E-DRUG: Need for cough mixtures (contd.)
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At the risk of moving this discussion about the need for
cough mixtures out of the realm of drug policy decision
making and onto a question of the efficacy of different
preparations, I have to point out that neither codeine nor dextromethorphan have been proved to be of value as
antitussives in patients with an acute cough due to an upper respiratory tract infection (URTI). The general assumption
has been that the central mechanism of cough is the same in
induced cough (induced through inhalation of citric acid),
chronic cough and cough due to URTI. While codeine has
been effective in chronic cough and induced cough there has
been very little objective evidence in its favour for cough
due to URTI. The same goes for dextromethorphan.
There are two studies that I am aware of that show that both dextromethorphan and codeine are INEFFECTIVE in cough due to
URTI. In the first study children with a night cough were given
either placebo, codeine or dextromethorphan. Neither active medication was better than placebo. (Taylor JA, Novakc AH,
Almquist JR, Rogers JE. Efficacy of cough suppressants in
children. J Pediatrics 1993;122:799-802.) In the second study,
adults with an acute cough were given either codeine or syrup
vehicle and again codeine was no better than the vehicle.
(Eccles R, Morris , Jawad M. Lack of effect of codeine in the treatment of cough associated with acute upper respiratory tract infection. J Clinical Pharmacy and Therapeutics 1992;17:175-180.)
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: (416)-964-7186
Fax: (416)-923-9515
e mail: joel.lexchin@utoronto.ca
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