Cough
Quick treatment options you can try to patients complaining about cough. However - note that "relatively few drugs are effective for the nonspecific suppression of cough".
Good review articles:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205006
https://journal.chestnet.org/article/S0012-3692(15)52856-0/fulltext
Summary:
- Try tessalon perles + guaifenesin first
- If that's not working try dextromethorphan
- Give other symptomatic stuff as needed
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Dextromethorphan (ROBITUSSIN)
- Most common non-opioid, centrally-acting antitussive
- Reduced cough intensity more than codeine: https://pubmed.ncbi.nlm.nih.gov/6852361/
- So, I would use it instead of codeine because why use an opioid that is less effective and can cause side effects like constipation and somnolence when you have something that works better all around?
- Available at UC Davis as ROBITUSSIN-DM, which includes guaifenesin
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Benzonatate (TESSALON PERLES)
- Most common peripherally-acting antitussive
- Anesthetizes stretch receptors in the lungs and pleura
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Guaifenesin (MUCINEX)
- Expectorant which helps loosen congestion in chest and throat (mucolytic)
- Always good to order in anyone who sounds like they have lots of secretions
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Throat lozenge / phenol spray
- Lozenges = cough drops. Menthol, lidocaine, and many other options available
- Phenol spray / benzocaine spray
- Honey has good evidence
- Warmed fluids, soft-foods, teas, etc. though not much evidence
- Decent options to try in patients who are coughing + getting a sore throat
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Ipratropium bromide
- Only inhaled anticholinergic recommended in cough due to URI or chronic bronchitis
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Consider GERD
- Try a PPI
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Consider asthma
- Try albuterol
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Gabapentin/pregabalin
- Apparently can be used to treat chronic cough which I did not know: link
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BTW - chlorpromazine (THORAZINE) and baclofen for hiccups
- I had a patient with chronic hiccups and I didn't know these were some of the treatments for that lol. It actually seemed to work pretty well!
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Decrease anticholinergics
- Anticholinergics dry out mucus and thicken it, making it harder to expectorate
- Exception is trial of ipratropium as above