Antitussive

1. Pharmacotherapy
of
Cough
Zaeid Alhamashi

2. Cough
 Protective reflex mechanism which removes foreign material
and excessrespiratory secretion

4. Typesof cough
Productive cough
Non-productive/Dry cough

5. Drugswhichinduce cough
ACEinhibitors
Amiodarone
Beta blocker -
(non_selective )

6. Anti tussive– Coughsuppressant
Mucolytic- Reduceviscosity of mucus
Mucokinetic-Increase mobility of cough
Classificationof Drugsfor cough
Antihistamines
Bronchodilators

7. Antitussives
Ideally cough should not besuppressed
Treatment of underlyingcause


 Drugs which suppresscough-Antitussives
Raise threshold of cough centre in medulla
In respiratory tract reduce tussalimpulse

 Useful for drycough

8.  Semisynthetic opioidanalgesic
 Lesspotent than morphine
 More selective for coughcentre
 Potent coughsuppressantaction at low dose(10 mg)
 Anti tussive action –blockedbyNaloxone
 Haslessaddiction
S/E
 Constipation,Drowsiness,Respiratorydepression
 Contraindicated in bronchialasthma
Codeine

9. Pholcodine
 Antitussive efficacy similar tocodeine
 No analgesic/addictive effect
 Longer acting
 Dose10-15mg 3-4 times aday

10. Mucolytics
Acetylcysteine
 Reduceviscosity of sputum by opening disulfide bondof
mucoprotein
S/E
Nausea,vomiting,gastratitis,bronchospasm,rhinorrhea
 Administer directly to respiratorytract

11. Carbocysteine
Liquefies viscid sputum
 Other mode of action
S/E
G.Iirritation

12. Antihistamines
Added to antitussives/expectorantformulation
Relief in coughdue to sedative & anticholinergicactions
Lack selectivity for coughcentre
No expectorantaction
↓Secretions (anticholinergiceffect)
Suitable for allergic cough but not for asthma
Ex., diphenhydramine, promethazine

13. Bronchodilators
Bronchospasm induce or aggravate cough
↑Surface velocity of air flow during cough
 Clear secretions of airway
Not used routinely for every type of cough
present ( Bronchial Use only when bronchoconstriction is
asthma)
Ex. β2-agonist (salbutamol,terbutaline)

14. Localanesthetic
 Lignocaine
 For intractable cough of Bronchialcarcinoma
 Administer by nebulizer
 Toprevent cough during endoscopy
 Instill topically inairway

15. Roleof hydration in cough
Dehydration increase viscosity of secretion
Adequate fluid –decreaseviscosity
Highly effective Roleof
steaminhalation
Useful for liquefaction of tenacioussputum
Roleof other agents

16. Summary
Cough-protective reflex
Treat underlying cause
Provides symptomatic treatment
Antitussive –Suppresscough centre
Opioid&non opiod
Mucolytic-Lysis
Adjuvants-Anti-histamine,Bronchodilator

17. Thank you