Newspaper “News of Medicine and Pharmacy” 4 (402) 2012
Cough is not an independent disease, but a clinical symptom. Cough accompanies more than 100 different diseases; it can be a painful ailment, and therefore a serious problem not only for the patient, but also for the doctor.
Cough is a reflex reaction of the body, caused by irritation mainly of the mucous membrane of the respiratory tract and accompanied by involuntary forced respiratory movements. There is ongoing debate around the world about the most acceptable clinical definition of cough. In the British Thoracic Society guidelines for the management of adult cough, the working group adopted the following definition: cough is a forced expiratory maneuver, usually with the vocal cords closed, that is accompanied by a characteristic sound (AH Morice et al., 2007). The physiological significance of cough is to cleanse the respiratory tract from substances that have entered them from the outside (smoke, dust, various microorganisms, foreign bodies, etc.) and from endogenous components (particles of bronchial epithelium, mucus, etc.). Normally, due to the peristaltic movements of the small bronchi and the activity of the ciliated epithelium of the large bronchi and trachea, from 10 to 100 ml of secretion are evacuated along the tracheobronchial tree (Yu.M. Mostovoy, A.V. Demchuk, 2005). An increase in the viscosity of the secretion reduces the mobility of the cilia of the bronchial mucosa and causes a violation of their cleansing drainage function. The movement of secretions along the bronchial tree slows down, sometimes stopping altogether. The mucus plugs that form in this case, blocking the lumen of the distal bronchi, cause the development of obstructive syndrome. If the patient has bronchospasm, then obstruction occurs easier and faster and is much more severe.
Cough is classified according to a number of signs and causes of its occurrence (by nature, intensity, duration, course, etc.) (Yu.M. Mostovoy, A.V. Demchuk, 2005).
The diagnostic search for a patient with a cough depends primarily on whether the cough occurs acutely or exists for a long time and how treatable it is (RS Irwin, 2010). In cases of acute respiratory infection affecting both the upper and lower respiratory tract, especially during epidemics, the cause of the cough is usually not in doubt. If necessary, the diagnosis is clarified by consultation with an ENT doctor and confirmed by the effectiveness of the therapy or X-ray studies performed (M.A. Ryabova, 2010).
Acute cough is the most common symptom in primary care physician practice and is most often associated with viral infections of the upper respiratory tract. In the absence of significant concomitant pathology, acute cough, as a rule, has a benign course and resolves spontaneously. In the UK, the cost of acute cough is at least £979 million, of which £875 million is lost due to lost productivity and £104 million is spent on medical care and over-the-counter medicines. It has been established that in the United States, due to the common cold (excluding influenza-like respiratory tract infections), 25,000 million USD are lost, of which 16,600 million are lost due to decreased labor productivity, 8,000 million due to absenteeism and 230 million due to absence from work due to the need to care for the sick (A.H. Maurice et al., 2007).
Clinically significant upper respiratory tract infections (URTIs) occur with a frequency of 2–5 episodes per adult per year and 7–10 episodes per school-age child per year. If we take 2 episodes per year per adult as the minimum incidence of URTI, this equates to 120 million URTI episodes per year in the UK.
Sales of over-the-counter cough medicines in the UK amounted to £96.5 million in 2001. This figure is an underestimate because it does not take into account sales outside the pharmacy chain. With cough medicines costing an average of £3–4 per pack in the UK, this equates to at least 24 million episodes per year.
As a rule, difficulties arise when recognizing a chronic, especially uncorrectable cough. In patients with an unclear cause of cough, a thorough analysis of its features is necessary, which sometimes helps to establish its etiology. In many cases, the cause of cough can be determined by studying anamnesis, laboratory and instrumental studies.
Chronic cough has a variety of effects on your overall health. Assessing general health status is a necessary part of the evaluation of a patient with chronic cough, both in clinical practice and in research.
The Leicester Cough Questionnaire is a well-validated cough-specific quality of life questionnaire that can be used to assess the long-term impact of chronic cough.
Observational studies have shown a significant predominance of women among patients with chronic cough. In women with a cough, the sensitivity of the cough reflex is increased. Smoking is one of the most common causes of persistent cough, which appears to be dose-dependent. Patients often note that the nature of their cough changes after quitting smoking. The prevalence of chronic cough is higher in smokers (Yu.I. Feshchenko, 2009). A case-control study involving almost 2 thousand people showed a significant predominance of chronic cough in smokers. Quitting smoking leads to a short-term increase in the sensitivity of the cough reflex (A.H. Maurice et al., 2007).
According to consensus, questioning a patient with a cough should necessarily cover certain points. You can recommend that the patient fill out an anamnesis questionnaire.
To choose the right cough treatment tactics, it is important to determine its cause. The approach to cough treatment depends on the diagnosis. In cases where the cough is so intense that it significantly interferes with the quality of life, its symptomatic treatment is indicated (A.V. Babushkina, 2010). The decision to prescribe antitussive drugs should be justified by the presence of a painful cough that causes significant physical and psychological discomfort in the patient. The choice of an antitussive drug (S.A. Rachina, S.N. Kozlov, 2006) should be made individually, taking into account the mechanism of action, antitussive activity of the drug, the risk of side effects, the presence of concomitant pathologies, and possible contraindications. Indications for the use of antitussive drugs are clinical conditions in which there is an obsessive, debilitating cough, leading to disturbances in sleep, appetite, and sometimes even vomiting (painful, debilitating cough) (A.V. Volkov, 2009). Consequently, the rational choice of antitussive therapy is always based on a good knowledge of the mechanisms of action of drugs (A. Belov, 2009).
Since cough is a reflex (N.V. Shartanova, 2009), then, like any reflex, it has a reflex arc: a receptor link, a cough center, nerve fibers that transmit information, and an executive link - the respiratory muscles. Cough is suppressed most effectively at two levels - the receptor level and at the level of the cough center. In this regard, antitussive drugs are divided into two groups - central and peripheral action. In cases of non-productive cough, the use of cough suppressant medications is indicated. In mild cases of dry cough, resorption of special lozenges and infusions of antitussive herbs, as well as acupressure, are effective. For severe non-productive cough, especially painful (in cancer patients, with pleural pathology, at the onset of influenza), antitussive drugs are used. According to the mechanism of action, they are divided into drugs of central narcotic and non-narcotic action, causing inhibition of the cough center, and peripheral action, reducing the sensitivity of cough receptors (local anesthetics, drugs of combined action and drugs that suppress the release of neuropeptides by inhibiting the conduction of nerve impulses along C-fibers). The most well-known narcotic antitussive drug is codeine (I.G. Bereznyakov, 2007). Its use, like other medications in this group, is sharply limited by addiction to them. Currently, they are prescribed mainly to cancer patients. Clearly, for the treatment of cough resulting from inflammatory diseases of the respiratory tract in adult patients and especially in pediatric patients, the most safe and effective antitussive drug should be prescribed.
An example of such a combination of safety and effectiveness is Stoptussin (manufactured by Teva), a combined antitussive and expectorant drug whose active components are butamirate citrate and guaifenesin.
Butamirate citrate is a peripherally acting antitussive substance and has a peripheral, local anesthetic effect on lung receptors, which provides an antitussive effect. Unlike opioid antitussives, it does not cause central nervous system inhibition, does not depress respiration, does not cause dependence, and also has moderate bronchodilator properties. Stoptussin is approved for use in children starting from 6 months of age. The drug does not interfere with intestinal motility, so it can be recommended for digestive problems.
Butamirate citrate is quickly and completely absorbed. 98% of it is bound by plasma proteins. Metabolized to form two main metabolites (2-phenylbutyric acid and diethylaminoethoxyethanol), which also have an antitussive effect. 90% of metabolites are excreted by the kidneys and only a small part is excreted in the feces. The biological half-life of the drug is 6 hours.
It is also suitable for patients prone to caries and patients with diabetes mellitus, since butamirate citrate does not contain glucose or sugar. There are a number of advantages of butamirate citrate over other similar agents:
— high efficiency: suppresses persistent cough, even with whooping cough, improves and facilitates breathing;
- excellent tolerability: much better tolerated than codeine-containing drugs, does not have the disadvantages of codeine;
— the antitussive effect of butamirate citrate begins after 30 minutes and lasts for 6 hours.
Guaifenesin in its action occupies an intermediate position between expectorants and mucolytic drugs. Reduces the surface tension and adhesive properties of sputum, which reduces its viscosity and facilitates evacuation from the respiratory tract. Since guaifenesin has an anxiolytic (anti-anxiety) effect, its use is most justified for painful paroxysmal coughs. After oral administration, it is quickly and easily absorbed from the gastrointestinal tract. A small amount of the drug binds to blood plasma proteins. It is excreted by the kidneys, mainly in the form of metabolites, a small amount is unchanged. The biological half-life is 1 hour.
Despite the different mechanisms of action of the above substances and apparent incompatibility, Teva managed to combine them and create an effective drug. The drug is available in several forms: Stoptussin tablets - for adults and children from 12 years of age, Stoptussin drops - for adults and children from 6 months, Stoptussin syrup - for adults and children from 3 years of age (all forms contain butamirate and guaifenesin) and Stoptussin Phyto (contains liquid extracts of thyme (Thymi herba), creeping thyme (Serpylli) and plantain (Plantaginis)), which can be recommended for adults and children from 1 year.
The high effectiveness of the drug Stoptussin was confirmed in extensive multicenter clinical studies, one of which was conducted in 1985 involving 4326 patients with ARVI, pneumonia and exacerbation of chronic respiratory diseases. A reduction in cough intensity and frequency was achieved in 94.7%.
During 2001–2002 Two multicenter, open-label, randomized, parallel-group studies were conducted. During these studies, the effectiveness of Stoptussin was determined in patients of different age groups with obsessive, debilitating cough (Fig. 4, 5).
Both studies assessed three outcomes: reduction in cough frequency, reduction in cough intensity, and improvement in sputum production. According to the research results, Stoptussin demonstrated high efficiency simultaneously in all three assessed indicators, thereby proving the complexity and effectiveness of its action against obsessive cough. The safety of Stoptussin was also assessed, which in both studies was more than 95%.
Another form of Stoptussin - Phyto syrup - contains liquid extracts of thyme (Thymi herba), creeping thyme (Serpylli) and plantain (Plantaginis) and can be used in the treatment of adults and children from one year of age. The drug has a mucolytic, secretomotor, antitussive and anti-inflammatory effect, acting on the surface of the mucous membranes of the respiratory tract, reducing the viscosity of sputum, thereby separating it from the walls of the mucous membrane and modulating cough.
The effectiveness of the use of Stoptussin Phyto syrup in the treatment of acute respiratory infections and acute respiratory viral infections was demonstrated in an open controlled study in laboratory and outpatient conditions in children aged 1.5 to 15 years (n = 52) (T.L. Kiseleva, T.A. Mironenko, T.V. Urzhumova, G.S. Kozina, O.A. Afanasyeva, Institute of Traditional Medicine and Homeopathy, Ministry of Health of the Russian Federation, 2001). Based on the results of the study, it was concluded that Stoptussin Phyto syrup is effective for dry coughs and coughs with sputum and can reduce the duration of the disease by an average of 30%.
The experience of combined use of the drugs Stoptussin Phyto and Stoptussin drops in children with ARVI is interesting. At the same time, Stoptussin Phyto was prescribed 3 times a day in an age-appropriate dosage and Stoptussin drops - in an appropriate age-specific dosage at night for 12 days (Yu.M. Mostovoy, A.V. Demchuk, 2005).
Thus, Stoptussin effectively achieves two treatment goals: it reduces the frequency and intensity of cough - it removes “extra” or “empty” cough shocks (which do not contribute to the evacuation of sputum, but only interfere with the patient) and improves the discharge of sputum.
In all studies, Stoptussin was prescribed to patients at the very beginning of the disease, when the cough was extremely dry and debilitating.
In rare cases (about 4%), patients may experience side effects - dyspeptic disorders (nausea, vomiting, diarrhea, stomach pain), dizziness, headache, drowsiness, urticaria and skin rash, which indicates the safety of the drug.
conclusions
1. Stoptussin is most effective for obsessive, debilitating cough.
2. The best effect is achieved in the initial stages of acute respiratory infections and acute respiratory viral infections.
3. By reducing the frequency and intensity of cough impulses, it does not inhibit the process of formation and discharge of sputum.
4. Has an equivalent effect in equivalent doses in different forms of release.
5. Stoptussin in the form of drops can be used in the treatment of children from 6 months of age.
6. Relieves the feeling of fear during prolonged paroxysmal cough due to the anti-anxiety effect of one of the components of the drug.
7. Has a minimal frequency of side effects and reactions.
8. The use of Stoptussin in the complex therapy of diseases of the respiratory system, accompanied by an obsessive cough, can help improve the effectiveness and safety of therapy for the underlying disease.
Compound
1 tablet contains the active substances guaifenesin and butamirate citrate in volumes of 100 mg and 4 mg, respectively; excipients are also present: colloidal silicon dioxide , glyceryl tribehenate , mannitol , magnesium stearate, MCC.
1 ml of Stoptussin drops contains the active substances guaifenesin and butamirate citrate in volumes of 100 mg and 4 mg, respectively; excipients: 96% ethanol - 0.3 g, purified water - 0.007 g, floral flavor (alpine flowers) - 0.002 g, liquid licorice extract - 0.003 g, polysorbate 80 - 0.001 g, propylene glycol - up to 1 ml.
Analogs
Level 4 ATX code matches:
Cashnol
Anise oil
Bronchophyte
Pine buds
Pertussin
Bronchosan
Gedelix
Mixture for inhalation
Herbion ivy syrup
Herbion plantain syrup
Herbion primrose syrup
Mukaltin
Sinupret Forte
Dr. Theiss syrup with plantain
Bronchosept
Joset
Thermopsol
Tussamag
Marshmallow syrup
Dry cough syrup
An analogue of Stoptussin is the drug Stresam , which contains the same substances. However, the price of this drug is 3-4 times higher than the price of Stoptussin, which makes medicine from the Czech Republic more preferable.
Reviews for Stoptussin
The summary of the drug is that if we talk about reviews of the tablets, they are very positive, and everyone recommends them. Moreover, many even prefer them to drops. Regarding how many days you can take Stoptussin, many talked about the immediate effect and that after a few days of using the medicine, the cough had already gone away completely.
If we talk about reviews of Stoptussin-Fito, they are not clear-cut. Of course, many users have stated that the medicine is excellent for children and has a very good expectorant effect. But there were also those who stated that the syrup had no effect.
Instructions for use of Stoptussin (Method and dosage)
The tablets are taken orally and washed down with water without chewing. The dosage depends on the patient's weight. If weight is less than 50 kg, then half a tablet. A whole tablet if the weight is from 50 to 70 kg and 1.5 tablets if the weight is more than 70 kg.
How to take Stoptussin drops? To do this, you need to dissolve the drops in one hundred milliliters of liquid. The dosage depends on the patient's weight. If you weigh less than 7 kg, 8 drops are enough. If the weight is more than 70 kg, then you need to dissolve 40 drops in one hundred milliliters of liquid.
The instructions for Stoptussin-Fito are very simple. For children, half a tablespoon of syrup. If an adult, then a whole tablespoon of syrup.
Stoptussin price, where to buy
The price of tablets is around 110-140 rubles for one pack of 20 tablets.
If we talk about syrup, the price for Stoptussin-Fito is 166 rubles.
Stoptussin cough drops have the best effect for children. The price for them varies from 72 rubles to 212, depending on the volume of the medicine.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- Ambrobene stoptussin cap.
for oral administration 10 mlTeva Pharmaceutical 150 rub.order - Ambrobene stoptussin cap. for oral administration 25 mlTeva Pharmaceutical
RUB 282 order
- Ambrobene stoptussin drops for oral administration 4 mg + 100 mg/ml fl. with cap. 50mlTeva Pharm. enterprises s.r.o.
RUB 365 order
Pharmacy Dialogue
- Ambrobene STOPTUSSIN (tab. 4 mg + 100 mg No. 20) Teva Operations
RUB 271 order
- Ambrobene STOPTUSSIN (bottle 25ml)Teva Czech Industries SRO
RUB 275 order
- Stoptussin PHYTO (vial 100ml)Ivax Pharmaceuticals
RUB 266 order
- Stoptussin PHYTO (bottle 100ml)Teva
RUB 287 order
- Ambrobene STOPTUSSIN (drops d.pr. orally 4mg+100mg/ml 50ml) Teva Czech Enterprises s.r.o.
RUB 377 order
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Pharmacy24
- Stoptussin Phyto 100 ml syrup TEVA Czech Industries s.r.o., Czech Republic
107 UAH.order - Stoptussin No. 20 tablets TEVA Czech Industries s.r.o., Czech Republic/TOV Teva Operations Poland, Poland
66 UAH order
- Stoptussin 100 ml syrup TEVA Czech Industries s.r.o., Czech Republic
121 UAH order
PaniPharmacy
- Stoptussin phyto liquid Stoptussin phyto syrup 100ml, Teva Czech Industries
127 UAH order
- Stoptussin liquid Stoptussin drops 10ml, Teva Czech Industries
89 UAH order
- Stoptussin liquid Stoptussin syrup 100ml, IVAX Pharmaceuticals
158 UAH order
- Stoptussin tablets Stoptussin tablets. No. 20, Teva Czech Industries
79 UAH order
- Stoptussin liquid Stoptussin drops 25ml, Teva Czech Industries
148 UAH order
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