Cough suppressants

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By Dr. Victor Dumaguing

To Your Health

Friday, July 25, 2014


THE article on cough medicines the previous weekend may have stirred the hornet's nest, so to speak.

Someone texted, most probably a nurse, and emphasized that water should also be included as a mucolytic-expectorant, which the author concurs with one hundred percent. Indeed, water therapy is not only recommended to patients with urinary problems but also those patients who may have to expel hardened mucus and phlegm in their respiratory passages.

The other type of cough medicines are the cough suppressants, otherwise called antitussives from the Spanish word "tos” or “tus" meaning cough.

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As mentioned earlier, the cough center is one of the seven vital centers in the medulla oblongata of our brain which include sneeze, vomiting, respiratory, cardiac, vasomotor centers, the function of which is to initiate coughing every time an irritating substance, solid, liquid or gas, stimulates the throat.

Cough is a forceful expiratory effort, so powerful that if the cough has been there for a long time, the vocal cords would have been grazed so that either the person has hoarse voice or aphonia, no voice at all.

Thus, the doctor might just decide to suppress that cough already if he feels that the coughing effort is now doing more harm than good.

Examples of clinical situations that require a cough suppressant would be advanced pulmonary tuberculosis with hemoptysis, which is coughing out blood, whooping cough or pertussis, in elderlies whose coughing is accompanied by urinary incontinence (cannot control their urination), or in people who now complain of pain along the lower ribs margin caused by severe uncontrolled coughing, or among COPD patients like smokers , whose cough is not productive of any phlegm and may be disturbing their sleep.

Codeine is a naturally occurring opium alkaloid belonging to the phenanthrene family, which includes morphine. Thus, it is a reliable narcotic - capable of depressing consciousness - pain reliever.

However, most of its clinical use is that of an antitussive, i.e. it is capable of suppressing the cough center thus decreasing the frequency of coughing. And being a narcotic, given at the right dose, it also helps the patient sleep. There are cough medicines in drugstores with Codeine but their dispensation requires strict adherence to our local PDEA policies - written in a special prescription paper, in triplicate, and most importantly, the doctor must have the so-called S2 license number, on top of the usual PRC and Professional Tax Receipt number.

Obviously, it is not easy to acquire the Codeine-containing cough medicines, which is good because it somehow helps in reducing addicts.

Thus, there are alternative medicines. Dextromethorpan is a dextro-isomer of codeine, thus it is as strong and as effective antitussive, i.e it depresses the cough center as well as Codeine, without the propensity or likelihood of inducing addiction. Cough medicines with the suffix "DM" contain dextromethorpan. Thus, Robitussin AC contains codeine while Robitussin DM contains dextromethorpan.

Or the patient may be given Butamirate, the most popular tradename is Sinecod both in tablet and syrup form. Or there is Levodropropizine (Levopront), available only in liquid form.

At this juncture, the author strongly advises against self-medication, because only your doctor or family physician would know which is best for the patient. Remember, cough is just a symptom, it has several causes; for example a person in congestive heart failure has cough, also a person with pulmonary edema, or for that matter, an asthmatic patient.

Be that as it may, and having said some basic facts about cough medicines, when that throat starts to itch and a cough follows, remember, there are different types of cough medicines.

Next Week: Be careful of WILDS

Published in the Sun.Star Baguio newspaper on July 26, 2014.

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