•decongestant is recommended to be taken orally not topically to avoid rebound

congestion. (Symptoms of allergic rhinitis may last more than 7 days but topical
decongestant should not be used more than 3 to 4 days)
•In pregnancy, the safest drug for allergic rhinitis is cromolyn sodium.
•antihistamine as OTC given for older than 12 years old.

Cough
It is only a symptom, not a disease and the most frequent cause is the common cold.
Cough occurs due to irritation of a sensory nerve and inflammation of cough receptors in
the upper airway.
If the cough is a productive cough, it means that there is sputum. Thus, it should not be
suppressed but patient can use expectorant.
If the cough is combined with lunge inflammation, the inflammation should be treated first.
If the cause of cough is stomach acid because of GERD it should be treated with PPI.
In case of COPD or chronic bronchitis, the patient should be referred to the physician

.
Non-pharmacologic treatment for cough:
Fluids: for thinning the secretion and soothing the irritated throat (honey in hot water, or
lemon juice).
Advise the patient to avoid caffeine because it dehydrated the throat and drink plenty
amount of water when he drinks tea of coffee.

For Dry cough:

Examples of antitussives:

Dextromethorphan:
Non-narcotic
Not analgesic
Not addictive
Works centrally in the medulla to increase the cough threshold

Codeine (not OTC):

It is an opioid pain reliever used to treat mild to moderately severe pain. It is also used,
usually in combination with other medications, to reduce coughing.

Diphenhydramine:
MOA: like dextromethorphan
Is an antitussive and antihistamine, the dose for an antitussive effect is the half of dose of
an antihistamine.

Camphor and menthol

The only FDA approved as topical antitussive.
It is applied on the throat and chest from outside, then is covered by a worm cover. This
process can be repeated three times a day.
They work through stimulating cold sensory receptors.
They also can be used as a steam inhalant: 15ml in 1000ml boiled water and the vapor can
be inhaled. It is not suitable for children less than 6 years.
They can be used also topically to relieve muscle pain and pain because of insect bite.
Mentholatum Balm
(Ointment)

VapoRub (menthol) (ointment)

Menthogel (cream)
Menthol (5-10 mg) effective as antitussive in oral lozenges or compressed tablets (coolness
and local anesthetic effect)
Ex: Strepsils (menthol and eucalyptus)

For reproductive cough:

Expectorants: increase the output of thin respiratory tract fluid by helping to liquefy the
mucus
Works by irritating the gastric mucosa and stimulating secretions of the respiratory tract.
Guaifenesin: the only OTC drug approved as expectorant.
Category C in pregnancy.

Dosage regimen of Guaifenesin:

Adult: Syrup: 200-400mg Q 4 hrs
Extended-release tablet: 600-1200 my Q 12 hr

Children (6-12 yr): 100-200 mg q 4 hr

Children(2-5yr): 50-100mg q 4 hr

Guaifenesin Pectosin Syrup: BeitJala Expectorant syrup

100mg/5ml Sugar free (suitable for
diabetic)
Resyl Syrup: GSK
100mg/5ml
 X-PECT Syrup: Pharmacare
100mg/5ml

Mukigo syrup: Sama

100mg /5ml

Drinking plenty of water while taking guaifenesin may help loosen mucus or phlegm in
the lungs.

Dextromethorphan 10mg Tussin DM Syrup Perrigo

Guaifenesin 100mg

Paracetamol Dexamol Cold Caplet Decxel

Guaifenesin
Dextromethorphan

Chlorpheniramine 1mg Alcinal Syrup Rekah

Dextromethorphan 7.88mg
Guaifenesin 105mg

Oxomemazine(antihistamine) Oxacatin Syrup Taro

1.65mg
Potassium guaiacol
sulphonate 33.3mg

Triprolidine 1.25 my/5ml Pulmadrin syrup Birzeit

Pseudoephedrine 30mg/5ml Banana flavor

Histafed Syrup Trima

Triprolidine 1.25 my/5ml Pulmadrin DM syrup sugar free Birzeit

Pseudoephedrine 30mg/5ml
Dextromethorphan 10mg Tussibal Honey Syrup Jepharm

Triprolidine 1.25 my/5ml Pulmadrin expectorant Syrup Birzeit

Pseudoephedrine 30mg/5ml
Guaifenesin 100mg Tussibal expectorant Syrup Jepharm

Histafid expectorant Syrup Trima

Pulmadrin compound Syrup Birzeit

 Codeine (control) Tussibal CO Syrup Jepharm
Pseudoephedrine

Triprolidine

Dextromethorphan Tussophedrine Syrup Trima

Ephedrine

Guaiacol sulphonate

Safety and efficacy of pseudoephedrine is not established for less than 2years old

Promethazine Prothiazine Syrup CTS

Promethazine Prothiazine Syrup CTS

Guaifenesin expectorant

------------------------------------

Mucolytic agents: breaks down the mucus that present in the lung

Acetylcysteine (and its metabolic byproduct cysteine) exerts its mucolytic action through its
free sulfhydryl group, which reduces the disulfide bonds in the mucus matrix and lowers
mucus viscosity.

N- Rheunac Effervescent tablet: It can be taken in various

acetylcysteine 200mg ways, including by mouth, by
(NAC) IV, and by inhalation.
Siran Effervescent tablet:
200mg It is most commonly taken by
mouth in doses of 600-1200
Reolin Effervescent tablet:
mg daily.
200mg

Restoux Nac Effervescent tablet:

200mg

Bio-solve Cap: 600mg

NAC, is better to be taken on an empty stomach because the absorption of amino acids can
be affected by the food and other amino acids.
Safe in pregnancy.

Off-Label use: N-acetyl-cysteine (NAC), a derivative of amino acid L-cysteine, is currently

used mainly as an antioxidant. NAC also contributes to glutathione (GSH) synthesis and may
help restore the depleted pool of GSH often caused by oxidative stress and inflammation.
(Increased pathological ROS generation leads to sperm dysfunction (lipid peroxidation),
decreased semen quality and sperm DNA damage)

NAC oral supplementation may improve sperm parameters and motility and
oxidative/antioxidant status in infertile males.
------------------------
Bromhexine
The active metabolite for it is Ambroxol

Bromhexine Biosolvon (Brand) Oral liquid: 8mg/5ml Boehringer

Ingelheim
Tablet: 8mg

Solvex Tab:8mg Teva

Mucocare Tab: 8mg Pharmacare

Elixir: 4mg/5ml

Movex Tab: 8mg Vitamed

This medicine is generally considered safe during pregnancy.

Ambroxol Mucosolvan Syrup:30mg/5ml Boehringer

(Brand) cap: 75mg Ingelheim

Muzil Syrup: 30mg/5ml Beit jala Sugar free

Ambrocare Syrup: 15,30mg/5ml Pharmacare sugar free

AMBROXOL is a Category C pregnancy drug and is not recommended for pregnant women
especially in the first 3 months.

Carbocisteine

Carbocisteine Mucodyne (Brand) Cap:375mg Sanofi

 Mucolit cap: 375mg CTS

syrup: 250mg/4ml

oral drops:
75mg/ml

Muco-treat Syrup:250mg/5ml Tree of life

Mical Tab: 375 Meditec

For adult: two 375mg cap taken for 3 times a day. When symptoms are improved, take one
cap 4 times a day.

Syrup: 15ml 3 times a day. When symptoms are improved, take 10ml 3 times a day.

Carbocisteine is not generally recommended when pregnant. This is because there is very
little information to say whether it is safe.

—————

Herbal cough drugs:

Apipol white marshmallow root + Sooth cough and reduce throat irritation
honey For dry cough
1-3 years: 2.5ml 3 times after a meal
3-12years: 5ml 3 times daily after meal
Above 12: 5ml 3-5 times after a meal
Not used for diabetic patient
Safe in pregnancy

Prospan Dry Ivy leaves extract For chronic inflammatory bronchial

conditions and productive coughs due to
its actions as an expectorant.

Can be used for diabetic patients

(Sugar-free)
2-6 yr: 2.5ml 2 times daily
6-12yr: 5ml 2 times daily
Adult: 5ml 3 times daily
 Safe in pregnancy

Cofspan Dry ivy leaves extract Jerusalem

Pikta Thyme syrup

Pikta forte

Restoux Adult syrup: Herbal syrup Safe in pregnancy

with zinc

Baby syrup: 3-36 months

Throat spray

Lichensed Bimbi Safe in pregnancy

Adult

Thymoli syrup Thyme extract

For pregnant women:

For reproductive cough
Hydration
Mentholatum nebulization
If not effective  NAC, Bromhexine and Ambroxol (safe for pregnant)
If not effective  Guaifenesin (category C)

For dry cough

Dextromethorphan and codeine can be safely used
Not high dose, not for longer period, not near delivery  because of respiratory depression
---------------------------------------------------------------------------------------------------------------------