SIR KINGS’ NOTE

PHARMACOLOGY
ANTITUSSIVE PHARMACOLOGY
Cough also known as tussives is a sudden reflex or forceful making sound to release air and clear
an irritation in the throat or Airways. Cough can have causes that aren't due to underlying
diseases. Eg: normal clearing of airways, irritants such as smoke, tobacco use or improperly
swallowing food and liquids. It could be irritation such as foreign particles, microbes, fluids and
mucus. Cough can also be a rapid expulsion of air from the lungs.
Antitussives: Drugs that suppress cough possibly by reducing the activity of the cough center in
the brain. It is also called cough suppressant. Many antitussive are opiods. Antittusive should
only be considered for dry, irritating coughs that do not involve mucus production. Suppressing
productive or mucus-producing coughs caused by some respiratory diseases with antitussives
may be hazardous.

CLASSIFICATION OF COUGH
1. Acute cough: This is a cough of sudden onset that last up to three weeks.
2. Sub-acute cough: This type of cough persists between 3 and 8 weeks.
3. Chronic cough: This type persists over 8 weeks.
4. Nocturnal cough: Only occurs at night.

TWO BASIC TYPES OF COUGH

Productive cough: remove excessive secretions.
Non productive cough: Dry cough and it is harmful.
Antitussive indication: They are used to stop the cough reflex when the cough is not productive
i.e., dry cough.

CLASSIFICATION OF ANTITUSSIVE
1. Narcotic/Opioid antitussive: Codeine and hydrocodeine
2. Non-narcotic/ Non Opioid antitussive: Dextromethorphan, Benzonate, etc

Antitussive Page 1
 SIR KINGS’ NOTE

MECHANISM OF ACTION
Antitussive have two major mechanism of action; inhibiting coughing through Direct (centrally)
on the cough center in the brain (Narcotics). Eg: Codeine and hydrocodeine or peripherally
through inhibiting cough receptor in respiratory tract (Non narcotics). Non-narcotic drugs
suppress the cough reflex by anesthetizing the cough receptors in the respiratory tract and thus
keeping the cough reflex from being stimulated in the medulla. E.g: Benzonate.

NARCOTIC AGENTS
They are effective in suppressing the cough centers (receptors) in the brain. They are prescription
medication drugs because their use can lead to dependence.

CODEINE
It is a very popular narcotic antitussive drug which is potentially addictive. It depresses CNS
activity and is contraindicated in hypersensitivity patients, respiratory depression and seizure
disorders.
Dosage 10 - 20 mg
Note: Codeine can be an effective antitussive at lower doses than required for analgesia therefore
some of the most important side effects of codeine such as respiratory depression can generally
be avoided at the antitussive dose. The exception appears to be young children less than five
years of age who may be more sensitive to the respiratory depression. Codeine is therefore not
recommended for children under the age of 2 and should be used with caution in children 2 to 5
years old. Codeine comes in form of tablets, syrup, suspension or capsules.
Note: Do not crush, chew or break the tablets or capsules. Doing so can destroy the long action
of the drug. If you suddenly stop using this medication, you may have withdrawal symptoms
such as restlessness, watering eyes, running nose, nausea, sweating, and muscle aches.

PHARMACOKINETICS OF CODEINE
It is metabolized in the Liver to morphine and has onset of action of 15 to 30 minutes and
duration of action of 4hrs. Common side effects include vomiting and constipation, itchiness,
lightheadedness, dizziness, and drowsiness. Serious side effects are breathing difficulty and
addiction.

Antitussive Page 2
 SIR KINGS’ NOTE

NON-NARCOTIC AGENTS
Non-narcotic antitussive drugs are less effective than narcotic ones. They are available either
alone or in combination with other agents. They are POM drugs. Example are dextromethorphan,
benzonate.

BENZONATATE
It works by anesthetizing throat and lungs making the cough reflex less active. It is taken by
mouth. Use is not recommended in those under the age of 10. Effects generally begin within 20
minutes and lasts up to 8 hours. Side effects include headache, sleepiness, hallucination,
bronchospasm, and dizziness. Excessive dose may cause seizures or irregular heartbeats.
Adverse effects include mental confusion and visual hallucination.
Dosage: Benzonate is sold in 100 mg and 200 mg soft gel capsule. Initial dose is 100 mg gel cap
by mouth three times a day. Dosage may be increased as necessary up to a maximum of 600 mg
per day. Due to its potency and potential toxicity, the capsules must be swallowed intact in order
to allow slower release of the medication.

DEXTROMETHORPHAN
This is a medication most often used as a cough suppressant in over-the-counter drugs. It is sold
in syrup, tablet, spray, and other forms. Some of its trade name include robitussin, Dentone and
others. It is metabolized in the liver and excreted in the urine. It has a half-life of 24 hours.
Contraindications: because dextromethorphan can trigger a histamine release, (allergic
reaction) atopic children who are especially susceptible to allergic reaction should not be
administered to the drug only if absolutely necessary and only under the strict supervision of
health care professional. Dextromethorphan can increase serotonin levels and may interact with
other medicines that also increase serotonin.
Side effects: body rash, itching, nausea, vomiting, drowsiness, dizziness, constipation, diarrhea,
sedation, confusion, nervousness, close eye hallucination. A rare side effect is respiratory
depression.
Dosage varies. For adults 10 to 20 mg orally every 4 hours or 30 mg orally every 6 to 8 hours. It
is not recommended for children under 4 years. 4 to 6 years is 2.5 to 5 mg orally every 4 hours or

Antitussive Page 3
 SIR KINGS’ NOTE

7.5mg orally every 6 to 8 hours. 6 to 12 years: 10 mg orally every 4 hours. 12 years or older, 10
to 20 mg orally every 4 hours.
Side effects of antitussives; dizziness, headache, drowsiness, dry, mouth, nausea, vomiting,
constipation.

Antitussive Contraindications: Asthma, chronic obstructive pulmonary disease,

hypersensitivity, traumatic brain injury.

NURSING CONSIDERATIONS FOR ANTITUSSIVE

1. Assess for possible contraindications and cautions. For example, history of allergy to the
drug.
2. Assess respiration and adventitious sound.
3. Prevent overdose; ensure the drug is not taken any longer than recommended.
4. Assess underlying problem (medical evaluation for cough that persist or accompanied by
high fever, rash, excessive secretion) and arrange for appropriate treatment of the
underlying problem.
5. Provide other relief measures from cough; it includes humidifying the room, providing
fluids, use of lozengens and cooling room-temperature.
6. Educate the patient; provide thorough patient teaching including the drug name and
prescribed dosage etc.
7. Provide emotional support; offer support and encouragement to help the patients cope
with the disease and drug regime.
8. Evaluation; monitor patient's response to the drug, monitor for adverse effects and
monitor the effectiveness of other measures to relieve cough.

NATURAL REMEDIES
HONEY (You can create your own remedy at home by mixing up to 2 teaspoons of honey with
warm water and lemon).
PROBIOTICS: You can get probiotics from fermented foods like yogurt.
BROMELAIN: Enzymes found in Pineapple (eat a slice of pineapple or drink 3.5 ounces of
fresh pineapple juice three times a day).

Antitussive Page 4
 SIR KINGS’ NOTE

PEPPERMINT LEAVES. (drinking or inhaling): To make a steam bath, add 3 or 4 drops of

peppermint oil for every 5 ounces of hot water. Drape a towel over your head, and take deep
breaths directly above the water.
SALT AND WATER GARGLE: Mixing 1/4 to 1/2 teaspoon of salt with 8 ounces of warm
water can help to relieve irritation.

Sir Kings note

Info: 08064061746

Antitussive Page 5