Cough medicine (antitussive): list, danger

Cough is an unpleasant symptom, both during winter periods due to colds and the rest of the year as during allergies or irritations. Cough syrups are plentiful but should be taken with caution.

Definition: what is a cough suppressant?

A cough suppressant is a medication that relieves dry cough unproductive. There are various classes of antitussives, which are distinguished by their mode of action (central or peripheral) and the nature of their active ingredient(s). Cough suppressants usually come in the form of syrups or drinkable solutionsand more rarely in the form of tablets. Antitussives are to be distinguished from medicines intended for the wet cough (productive) that are mucolytics (or bronchial thinners). The latter tend to cause coughing to help clear congested airways and facilitate the evacuation of mucus. This is why the combination of a cough suppressant with a bronchial thinner is often unjustified from a medical point of view. Also, cough suppressants are symptomatic treatments that aim to relieve cough, but which do not address the cause. This is why it is very important to be able to identify the origin of a cough and to use antitussives, adjunctive treatments, only on a period of a few days. If the cough persists, the diagnosis should be reviewed with your doctor.

Indications: when to take a cough suppressant?

An antitussive is indicated during a non-productive dry cough. These drugs are not not indicated for fatty coughs because by blocking the cough, they would prevent the evacuation of mucus and risk aggravating the situation. In case of chronic cough, it is imperative to know the origin and to eliminate the cause, because a cough that lasts over time can be one of the signs of another pathology (example: allergy, intolerance to a substance or certain medications, affection of the bronchi or lungs such asasthma, etc.). A medical opinion is then strongly recommended and additional examinations may be prescribed. Antitussives can be taken for example when the airways are irritated and trigger coughingas during a transient ENT condition (common coldrunny nose, etc.), a dryness of the ENT mucous membranes or in smokers, or during an allergic reaction resulting in an irritative cough. Antitussives causing drowsiness (opioids or antihistamines) are rather to be preferred during dry nocturnal coughs.

What is the mode of action of a cough suppressant?

Antitussives have a different mode of action depending on the localization of their effects (central or peripheral) and the therapeutic class to which they belong. Opioid cough suppressants and pentoxiverine Clarix® and Paxeladine® have a central action ; they act directly on the cough center in the central nervous system by increasing the cough trigger threshold. Some also have properties antispasmodics. Antihistamine cough suppressants act peripherally by blocking histamine H1 receptors and reducing its effects on the bronchi, namely coughing. Other cough suppressants have a softening and antiseptic action (ex: marshmallow and thyme) or antispasmodic (ex: climbing ivy). There are also homeopathic specialties against cough whose mechanism of action is not known. Some syrups combine the antitussive substance with a bronchial thinner, which is not medically justified.

What are the main antitussive drugs?

Antitussives are divided into 4 categories:

  • Opioid cough suppressants made of codeinedextromethorphan, ethylmorphine (or codethyline), noscapine or pholcodine (Biocalyptol®, Broncalene® adult and child, dextromethorphan, Dimétane®, Euphon® and Neo-codion® syrup and tablets, Nodex®, Polery®, Padéryl®, Pholcodine®, Pulmodexane®, Pulmoserum®, Tussipax®, Tussidane®, Tussisedal®, Vegetoserum®),
  • The antitussives antihistamines (Humex® dry cough oxomemazine, Toplexil® and its generics, Tussonil®, Fluisedal®)
  • The non-opioid non-antihistamine cough suppressants (Pentoxyverine Clarix® and Paxeladine®)
  • Other antitussives, herbal (syrups based on climbing ivy such as Prospan® or Herbion®, based on mucoglycoprotein from Helix promatia L: Hélicidine®, based on marshmallow and thyme: Bronwel®) or even homeopathic (Baudry® pectoral paste, Drosera complex n°64®, Drosetux®, Homéoquintyl®, Homéorub®, Sambucus® liquorice pastes, Pertudoron®, Stodal® and Stodaline®).

Antitussives pholcodine-based opioids (Dimetane®, Broncalene®, Pholcodine®, Biocalyptol®) have been withdrawn from sale since September 8, 2022 because of the serious risk of cross-allergy that they can cause with the muscle relaxantsproducts used in anesthesia.

What are over-the-counter cough suppressants?

Since 2017, all opiate cough suppressants containing codeine, dextromethorphan, ethylmorphine or noscapine can only be purchased upon presentation of a prescription. Thus, to date, all opioid cough suppressants require a medical prescription. The only cough suppressants available today without a prescription are the specialties based on oxomemazine (e.g. Toplexil®), non-opioid non-antihistamine cough suppressants (Clarix® pentoxyverine and Paxeladine®) and other cough suppressants (climbing ivy, Prospan®, Herbion®, Helicidin®, Bronwel® and homeopathic specialties). Other advice specialties with antitussive properties and offered over the counter can also be purchased without a prescription.

What are the side effects and dangers of cough suppressants?

All cough suppressants can cause allergic reactions the active principles or the excipients which they contain. Pholcodine-based antitussives are also the cause, in a rare but serious way, of allergic reactions to muscle relaxants (drugs used in anesthesia and resuscitation) which may manifest as a anaphylactic shock. This is the reason why they are withdrawn from the market to this day. Opiate cough suppressants have some side effects such as drowsiness, dizziness, nausea and constipation. Driving a car or machinery can be dangerous when taking these drugs and even more so if they are administered in the morning or during the day. In addition, they are likely to cause addiction (addiction) or a respiratory depression, and all the more so if they are taken for too long (more than a few days) and/or in high doses. Only dextrometorphan does not cause respiratory depression at the usual doses. The main adverse effect of antihistamine cough suppressants is sedative effect, which can be dangerous when driving. They also have effects anticholinergics (or atropine) such as dry mouth, constipation, urinary retention, visual disturbances may trigger or worsen glaucoma. Other antitussives are generally better tolerated, their side effects are less marked and depend on the drug concerned.

What are the contraindications of cough suppressants?

Opiate cough suppressants should not be used in case of productive wet cough (particularly asthmatic), a history asthma, hepatic or respiratory insufficiency, nor in case of pregnancy or breastfeeding. They are also contraindicated with certain medications such as morphine or certain antidepressants (MAOIs). Antihistamine cough suppressants are contraindicated in patients with a history ofagranulocytosis, angle-closure glaucoma and prostate disorders (adenoma). All antitussives are contraindicated in infants and children under 2 years old. Finally, in general, no cough suppressant should be used in case of wet cough.

Do not use them in case of wet cough

What are the precautions for using cough suppressants?

The consumption of cough suppressants is not without risk. The following rules must be observed when taking them: do not use them in case of wet cough, respect treatment times recommended (maximum 5 days as a general rule), do not increase the doses if the cough persists, do not use thinner at the same time as a cough suppressant and ascertain the origin of the cough before using the cough suppressant. For example, certain drugs such as ACE inhibitors (antihypertensives) can trigger coughing in the event of intolerance: this cause must therefore be excluded before taking an antitussive. Opioid cough suppressants should also be used with caution if there is an increased risk of addiction. Alcohol can also potentiate the drowsiness effect caused by certain antitussives. Also, driving a car or machinery should be avoided with these and taking it in the evening is preferred. Finally, you have to be be careful when combined with other drugs and ensure that there are no interactions.

Leave a Comment

Your email address will not be published.