Important drugs for cough in advanced cancer

Cough is a defense mechanism that prevents the entry of noxious materials i nto the respiratory system and clears foreign materials and excess secretio ns 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 l ife. Empiric treatment with antitussive agents is often needed. Two classes of antitussive drugs are available: (1) centrally acting: (a) opioids and (b) nonopioids; (2) peripherally acting: (a) directly and (b) indirectly. A ntitussive availability varies widely around the world. Many antitussives, such as benzonatate, codeine, hydrocodone, and dextromethorphan, were exten sively studied in the acute and chronic cough settings and showed relativel y high efficacy and safety profiles. Benzonatate, clobutinol, dihydrocodein e, hydrocodone, and levodropropizine were the only antitussives specificall y studied in cancer and advanced cancer cough. They all have shown to be ef fective and safe in recommended daily dose for cough. In advanced cancer th e patient's current medications, previous antitussive use, the availability of routes of administration, any history of drug abuse, the presence of ot her symptoms and other factors, all have a role in the selection of antitus sives for prescription. A good knowledge of the pharmacokinetics, dosage, e fficacy, and side effects of the available antitussives provides for better management.