Different antitussives:

(1) Codeine – “gold standard” of antitussive therapy; average adult dose is 15 mg every 4-6
hours. On its own codeine is C-II, but in combination with other drugs can have other control
schedules. It is a CNS depressant, not to be combined with other CNS depressants like
alcohol. Most common side effects are nausea, drowsiness, lightheadedness, and constipation;
should be taken with food to decrease upset stomach.

Codeine has the possibility for dependency, even when used at the recommended dose; however,
because of frequent misuse, stringent controls have been enacted regarding its dispensing.

In some states, codeine containing cough syrups can be purchased without a prescription, but it
must be signed for, by an adult with identification. These products can only be dispensed by the
pharmacist, because the pharmacist is required to sign their name by the patient’s signature.

(2) Diphenhydramine (Benadryl) – antitussive and antihistamine; usual adult dose 25mg every 4
hours; main side effect is drowsiness.

(3) Benzonatate (Tessalon) – used for nonproductive cough; local anesthetic on stretch receptors in
the airway, lungs, and pleura (membrane that lines the thoracic cavity); does not affect the
respiratory center; capsules should not be chewed – results are unpleasant effect with pronounced
salivation; fluid intake is encouraged to liquefy sputum; main side effects are sedation, headache,
and dizziness.

(4) Dextromethorphan (Delsym) – equivalent to codeine, without its analgesic properties, and does
not depress respiration; acts on the same receptors as codeine; nonopioid derivative of morphine;
acts on the cough center to suppress the cough reflex; average adult dose is 10-20 mg every 4 hours;
interacts with MAOIs; consumption of large quantities can cause hallucinations, “robo-tripping;”
purchasers must provide proof they are over the age of 18, because of the potential for misuse.

Expectorants
Expectorants – enable the patient to rid the lungs and airway of mucus when coughing; decreasing
the thickness and viscosity (stickiness) of mucus so a cough will eject mucus and other fluids from
the bronchi – a productive cough; also used for dry, and unproductive coughs. For a well hydrated
patient, coughing up mucus is not a problem; fluid intake and adequate humidity are important to
liquefy mucus in the respiratory tract.

Guaifenesin – OTC expectorant; available in caplet, capsule, liquid, syrup, tablet (Mucinex), and
sustained-release forms; often combined with other drugs; derived from tree bark extract; loosens
phlegm (mucus) and thins bronchial secretions, making coughs more productive; side effects
include vomiting, nausea, GI upset, and drowsiness.