, dextromethorphan, antihistamines,
benzonatate.
2. Pharyngeal demulcents
Lozenges, linctuses, liquorice.
3. Expectorants
Sodium and potassium citrate, potassium iodide, guaiphenesin,
ammonium chloride.
4. Mucolytics
Bromhexine, acetylcysteine, carbocisteine, ambroxol.
Anti-tussives
They inhibit cough reflex by suppressing the cough centre in the medulla.
They are used for the symptomatic treatment of dry unproductive cough.
Antitussives should be avoided in children below the age of 1 year.
1. Codeine:
a. Has cough centre suppressant effect.
b. Causes mild CNS depression, hence drowsiness can occur.
c. Causes constipation by decreasing intestinal movements.
d. Should be avoided in children and asthmatics.
Codeine is administered orally, has mild analgesic and less addiction liability
than morphine
2. Pholcodine:
Antitussive action is similar to codeine.
It has no analgesic or addiction liability.
It is administered orally and has a long duration of action.
3. Noscapine:
It is an opium alkaloid with potent antitussive effect.
It is useful in spasmodic cough.
It has no analgesic effect, does not cause constipation, addiction or
CNS depression.
The side effects are nausea and headache.
4. Dextromethorphan:
It is a centrally acting antitussive agent.
It has no analgesic property, does not cause constipation and addiction;
mucociliary function in respiratory passages is not affected.
5. Antihistamines:
Diphenhydramine, chlorpheniramine, promethazine, etc. are useful in
cough due to their sedative, antiallergic and anticholinergic actions.
They produce symptomatic relief in cold and cough associated with
allergic conditions of respiratory tract.
6. Benzonatate:
It is a peripherally acting cough suppressant and chemically related
to local anaesthetic, procaine.
It acts on the pulmonary stretch receptors.
Pharyngeal Demulcents
Syrups, lozenges, linctuses or liquorice may be used
when cough arises due to irritation above the larynx.
They increase salivation and produce protective
soothing effect on the inflamed mucosa.
Expectorants (Mucokinetics)
They increase the volume of bronchial secretion and reduce
viscosity of the sputum; hence, cough becomes less tiring and
productive.
They include iodides, chlorides, bicarbonates, acetates, volatile
oils, etc.
These drugs are useful in the treatment of chronic cough.
Mucolytics
These agents break the thick tenacious sputum and
lower the viscosity of sputum →so that the sputum
comes out easily with less effort.
Bromohexine
semisynthetic agent used orally. It has potent
mucolytic and mucokinetic effects.
Side effects include rhinnorhea and lacrimation
Acetyl cysteine &
Carbocisteine
mucolytic agent used as aerosol in t/m of cough
MOA: break disulphide bond in mucoproteins of
sputum→ sputum become thin or less viscid→cough
become less tiring and productive
Side effects: Nausea, Vomiting and bronchospasm
Carbocysteine is administered orally
