Induced cough

Levopropoxyphene [2338-37-6] (42), the optical antipode of the dextrorotatory analgetic propoxyphene, is an antitussive without analgetic activity. The 2-naphthalenesulfonate salt has a less unpleasant taste than the hydrochloride salt, and is widely used. Clinical effectiveness has been demonstrated against pathological and artificially induced cough, but the potency is somewhat less than codeine. The compound is reported not to cause addiction. Levopropoxyphene can be prepared (62) by first resolving [ -dimethylamino-CX-methylpropiophenone with dibenzoyl-(+)-tartaric acid. The resolved... 

Angiotensin receptor blockers show similar tolerability to ACE inhibitors with regard to hypotension and hyperkalemia, but they do not induce cough since ARBs do not cause an accumulation of bradykinin. Angiotensin receptor blockers can be considered in patients with ACE inhibitor-induced angioedema, but they should be initiated cautiously, as crossreactivity has been reported. Many of the other considerations for the use of ARBs are similar to those of ACE inhibitors,... 

ACEIs Cough leading to SUI (ARBs do not induce cough)... 

Tenenbaum, A., et al. (2000). Intermediate, but not low, doses of aspirin can suppress angiotensin-converting enzyme inhibitor-induced cough, Am. J. Hypertens., 13, 776-782. 

Arbutin [497-76-7] (67) has been suggested as a potential antitussive (96). Both oral and intraperitoneal administration of arbutin to mice in a range of 50 to 200 mg/kg showed a concentration-dependent activity against ammonia induced cough. 

Among the long list of diverse structures reported to possess central antitussive activity is Ahtetrahydrocannabinol (THC) [1972-08-3] (68), the principal psychoactive component of marijuana (see PSYCHOPHARMACOLOGICALAGENTS). This compound was found to be comparable to codeine against electrically induced cough in the anesthetized cat (90). Two other naturally occurring cannabinoids, cannabidiol and cannabinol, are inactive. 

Noscapine resembles papaverine in its action on smooth muscle and, in large doses, induces bronchodilation in animals. It is readily absorbed from the gastrointestinal tract, but its metabolic fate is unknown. In experimentally induced cough in animals and humans, noscapine exerts an antitussive action approximately equal to that of codeine, without any of the unpleasant side effects of codeine. It is administered orally in doses of 15 to 30 mg, three or four times daily as an antitussive. 

Capsaicin causes transient bronchoconstriction and induces coughing, especially in individual with severe asthma, potentially triggering fatal crises [37]. These adverse respiratory effects are probably due to the limited capacity of respiratory tissues to metabolize capsaicin (see Section 4.3) [38], and are a major problem with the use of pepper sprays as antiriot agents [37]. Smokers are less sensitive to the respiratory effects of capsaicin, but asthmatic patients should avoid chilies and hot cuisine, as should people using drugs such as ACE-inhibitors, which have an intrinsic capacity to induce cough. 

In a multicenter controlled study in patients with hypertension and a history of ACE inhibitor-induced cough, eprosartan significantly reduced the risk of cough by 88% compared with enalapril (16). 

Conigliaro RL, Gleason PP. Losartan-induced cough after lisinopril therapy. Am J Health Syst Pharm 1999 56(9) 914-15. 

Oparil S. Eprosartan versus enalapril in hypertensive patients with angiotensin-converting enzyme inhibitor-induced cough. Curr Ther Res Clin Exp 1999 60 1-4. 

Ohya Y, Kumamoto K, Fujishima M. Effects of crossover application of sulindac and azelastine on enalapril-induced cough. J Hum Hypertens 1992 6(l) 81-2. 

Os I, Bratland B, Dahlof B, Gisholt K, Syvertsen JO, Tretli S. Female sex as an important determinant of lisino-prU-induced cough. Lancet 1992 339(8789) 372. 

Kohrogj, H., Graf, P.D., Sekizawa, K. etal. (1988). Neutral endopeptidase inhibitors potentiate substance P- and capsaicin-induced cough in awake guinea-pigs. J. Clin. Invest. 82, 2063-2068. 

Fig. 12 Antitussive effect of compound 21 (TRK-851) on capsaicin-induced coughing in rats (p.o. administration). The number of coughs over 3 min were counted in the same rats before and 60 min after p.o. administration. The ED50 value (the dose that reduced the number of coughs to 50% vs control) for the inhibition of coughing was calculated to be 35.5 pg/kg (95% confidence limits 16.8-72.9 pg/kg). Reprinted from [6] with permission from Elsevier. Copyright (2008)...

Bradykinin B2 receptor ACE inhibitors ACE inhibitor induced cough 139... 

Although cannabis was used as a bronchodilator in the nineteenth century, modern human research seems to have been limited to a brief period in the 1970s. Small controlled studies in asthmatic volunteers (Tashkin et al. 1974 Williams et al. 1976 Tashkin et al. 1977) showed that oral, smoked and aerosolised THC had significant bronchodilator activity comparable to that of salbutamol, though slower in onset. Dose-related tachycardia and intoxication occurred at higher doses. An inhaled aerosol avoided systemic absorption of THC but induced cough and chest discomfort, which limited its usefulness. 

Angiotensinogen ACE inhibitors regression of left ventricular hypertrophy, renoprotective effects, drug-induced cough Blood pressure reduction ... 

---