Antitussives, also known as cough suppressants, are medications used to relieve coughing. They work by suppressing the cough reflex in the brain. As a nurse, understanding the proper use, administration, and patient education related to antitussives is crucial for providing optimal care.
Common Antitussives
Generic names:
Dextromethorphan, Codeine, Benzonatate
Brand names:
Robitussin, Delsym, Benylin DM, Vicks 44, Tessalon Perles
Pharmacologic class:
Opioid derivatives (codeine), non-opioid antitussives (dextromethorphan, benzonatate)
Therapeutic class:
Antitussives, cough suppressants
Mechanism of Action
Antitussives suppress the cough reflex. Dextromethorphan and codeine act on the cough center in the medulla oblongata of the brain. Benzonatate anesthetizes stretch receptors in the lungs and pleura.
Indications for Use
Antitussives are used to temporarily relieve coughs caused by minor throat and bronchial irritation, such as those accompanying the common cold or inhaled irritants.
Precautions and Contraindications
- Hypersensitivity to any components of the medication
- Respiratory depression or impaired respiratory function
- Pregnancy and breastfeeding (consult healthcare provider)
- Children under four years old (for most OTC antitussives)
- Patients with chronic cough or cough associated with smoking, asthma, chronic bronchitis, or emphysema
Drug Interactions
- MAO inhibitors may increase the effects of dextromethorphan
- Alcohol and other CNS depressants may enhance sedative effects
- CYP2D6 inhibitors may increase dextromethorphan levels
- Opioid analgesics may have additive CNS and respiratory depressant effects with codeine-containing antitussives
Adverse Effects
- Drowsiness, dizziness
- Nausea, vomiting, constipation
- Dry mouth
- Headache
- Rash or itching
- Respiratory depression (with high doses or in sensitive individuals)
Administration Considerations
Available preparations:
Syrups, tablets, capsules, lozenges, and liquid-filled capsules
Dosages:
Vary depending on the specific medication and patient’s age. Always follow package instructions or healthcare provider recommendations.
Onset, Peak, and Duration:
- Onset: Usually within 15-30 minutes
- Peak: 2-3 hours
- Duration: 6-8 hours for most preparations
Nursing Considerations for Antitussives
Related Nursing Diagnoses
- Ineffective breathing pattern related to persistent cough
- Risk for injury related to dizziness or drowsiness from antitussive use
- Deficient knowledge related to the proper use of antitussives
Nursing Assessment
- Assess for allergies to antitussives or their components.
- Evaluate the type, duration, and characteristics of the cough.
- Assess respiratory rate, depth, and pattern before and after administration.
- Check for signs of respiratory depression, especially in patients taking opioid-based antitussives.
- Assess for potential drug interactions with the patient’s current medications.
Nursing Interventions
- Administer antitussives as prescribed, following proper dosing guidelines.
- Monitor the effectiveness of the medication in suppressing cough.
- Observe for adverse effects, particularly drowsiness and respiratory depression.
- Implement fall precautions for patients experiencing dizziness or drowsiness.
- Provide non-pharmacological interventions to relieve cough, such as increased fluid intake and use of a humidifier.
Patient Teaching Associated with Antitussives
- Instruct patients to take antitussives precisely as prescribed or directed on the package.
- Advise patients to use the measuring device provided with liquid preparations to ensure accurate dosing.
- Inform patients that antitussives may cause drowsiness and to avoid driving or operating machinery until they know how the medication affects them.
- Teach patients to avoid alcohol and other CNS depressants while taking antitussives.
- Instruct patients to seek medical attention if cough persists for more than 7 days, occurs with fever, rash, or persistent headache.
- Advise patients to keep antitussives out of reach of children to prevent accidental ingestion.
- Educate patients on the importance of staying hydrated and using other non-pharmacological methods to manage cough.
- Inform patients taking benzonatate to swallow capsules whole and not to chew or dissolve them in the mouth, as this can cause local anesthesia of the mouth and throat.
This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist or healthcare provider for complete information.
By understanding these nursing considerations for antitussives, healthcare professionals can ensure these medications’ safe and effective use, improving patient outcomes and symptom management.
References
- Smith, S. M., Schroeder, K., & Fahey, T. (2014). Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database of Systematic Reviews, (11). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001831.pub5/full
- Dicpinigaitis, P. V. (2019). Clinical perspective – cough: an unmet need. Current Opinion in Pharmacology, 46, 196-202.
- Bolser, D. C. (2019). Cough suppressant and pharmacologic protussive therapy: CHEST guideline and expert panel report. Chest, 155(5), 938-945.
- Malesker, M. A., Callahan-Lyon, P., Ireland, B., & Irwin, R. S. (2017). Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold: CHEST Expert Panel Report. Chest, 152(5), 1021-1037. https://journal.chestnet.org/article/S0012-3692(17)31408-3/fulltext
