Drugs used for the

treatment of cough
Dr AneeIa KhaIid
ARNING OBJ%IV$
Classification of drugs used for the non
specific treatment of cough
Define the term Expectorant and
mucolytic
Describe the mechanism of action,
adverse effects and clinical uses of
Expectorants
Antitussives
Iassification of drugs used for
non specific treatment of cough
1. ough suppressants
entraIIy acting Antitussives
PeripheraI Antitussives
2. ough expectorants
3. Antihistamines
4. BronchodiIators
1) OUGH $UPPR$$AN%$ (Anti-
tussives)
1- entraIIy acting Antitussives
Narcotic antitussive
Opiates
Codeine
Pholcodine
Hydrocodone
Non narcotic antitussives
Opiates
Dextromethorphan
Levopropozyphene
Noscapine
Non-Opiates
Diphenhydramine
Benzonatate
2- PeripheraI Antitussives
1 DemuIcents
Linctus
Lozenges
Liquorice
2 InhaIation
Water aerosol inhalation
Benzoin
Menthol
3 ocaI anaesthetics
Benzonatate
Lignocaine (only in special circumstances)
2) ough xpectorants
1 Drugs acting RefIexIy
pecacuanha
Ammonium chloride
Potassium odide
2 Drugs Acting DirectIy
Potassium odide
Guaiphenesin
3 MucoIytics
Acetylcysteine
Bromhexine (Bisolvon)
Carbocisteine
Methylcysteine
Definition of MucoIytic and
xpectorant
MucoIytic
A mucolytic is a drug that breaks down thick
mucus, making it thinner and easier to cough
out.
xpectorant
An expectorant is a drug which makes the cough
more productive by loosening and liquefying
bronchial secretions.
Also known as Mucokinetics
Antitussives
Antitussives are substances that specifically
inhibit or suppress the action of cough
1) Depression of medullary centre or associated
higher centers.
2) ncreases threshold of the cough centre.
3) nterruption of tussal impulses peripherally in
the respiratory tract.
4) nhibition of conduction along the motor
pathways.
Narcotic Antitussives
odeine and PhoIcodeine
An opium alkaloid similar to morphine
less potent then morphine as analgesic and
respiratory depressant.
60% effective orally then parentrally as an
analgesic and respiratory depressant.
A standard antitussive
A small fraction of administered codeine is
metabolized to morphine which is responsible
for analgesic effects of codeine.
MOA of odeine:
Directly suppresses cough centre by binding to
distinct receptors in Medulla.
Suppresses cough for about 6 hrs.
Dosage: 15 mg
Adverse effects of odeine:
n therapeutic doses minimum side effects
Sedations, nausea, constipation
At higher doses respiratory depression and
drowsiness can occur.
Contraindicated in asthmatic patients and
patients with diminished respiratory reserves.
Pholcodeine has similar efficacy as
codeine with longer duration of action of
12hrs
t has no analgesic or addiction property
Non Narcotic Antitussives
Dextromethorphan Hydrobromide
A synthetic compound.
t is a dextrorotatory sterioisomer of a
methylated derivative of levorphenol.
Strong and partial agonist.
As effective antitussive as codeine.
MOA:
1. Controls cough spasm by depressing
cough centre in medulla
2. ncrease the threshold for coughing
Advantages of Dextromethorphan
No effect on ciliary activity
No CNS depression
No addiction potential
No constipation
Dosage: 15- 30mg three or four times daily.
%oxicity:
Toxic doses may cause.
Stupor, ataxia, respiratory depression,
convulsion in children and death with abuse of
its purified powder.
Contraindicated in children below 6 yrs of age
and also in patients taking Monoamine oxidase
inhibittors.
evopropoxyphene
t is a sterioisomer of weak opioid agonist
dextropropoxyphene.
t is devoid of opioid effects
Sedation is the only adverse effect
Dosage: 50-100mg 4hrly
Noscapine
An opium alkaloid
No narcotic, analgesic or dependance
inducing properties.
Equally effective antitussive as codeine
Useful for spasmodic cough.
Headache and nausea are usual side
effects
Contraindicated in asthamatic patients.
Benzonatate
Chemically related to tetracaine.
MOA:
Reduces the cough reflex by anesthetizing
the stretch receptors in the respiratory
passages, Lungs and Pleura.
t has some central effects also.
Adverse effects:
Headache, Dizziness, Pruritus
Nasal Congestion, burning of eyes &
tightness in chest.
P%ORAN%$
These are the drugs which make the cough
more productive by loosening and
liquefying bronchial secretions.
Also known as Mucokinetics.
Guaiphenesin
t is a derivative of Guaiacol
Obtained from wood or synthetically prepared
MOA. Decrease sputum viscosity and increase
sputum volume thereby decreasing difficulty in
expectoration
onIy FDA Approved expectorant .
Adverse effects. Nausea, gastric disturbances
drowsiness and rash.
IPAUANHA
$ource: Natural alkaloid obtained from
roots of cephaelis acuminata contains:
Cephaeline
Emetine
MOA.
Loosening & liquefying mucosa
soothing irritated bronchial mucosa.
t also has emetic & amoebicidal properties.
Uses. Mainly used for emesis in accidental
poisoning.
ontraindications
Semiconscious, Unconscious or
convulsing person
Corrosive poisoning or kerosine poisoning.
MucoIytics
MOA of MucoIytics:
Mucolytics open disulphide bonds in the
mucoproteins present in the sputum
making it less viscid.
Bromhexine:
MOA: t depolymerizes the
polysaccharides directly as well as by
liberating lysosomal enzymes which
breaks down the fiber network in the
tenacious sputum.
Particularly useful for mucous plugs.
Adverse effects:
Rhinorrhoea, lacrimation, and gastric
irritation.
Antihistamines
Chlorphenaramine 2-5mg
Diphenhydramine 5-25mg
Promethazine 15-25mg
Anti histamines provides relief in cough
due to sedative and anticholinergic action.
They lack selectivity for cough centres
They have been promoted for treatment of
cough in allergic states.
No efficacy in Asthma
BronchodiIators
Bronchodilators by clearing secretions
through increase in surface velocity of
airflow during cough relieves .
Should be used only when element of
bronchoconstriction is present and not
routinely
Fixed dose combination of bronchodilators
with anti tussives not preferred .
$peciaI conditions
Cough may be useful or useless.
No roIe of Antitussives
Asthma
young infants
Congestive cardiac failure
Bronchiactasis, COPD, Tuberculosis.
Antitussives may be prescribed
For dry unproductive cough that is
hazardous or is disturbing sleep.
( hernias, piles, after surgical procedures
esp cataract surgery).
Pholcodeine along with diphenhydramine
is useful.
n whooping cough or in pertusis.
Bronchodilator along with
Diphenhydramine is useful.