Purpose: Cough is a common symptom in advanced cancer. The use of hydrocodone as an antitussive has not been studied previously in this setting. This study evaluates hydrocodone for cough in advanced cancer.

Methods: The results presented are from a phase II study with dose titration.

Setting: Palliative medicine program in a tertiary referral center.

Patients: 25 consecutive patients with cough from irreversible causes, on a stable opioid regimen for the prior 24 hours, and no previous or current use of hydrocodone for cough.

Intervention: 5 mg hydrocodone was administered twice daily. The dose was then titrated daily (maximum: 60 mg/24 h), if needed, until a ³ 50 percent improvement of the frequency of cough was achieved and then maintained for three consecutive days.

Measurements: Cough severity, frequency, complications, and hydrocodone side effects.

Results: 20 persons (10 women and 10 men) completed study evaluation. Median age was 63 years (range: 42-82). Nine patients had lung cancer and seven had lung or pleura metastases; 19 patients had at least 50 percent improvement of their cough frequency. The median best response was 70 percent improvement in the cough frequency (range: 50-90 percent). Median hydrocodone dose associated with the best response was 10 mg/day (range: 5-30 mg/day). Cough severity, frequency, associated symptoms and complications, and activities of daily living improved significantly. Side effects of hydrocodone (dry mouth, nausea, and drowsiness) were tolerable and rated as mild.

Conclusions: Hydrocodone is effective and safe to treat cough in advanced cancer. A starting dose of 10 mg per day in divided doses seems effective. Dose escalation may be required. Most improved within one day.

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A phase II study of hydrocodone for cough in advanced cancer