E-DRUG: Need for cough mixtures (contd.)
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I do think that the discussion around antitussives has become
quite confused. In the first place one should distinguish two different kinds of cough: (a) productive (mucus or pus) and
(b) nonproductive (irritation of larynx or bronchi - typical
example bronchial carcinoma). Therapy depends on the type of
cough. If there is an infection this should be treated - if this
takes some time (tuberculosis!) an additional antitussive might
be warranted.
Otherwise, all so-called antitussives containing mucus-dissolving
substances (acetylcysteine, bromhexine, ambroxol, etc.) taken
orally are ineffective. The only exception is acetylcysteine
aerosol as used in cystic fibrosis patients. The only reasonable antitussive (in children) are syrups with a high sugar content
(thyme syrup etc.) - the dangers of promoting dental decay are somewhat exaggerated - after taking a spoonful the mouth should
be carefully washed a few times with water.
Diphenhydramine and similar antihistamines/neuroleptics
(promethazine) should no longer be used - they should be
considered pacifiers for the parents and not for the children.
There is an - as yet not fully proven - link of those drugs with
cot death.
For nonproductive cough there used to be two alternatives
(both opioid substances): Noscapine and dextromethorphan. There
is some dubious data linking noscapine to genetic damage, and
there are no formal trials proving the antitussive effect of
that drug. Contrary to what Joel Lexchin has written, the
antitussive effect of dextromethorphan is definitely proven in controlled trials. The only snag is that the drug (as syrup) has
been misused by heroin addicts, and therefore put on prescription
in some countries. However, it is relatively expensive and its
taste is quite foul.
Should one market an OTC cough syrup? Provided it only contains
some sugar and some herbal extracts why not? Salbutamol should be reserved for crooks raising calves - but it is a very useful anti-asthmatic.
Best wishes,
Leo Offerhaus MD PhD
Chopinstraat 9 NL-1077 GL Amsterdam The Netherlands
Tel. 0031-20-6762434 Fax 0031-20-6756590
From 11.09.97: Tel 0031-35-6923288 Fax 0031-35-6923290
E-mail LO@EURONET.NL, CompuServe 71530,15
Eur J Clin Pharmacol ONLY: POB 75552, 1070 AN Amsterdam
Note from the moderator:
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Cough is a symptom not a disease. Priority should be to find
the cause, if possible and treat it. Leo rightly points that
coughs are generally of two kinds: 1. productive and
2. nonproductive.
And there are generally two types of cough remedies:
1. expectorants (which usually dont work) and
2. cough suppressants, also called antitussives.
Syed Rizwanuddin Ahmad
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