Drugs For Cough

Question 1

What are the drugs available for a dry cough and its considerations

Answer 1

Considerations.
- Give a single drug agent rather than a fixed combination due to increased risk of contraindications.
- Cough can be a cause for any underlying conditions ie GORD,postnatal drip,asthma) -Treat underlying condition first.
Drugs Available.
- Demulcents. Sucrose and glycerol- form protective layer over receptors
- Opioid cough suppressants. - codeine, and dextrometorphan
> codeine not recommended in kids <12 yrs
> Contraindicated in asthma and copd

Question 2

What are the drugs available for a wet productive cough and its considerations

Answer 2

Give a single drug agent rather than a fixed combination due to increased risk of contraindications.
Cough can be a cause for any underlying conditions ie GORD,postnatal drip,asthma) -Treat underlying condition first.

Drugs available
>Mucolytics- bromhexine - decrease viscosity of phlegm and help bring it up
>Expectorant- guaifenisin, ammonia salts and senega -increase coughing to bring up phlegm
>Other drugs used : NAC( n acetylecysteine)used to reduce mucus viscosity in people with cystic fibrosis,asthma, emphasema, copd

Question 3

Why are fixed dose cominations not preferred and its considerations for a cough

Answer 3

Combining agents may sometimes be irrational due to contraindications and MOA
For example
- Sedating antihistamines (diphenhydramine, chlorphenamine)- anticholinergic and sedating effects reduce cough- may be useful for postnasal drip but not for wet cough ( risk of mucus plug)

• Sympathomimetic decongestants - phenylephrine and pseudoephedrine- work by causing vasoconstriction of respiratory mucosa BUT
  >Risk of cns stimulations( mainly pseudo but also phenylephrine) nervousness, restlessness , insomnia
  >Cardiovascular( both)- increase heart rate an contractility
  > Not to be used for pregnancy and breastfeeding

Question 4

What options are available for kids for a cough ie dry or wet

Answer 4

Expectorants, decongestants, opioid cough suppressants and sedating antihistamines not recommended in kids under <6 years
Codeine cough suppressants not recommended in kids under 12 years
IVY LEAF EXTRACT AND ELDERBERRY