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DRUGS FOR COUGH 
Dr. D. K. Brahma 
Associate Professor 
Department of Pharmacology 
NEIGRIHMS, Shillong
WHAT IS COUGH ? 
It’s a protective reflex – for expulsion of 
respiratory secretions and foreign 
particles from air pass...
COUGH – TYPES AND MERITS 
 Non-productive (Dry Cough) and Productive 
 Nonproductive ones need suppression – 
cerebral h...
COUGH ETIOLOGY 
1. Upper/Lower Respiratory Tract Infection 
2. Postnasal drip due to sinusitis, rhinitis 
3. Smoking/Chron...
COUGH – DRUGS (NONSPECIFIC) 
1. PHARYNGEAL DEMULCENTS: Lozenges, cough 
drops, linctuses glycerine and liquorice 
2. EXPEC...
DRUGS OF COUGH – DEMULCENTS 
AND EXPECTORANTS 
Demulcents 
Soothing effect and symptomatic relief – reduce 
afferent imp...
ACTIONS OF DRUGS OF COUGH – 
MUCOLYTICS 
Bromhexine: Derivative of Adhatoda vasica 
(Vasaka) – increases bronchial secret...
ACTIONS OF DRUGS OF COUGH - 
ANTITUSSIVES 
 Action via CNS 
 Act by raising the threshold of cough centres 
 Also perip...
ANTITUSSIVE - CODEINE 
 Opioid – opium alkaloid – methyl morphine 
 Partly converts to Morphine 
 Less potent than Morp...
COUGH DRUGS - NONOPIOIDS 
 Noscapine: Opium alakaloid 
 Depresses cough, but no analgesic, narcotic or 
dependence liabi...
COUGH DRUGS 
Antihistamine: 
Chlorpheniramine, Diphenhydramine and 
Promethazine 
MOA: Sedative and anticholinergic 
U...
THANK YOU/KHUBLEI SHIBUN 
Cough syrups, remedies for cough and cold are 
FREELY AVAILABLE 
however, needs rational prescri...
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A Power point presentation on the Drugs used for cough suitable for reading by undergraduate Medical students.

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Drugs for cough

  1. 1. DRUGS FOR COUGH Dr. D. K. Brahma Associate Professor Department of Pharmacology NEIGRIHMS, Shillong
  2. 2. WHAT IS COUGH ? It’s a protective reflex – for expulsion of respiratory secretions and foreign particles from air passages Respiratory secretions ! – URT - LRT Stimulation of mechano or chemoreceptor – throat, respiratory passages and stretch receptors in the lungs Afferent fibres in vagus & sympathetic - impulses to cough center – medulla Cough Mechanism !
  3. 3. COUGH – TYPES AND MERITS  Non-productive (Dry Cough) and Productive  Nonproductive ones need suppression – cerebral hypoxia, rupture of bullas and fracture ribs etc.  Productive – needs to clear airway  May be harmful if suppressed !  Amount of product Vs effort of coughing  Most of the time, coughing is beneficial  Removes excessive secretions  Removes potentially harmful foreign substances  In some situations, coughing can be harmful, such as after hernia repair surgery
  4. 4. COUGH ETIOLOGY 1. Upper/Lower Respiratory Tract Infection 2. Postnasal drip due to sinusitis, rhinitis 3. Smoking/Chronic Bronchitis 4. Pulmonary Tuberculosis 5. Asthmatic cough 6. Gastrointestinal reflux 7. Drugs – Captopril and Iodides ……
  5. 5. COUGH – DRUGS (NONSPECIFIC) 1. PHARYNGEAL DEMULCENTS: Lozenges, cough drops, linctuses glycerine and liquorice 2. EXPECTORANTS: (MUCOKINETICS – secretion enhances): a) Secretion Enhancers: Sodium and Potassium citrate, KI, Guaiphenesin (Glyceryl guaicolate), Vasaka, Ammonium chloride b) Mucolytics: Bromhexine, Ambroxol, Acetylcysteine, Carbocysteine 3. CENTRAL COUGH SUPPRESSANTS: a) Opioids: Codeine, Pholcodeine b) Nonopioids: Noscapine, Dextromethorphan c) Antihistamines: Chlorpheniramine maleate, Diphenhydramine,promethazine 4. ADJUVANT: Salbutamol, Terbutaline
  6. 6. DRUGS OF COUGH – DEMULCENTS AND EXPECTORANTS Demulcents Soothing effect and symptomatic relief – reduce afferent impulses - act by increasing flow of saliva  Expectorants (Mucokinetics) 1. Increase Bronchial Secretion – Na and K citrate 2. Irritation of Bronchial mucosa – Iodides 3. Enhance Bronchial secretions (and mucociliary functions) – Guaiphenesin, Vasaka 4. Ammonium salts – nauseating, reflex stimulation of bronchial secretion
  7. 7. ACTIONS OF DRUGS OF COUGH – MUCOLYTICS Bromhexine: Derivative of Adhatoda vasica (Vasaka) – increases bronchial secretion Depolymerises mucopolysaccharides in bronchial secretions – directly or by liberating lysosomal enzyme  Fibres of sputum breaks down  Useful in mucus plug Ambroxol: Similar to Bromhexine Acetylcysteine: Breaks sulfide bond in mucopolysaccharides of bronchial secretions – Respiratory tract administration Carbocysteine: Similar to acetylcysteine – administered orally
  8. 8. ACTIONS OF DRUGS OF COUGH - ANTITUSSIVES  Action via CNS  Act by raising the threshold of cough centres  Also periphery – by reducing cough impulse  Uses:  dry and nonproductive cough  Unusually tiring cough, disturbed sleep or hazardous – hernia, piles, cardiac diseasead oculr surgery
  9. 9. ANTITUSSIVE - CODEINE  Opioid – opium alkaloid – methyl morphine  Partly converts to Morphine  Less potent than Morphine and degree of analgesia is equivalent to Aspirin (60 mg)  But, more selective for cough centers and action lasts for 6 Hours  Blocked by Naloxone  Low abuse liability  Drawbacks: constipation, respiratory depression and drowsiness (Higher doses)  PHOLCODEINE: No analgesia or addicting property – longer acting
  10. 10. COUGH DRUGS - NONOPIOIDS  Noscapine: Opium alakaloid  Depresses cough, but no analgesic, narcotic or dependence liability  Equipotent with codeine – spasmodic cough  Histamine release – no in asthma  Dextromethorphan:  Synthetic – d-isomer (antitussive) and l-isomer (analgesic)  Effective as codeine but no addicting and constipating effect – No impairment of mucocilliary function  But, dissociative effect – recreational drug?  In Combination – Paracetamol (acetaminophen)
  11. 11. COUGH DRUGS Antihistamine: Chlorpheniramine, Diphenhydramine and Promethazine MOA: Sedative and anticholinergic Useful in allergic cough Bronchodilators: Bronchospasm can induce cough and constriction Hyperactivity of Bronchial smooth muscles Bronchodilators – relieves cough and improves clearance during cough
  12. 12. THANK YOU/KHUBLEI SHIBUN Cough syrups, remedies for cough and cold are FREELY AVAILABLE however, needs rational prescribing
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A Power point presentation on the Drugs used for cough suitable for reading by undergraduate Medical students.

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