Cough is a defense mechanism that prevents the entry of noxious materials into the respiratory system and clears foreign materials and excess secretions from the lungs and respiratory tract. In advanced
cancer, it is a common symptom that interferes with the patient's daily activity and quality of life. Empiric treatment with
antitussive agents is often needed. Two classes of
antitussive drugs are available: (1) centrally acting: (a)
opioids and (b) non-
opioids; (2) peripherally acting: (a) directly and (b) indirectly.
Antitussive availability varies widely around the world. Many
antitussives, such as
benzonatate,
codeine,
hydrocodone, and
dextromethorphan, were extensively studied in the acute and
chronic cough settings and showed relatively high efficacy and safety profiles.
Benzonatate,
clobutinol,
dihydrocodeine,
hydrocodone, and
levodropropizine were the only
antitussives specifically studied in
cancer and advanced
cancer cough. They all have shown to be effective and safe in recommended daily dose for
cough. In advanced
cancer the patient's current medications, previous
antitussive use, the availability of routes of administration, any history of
drug abuse, the presence of other symptoms and other factors, all have a role in the selection of
antitussives for prescription. A good knowledge of the pharmacokinetics, dosage, efficacy, and side effects of the available
antitussives provides for better management.