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 a350 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.
Donnelly S, Walsh D: The symptoms of advanced cancer. Semin Oncol. 1995; 22(2 Suppl 3): 67-72.
2.
Cooke N: Cough. In Walsh D (ed.): Symptom Control. Oxford: Blackwell Scientific, 1989: 81-88.
3.
Donnelly S, Walsh D, Rybicki L: The symptoms of advanced cancer: Identification of clinical and research priorities by assessment of prevalence and severity. J Palliative Care. 1995; 11(1): 27-32.
Morita T, Tsunoda J, Inoue S, et al.Contributing factors to physical symptoms in terminally-ill cancer patients. J Pain & Symptom Manage. 1999; 18(5): 338-346.
6.
Walsh D, Donnelly S, Rybicki L: The symptoms of advanced cancer: relationship to age gender and performance status in 1,000 patients. Supportive Care in Cancer. 2000; 8: 175-179.
7.
Krech RL, Davis J, Walsh D, et al.: Symptoms of lung cancer. Palliative Med. 1992; 6: 309-315.
8.
Braga PC: Centrally acting opioid drugs. In Braga PC, Allegra L (eds.): Cough. New York: Raven Press, 1989: 109-143.
Drug Information for the Health Care Professional. 20th Ed.Englewood, CO: Micromedex, 2000.
11.
Antitussives, expectorants and mucolytic agents. In McEvoy GK (ed.): American Hospital Formulary Service Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 2000: 2457-2474.
12.
Doona M, Walsh D: Benzonatate for opioid-resistant cough in advanced cancer. Palliative Med. 1998; 12(1): 55-58.
13.
and November-December 1998; 48(6): 329.]
14.
Homsi J, Walsh D, Nelson KA, et al.: Hydrocodone for cough in advanced cancer. American J Hospice & Palliative Care. 2000; 17(5): 342-346.
15.
Adcock JJ: Peripheral opioid receptors and the cough reflex. Respir Med. 1991; 85 (Suppl A): 43-46.
16.
Karlsson JA, Lanner AS, Persson CG: Airway opioid receptors mediate inhibition of cough and reflex bronchoconstriction in guinea pigs. J Pharmacol Exp Ther. 1990; 252(2): 863-868.
17.
Experimental and pathological cough in man—subjective and objective components. In Beecher HK (ed.): Measurement of Subjective Responses: Quantitative Effects of Drugs. New York: Oxford University Press, 1959: 399-424.
18.
Turturro MA, Paris PM, Yealy DM, et al.: Hydrocodone versus codeine in acute musculoskeletal pain. Ann Emerg Med. 1991; 20(10): 1100-1103.
19.
Sackner MA: Effects of hydrocodone bitartrate on breathing pattern of patients with chronic obstructive pulmonary disease and restrictive lung disease. Mt Sinai J Med. 1984; 51(2): 222-226.
20.
Luporini G, Barni S, Marchi E, et al.: Efficacy and safety of levodropropizine and dihydrocodeine on nonproductive cough in primary and metastatic lung cancer. Eur Respir J. 1998; 12(1): 97-101.
21.
Ruffini E: I derivati polietilenglicolici nel trattamento della tosse mediastinica in corso di malattia neoplastica. Gaz Int Med Chir. 1957; 62: 725-732.
22.
Guffanti EE: Centrally acting nonopioid drugs. In Braga PC, Allegra L (eds.): Cough. New York: Raven Press, 1989: 147-194.
