Treating a Cough Continues to Present Challenges

Pharmacy Times

Despite the large number of prescription products available, nondrug therapies often work just as well.

Cold symptoms are a common patient complaint, with a cough cited as one of the most irritating and persistent symptoms.1 Patients often ask pharmacists and pharmacy technicians about the best way to stop the cough, but they may be hard-pressed to provide effective advice.

Consider that in 2017, the CHEST Expert Cough Panel assembled to look at the guidelines developed in 2006 and address 6 key clinical questions (Table 12) about treating acute coughs associated with the common cold.2,3 Unfortunately, the panel’s overall finding was that clinical trials in this condition have produced nothing significant since 2006.2
What Does Not Work?

The panel’s work yielded dismal results, so the question of what works remains. Nonpharmacologic and pharmacologic treatments crowd pharmacy shelves with combination or monotherapy options. Most new prescription products approved by the FDA since 2006 have been new combinations of previously approved products, including the following4-8:

Extended-release codeine polistirex and chlorpheniramine (Tuzistra XR)
  - A guaifenesin and hydrocodone bitartrate oral solution (Flowtuss, Obredon)
  - A guaifenesin/hydrocodone bitartrate and chlorpheniramine maleate (Vituz)
  - A guaifenesin, hydrocodone bitartrate, and pseudoephedrine hydrochloride oral solution (Hycofenix).

Further, the FDA has issued medication safety alerts about using some products in specific populations. Perhaps the most consequential for pharmacists was a strong recommendation not to use OTC cold and cough products for infants and children younger than 2 years, as serious and potentially life-threatening adverse effects (AEs) could occur.”9 Additionally, the FDA has warned against using codeine-containing medications to treat colds and coughs in children younger than 18 years, as these products create the potential for AEs such as difficult or slowed breathing.10

Finally, pharmacy staff members should remember that some individuals abuse certain OTC and prescription products. For example, dextromethorphan in high doses, often informally referred to as robotripping, can cause dissociative effects and euphoria.11 Some younger individuals have adopted the “purple drank” fad, made popular by some celebrities, by mixing promethazine with codeine syrup with alcohol, candy, fruit, or soda, which causes euphoria and intoxication.12 Unfortunately, such abuse can cause serious complications, including death.

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