It is obvious that cough conditions are treated for their underlying causes and not the cough itself. But if the cause of cough is not known or it is causing you lot of discomfort, your doctor may recommend either cough suppressants called antitussives or expectorants. Bronchodilators to relax the airways are also prescribed when required.
ANTITUSSIVES act on the brain and suppress the cough reflex. They treat dry coughs caused by colds, flu, and lung infections. In general, avoid consuming alcohol if you are taking antitussives.
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Type of Antitussive |
Key Comments |
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Codeine
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Codeine can be habit-forming. Do not take a larger dose or take it for a longer period of time than prescribed by your doctor. Codeine phosphate if taken beyond prescribed limits makes people drowsy and intoxicated and overdosing can prove to be fatal. If your child’s doctor prescribes it for him/her, be sure to follow the exact dosage and other instructions. Over dosage could cause severe side effects like unusual sleepiness, loud or difficulty breathing, blueness on the lips or around the mouth. |
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Dextromethorphan Dosage: 5 to 15 ml (10 to 30 mg) every 6 to 8 hours |
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ANTIHISTAMINES are medicines that provide symptomatic relief in cases of allergic cough by reducing the body’s production of histamine (chemicals that cause symptoms of allergy). Although antihistamines are prescribed for adults, chronic cough in children should not be treated with antihistamines. Do not use antihistamines for chesty coughs as they make it harder to remove mucus from your lungs. Rather use expectorants.
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Type of Antihistamine |
Key Comments
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Diphenhydramine Dosage: 25 to 50 mg orally every 4 to 6 hours as needed, not to exceed 300 mg/24hours. |
Used to treat sneezing, runny nose and cough due to allergies or irritation. This drug is also used in cases of insomnia and motion sickness. Exercise caution while driving, operating machinery or engaging in dangerous activities while on this drug. Avoid drinking alcohol as it may cause further dizziness and make you drowsier. |
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C.P.M. (chlorpheniramine) Dosage: 2 mg/5 ml, 10 ml every 4-6 hours not exceeding 24 mg or 120 ml per day. |
Do not take this drug for longer than 7 days in a row. Talk with your doctor if your symptoms do not improve after 7 days of treatment. |
EXPECTORANTS [1] help relieve chest congestion by loosening and thinning the mucus caused by cold or irritation. . Though they are relatively safe and do not cause any major drug interactions, some studies have shown that they could interact with herbs like liquorice [2], which is used as a herbal remedy for cold in some places.
Do not use a cough expectorant for chronic cough due to smoking, asthma, bronchitis, or emphysema, or if your cough is accompanied by excessive congestion (mucus), unless a doctor tells you to. It should not be used by children under 12 years of age, pregnant or breastfeeding mothers. Most used drugs are – mixture of Guaiphenesin and Ambroxol, or Guaiphenesin used alone
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Type of Expectorant |
Key Comments |
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Guaiphenesin Immediate release formulation: 200 to 400 mg orally every 4 hours as needed, not to exceed 2.4 g/day Sustained release formulation: 600 to 1200 mg orally every 12 hours, not to exceed 2.4 g/day |
Certain points to consider before taking this drug: Guaiphenesin in combination with dextromethorphan should not be used in patients taking MAOIs. Persistent or chronic cough such as that which occurs with smoking, asthma, chronic bronchitis, or emphysema. Consult your doctor if your symptoms do not improve after five days or if they get worse during treatment with this medicine.
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Ambroxol Adults: daily dose of 30 mg to 120 mg taken in 2 to 3 divided doses |
It is used for symptomatic treatment of bronchiectasis, bronchitis with bronchospasm asthma. Avoid using the medicine during the first trimester of pregnancy. |
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Bromhexine |
Bromhexine is used for the treatment of cough associated with excessive phlegm and wheeziness. It is to be taken only with the doctor’s prescription. Ask your doctor before taking this syrup if you have stomach ulcers. |
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Ammonium chloride |
Ammonium chloride is a safe, effective remedy for coughs. This medicine is unlikely to cause side effects for most people. |
BRONCHODILATORS [3] are generally used in cases of coughs as symptoms of asthma, COPD, and bronchitis. These medicines dilate the airways making it easier for the airflow to the lungs.
Bronchodilators can either be short-acting or long-acting.
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Type of Bronchodilator |
Key Comments
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Terbutaline – beta2- agonists
Dosage: As per doctor’s instruction.
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[4] The FDA (The Food and Drug Administration) approved terbutaline in 1974. Store tablets and injection at room temperature, 15-30 degree C (59-86 F). Don’t use terbutaline with beta blockers as these drugs reduce each other’s effects. Terbutaline is also known to reduce uterine contractions and may inhibit labor. [4] Terbutaline is on the prohibited list of the World Anti-Doping Agency and athletes need a Therapeutic Use Exemption clearance from the relevant Anti-Doping Organization. It is also currently under the USFDA scanner. |
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Salbutamol – beta2-agonist
Dosage: As per doctor’s instruction.
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[5] Salbutamol is sometimes abused for the purposes of fat burning and / or performance enhancement. The World Anti-Doping Agency keeps it in its prohibited list that requires ‘a declaration of use’ of maximum 1600 micrograms over 24 hours. Stop using this medicine and check with your doctor right away if you or your child have coughing, difficulty breathing, shortness of breath, or wheezing after using this medicine. |
Salbutamol is used as treatment for whooping cough as well. For example, a study[6] by Belcher and Reese at Guy’s Hospital, London, showed that oral salbutamol is more effective in cases of whooping cough than the inhaled salbutamol. That is because oral salbutamol could reduce both the cough as well as the ‘whoop’ as compared with the inhaled one which reduced only the ‘whoop’.
General precautions * you need to take for cough syrups:
- Do not use a cough or cold medicine if you have used antidepressants (MAO inhibitor) within the past 14 days. Serious, life-threatening side effects can occur if you take cough or cold medicine before the MAO inhibitor has cleared from your body
- Do not use any other over-the-counter cough, cold, allergy, or sleep medication if you are using any other medication. Ask your doctor first.
- Some cough syrups can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
- Avoid drinking alcohol when on any of these drugs. It can increase some of the side effects of cough syrups.
- Side effects of some cough syrups may include drowsiness, dizziness, light-headedness, blurred vision, constipation, and vomiting. Check with your doctor first.
- Antitussive drug reaction in adults may include difficulty breathing or swallowing, fast or irregular heartbeat, changes in vision, rash and seizures.
- Use the measuring cup or dispenser provided with the syrup for the correct dosage.
- Most of these drugs are available in combination with paracetamol. Taking such combination syrups may cause liver damage in the event of Paracetamol overdose.
Reference:
- * http://www.drugs.com
- [1]http://otcsafety.org/en/treatments/cough-expectorants/
- [2]http://math.unife.it/farmacia/lm.farmacia/insegnamenti/mini-siti-a.a.-2011-2012/farmacognosia-e-prodotti-erboristici-a.a.-2011-2012/materiale-didattico/19A_Plant_Pharm_interactions_review.pdf
- [3]http://www.clevelandclinic.org/health/health-info/docs/3500/3528.asp
- [4]http://www.medicinenet.com/terbutaline/article.htm
- [5]http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-IS-TUE/2011/WADA_TUE_Guidelines_V5.0_EN_01JAN11.pdf
- [6]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC460263/pdf/thorax00241-0082.pdf