Patient

Advise

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Drink at least 8-10 glasses of water a day.

Hot fluids (eg. Chicken soup) keep the air passages moist and may act as
decongestant
Stay away from cold,dry environments.Keep warm.
Use a humudifier to add moisture in a dry and cold room.This will allow the
patien to inhale air with moisture in it,making the throat moist.It may also help
liquefy the mucus,making it easier to expel.
Refrain from doing things that may cause irritation to the throat e.g. exposure to
the dust or if smoking, smoking at least until the attack eases off.The cough will
clear up soon after the irritant is expelled.
Ask the physician if shifting to another type of medication is needed.
If known to have seasonal allergies e.g. hay fever,stay indoors during days or
seasons when airborne allergens are high in the atmosphere.If possible, keep
the windows closed and avoid the use of fans that draw aire from the outside.
Hot steamy showers will help breakdown the mucus (phlegm) and make it
easier to cough up.
Avoid alcohol or caffeine containing drinks may cause fluid loss.Fluids are
essential in keeping the mucus thin.
Gargling with plain water for one minute three times per day eases symptoms.
Have plenty of bed rest
Paracetamol may be taken for fever and pain that accompany the
cough.However,some coug mixtures and cold remeides already contain
paracetamol so read the label to avoid getting an overdose.
Decongestants e.g.phenylephrine may be used to clear a stuffy nose that
accompanies the cough,especially if having a postnasal drip.However these
should not be used if the patient has high blood pressure or if the medicine is t
be given to a child under six years of age unless prescribed by the doctor.
Do not take antihistamines as these tend to dry up the secretions and leave
them in the lungs.
Avoid taking antibiotics immediately unless instructed by the doctor.By selfmedicating the patient becomes more suscpetible to the occurrence of microbial
resistance, or the resistance of the germ causing the cough to the
drug,especially if these medicines are not taken properly.

DISPENSING
TIPS

Counsel the patient on the medication and how to use it properlt i.e. name of medication,dose,frequency of dosage,
manner of use, etc
In case of excacerbation despite the treatment.Advise the patient to consult a physician at once
Advise the patient on the possible adverse effects of come cough preparations,especially those contaning opiate
derivatives.

Inform the patient about the possibility of side effects e.g.

dependence and drowsiness caused by some cough preparations.

Discuss PATIENT ADVICE throughly for more information on the

prevention and management of cough.

Treatment
Options

Cough & Cold Preparations

Treatment of a dry, non-productive cough may be considered as serving no useful
purpose for the patient.The initial approach in the treatment of such cough is the
treatment of any underlying disease condition,examples of which may include
asthma,chronic bronchitis,heart failure with pulmonary congestion,lung
cancer,esophageal reflux,postnasal drip,sarcoidosis or tracheitis.
If the cause of the cough is unknown or specific treatment is unsuccesful in relieving
cough, then symptomatic treatment in the form of cough suppressants for dry cough
and expectorants and mucolytics for productive cough may be useful.
Pholcodine,noscapine and dextrometorphan are the agenst commonly used as cough
suppressants and are considered to have fewer side effects than opiate derivatives i.e.
codeine which is also widely used.
Although pholcodine and noscapine are opium alkaloid siwth antitussive action,these do
not have analgesic or narcotic activity.
Cough suppressants containing opiate derivatives i.e. codeine act by directly
suppressing the cough center in the brain.Side effects may include mild to heavy
sedtion,dependence and constipation
Other cough suppressants act centrally but are not derived from opioids.These include
drugs e.g. butamirate citrate,clobutinol,pentoxyverine and sodium dibunate.Oxeladin,
also a centrally-acting cough suppressant, has been reported to be mutagenic in vitro,
and many preparations have since been withdrawn.
Pipathezate is also a centrally-acting cough suppressant which also has a peripheral
actions.
Levodropropizine is being used as a cough surpressant in non-productive cough due to
its peripheral action in the cough reflex and found to produce fewer CNS effects.
Combination products produce synergistic effects, targeting mainly the cholinergic
receptors and the cough centers.They may contain,aside from antitussives,
antihistamines that will reduce the urge to cough.On dry cough,avoid products with an
expectorant, which is useful only when there is only congestion; or products containing a
decongestant which may cause insomnia.

Expectorants, i.e. ammonium salts, eprazinone,guaiacol,guarenesin, ipecacuanha,

sulfogaiacoland terpin hydrate, loosen mucus by makingbronchial secretions thinner and
easier to cough.up.
Expectorants maybe found in combination withan antitussive agent, sympathomimetics,
antihistamines, and analgesics. In expectorantantitussive combinations, the antitussive
agentmay limit the frequency of cough while theprotussive agent relieves the physical
symptoms of chest discomfort.
Mucolytics, i.e. acetylcysteine, ambroxol,bromhexine, carbocisteine, cyclidrol,
erdosteine, -mesna and methyl N,5diacetyI-L-cysteinate, areagents used to reduce the
thickness of mucus.This action facilitates in coughing up mucous.These drugs are often
employed in cases wherethick, sticky bronchial secretions pose a majorproblem, i.e.
cystic fibrosis.
Some components of combination products maycause tachycardia, anxiety,
restlessness, insomniaand dry mouth. A combination of an antitussiveand an
expectorant should be avoided as much as possible. By suppressing cough, one defies
thepurpose of an expectorant In a productive cough.

Supplements

Herbal Cough Preparations

Aromatic Oils (eucalyptus, thyme, etc.), Ascorbic Acid, Bioflavonoids, Garlic, Lemon
Juice, Cider
Vinegar,Honev, Calamansi Juice

Products
Cough and Cold Preparation
Acetylcysteine
EXFLEM

Butamirate citrate
SINECOD FORTE
Carbocisteine
SOLMUX, TRIMULEX

Ambroxol
AMELEX, MEDIBRON, ZOBRIXOL

Clobutinol

Ammonium chloride

Codeine '

Bromhexine
MUCOLYPTUS

Cyclidrol
Dextrometorphan

Eprazinone
Erdosteine
Guaiacol

Oxeladin citrate
Pentoxyverine
Pholcodine

Guaifenesin
BENADRYL EXPECTORANT

Pipatezate hydrochloride

Ipecacuanha

Sodium dibunate

Lagundi
ASCOF/ASCOF FORTE

Sulfoguiacol
Terpin hydrate

Levodropropizine
Mesna
Methyl N,5-diacetyl-L-cysteinate
Noscapine

Combination Products*
DECOLSIN,MUCOBRIN
MUCOBRON D,MUCOBRON FORTE
NEO-BROMEXAN