Medicine for dry cough
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"dry cough" treatment antitussive
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Here is a comprehensive overview of medicines used for dry cough, drawn from pharmacology textbooks:
Medicines for Dry Cough (Antitussives)
Dry cough is a non-productive cough with no mucus. Treatment targets suppression of the cough reflex (antitussives), acting either centrally (brainstem) or peripherally (airway sensors).
1. π Opioid (Narcotic) Antitussives
These suppress the cough center in the brainstem. Effective at doses lower than those needed for analgesia.
| Drug | Dose | Notes |
|---|---|---|
| Codeine | 15 mg | Gold-standard cough suppressant; works centrally. Limited effect in COPD. Causes constipation, sedation, dependence. Avoid in children. |
| Morphine (slow-release) | Varies | Reserved for chronic refractory cough or palliative/terminal cancer patients. |
| Diamorphine (Heroin) | β | Used in UK palliative care only; not available in the USA. |
Side effects of opioids: sedation, respiratory depression, constipation, physical dependence, histamine-mediated wheezing (rare).
2. π‘ Non-Opioid (Non-Narcotic) Antitussives
Dextromethorphan (DXM) β Most commonly used OTC
- Synthetic derivative of morphine, but no analgesic or sedative effects at therapeutic doses.
- Suppresses the medullary cough center reflex.
- Dose: 15β30 mg, 3β4 times daily.
- As effective as codeine for acute and chronic cough; works for upper respiratory tract infections in adults.
- Caution: Avoid in children under 6 years (FDA ban), and in patients on MAO inhibitors (risk of CNS depression and serotonin syndrome).
- Available in many OTC products.
Benzonatate
- Peripherally acting antitussive β anesthetizes stretch receptors in the lungs and pleura.
- May cause drowsiness; rare serious effects include CNS excitation if capsule is chewed.
- Used for dry cough when central agents are undesirable.
Noscapine
- Opioid-derived but devoid of analgesic effects.
- Not available in the USA; used in some other countries.
3. π΅ Neuromodulators (for Chronic Dry Cough)
When cough persists >8 weeks and is refractory to standard treatment:
| Drug | Use |
|---|---|
| Gabapentin | Chronic refractory cough affecting quality of life |
| Amitriptyline (low-dose) | Chronic cough, likely acts via central neuromodulation |
| Speech & language therapy | First-line non-pharmacological for all chronic cough |
4. π’ Treat the Underlying Cause First
Dry cough often has a specific trigger. Treating it eliminates the cough:
| Cause | Treatment |
|---|---|
| ACE inhibitor use (very common) | Stop ACE inhibitor β switch to ARB (e.g., losartan) |
| Asthma / cough-variant asthma | Inhaled corticosteroids + bronchodilators |
| Allergic rhinitis / post-nasal drip | Nasal steroids + antihistamines |
| GERD | Proton pump inhibitors or Hβ blockers |
| Eosinophilic bronchitis | Inhaled corticosteroids |
Key Safety Points
- Children <6 years: Dextromethorphan is FDA-banned in OTC cold/cough products.
- MAO inhibitors: Avoid dextromethorphan and codeine (risk of serotonin syndrome).
- Opioids: Not first-line; reserved for refractory or palliative cases.
- ACE inhibitor-induced dry cough affects ~10β15% of users and resolves within weeks of stopping the drug.
Sources: Katzung's Basic and Clinical Pharmacology, 16th ed. | Murray & Nadel's Textbook of Respiratory Medicine | Goodman & Gilman's Pharmacological Basis of Therapeutics
Disclaimer: This information is for educational purposes. Always consult a healthcare provider before starting any medication.
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