J Korean Med Sci.  2022 Sep;37(36):e275. 10.3346/jkms.2022.37.e275.

Effectiveness and Safety of Codeine and Levodropropizine in Patients With Chronic Cough

• Lee SP
• Lee SM
• Lee BJ
• Kang SY

• KMID: 2533230
• DOI: http://doi.org/10.3346/jkms.2022.37.e275

Abstract

Background
Recent progress in chronic cough management includes controlling cough triggers and hypersensitivity using antitussives. Therefore, we investigated the effects and safety outcomes of antitussives, codeine and levodropropizine, in patients with chronic cough.
Methods
We conducted an open-label, randomized comparative trial with newly referred patients with chronic cough. Patients were orally administered codeine (60 mg/day) and levodropropizine (180 mg/day) for 2 weeks. Cough severity, including the visual analog scale (VAS), Cough Symptom Score (CSS), Leicester Cough Questionnaire (LCQ), and safety for each treatment were assessed. The primary outcome was VAS score changes before and after 2 weeks of treatment.
Results
Among the 88 participants, 45 and 43 in the codeine and levodropropizine groups, respectively, were included in the analysis. Changes in the VAS score were higher in the codeine group than in the levodropropizine group (35.11 ± 20.74 vs. 19.77 ± 24.83, P = 0.002). Patients administered codeine also had improved CSS (2.96 ± 2.35 vs. 1.26 ± 1.89, P < 0.001) and LCQ (3.28 ± 3.36 vs. 1.61 ± 3.53, P = 0.025) than those administered levodropropizine. Treatment-related adverse events, including drowsiness, constipation, and headaches, were more frequent in the codeine group than in the levodropropizine group. However, no significant differences existed in the adverse events leading to discontinuation.
Conclusion
Codeine is an effective and generally well-tolerated antitussive for chronic cough. However, it may induce side effects in some patients. Individual responses and adverse events should be carefully monitored when codeine is used to treat chronic cough.

Keyword

Chronic Cough; Codeine; Levodropropizine Visual Analogue Scale; Safety

Figure

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  Fig. 1 Flow diagram of participant selection.

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  Fig. 2 Effectiveness to chronic cough between codeine and levodropropizine.The changes in (A) VAS, (B) CSS, and (C) LCQ scores between the two groups are presented as the mean ± standard deviation.VAS = visual analogue scale, CSS = Cough Symptom Score, LCQ = Leicester Cough Questionnaire.*P < 0.05 and **P < 0.01.

• 

  Fig. 3 Comparison of response rate to chronic cough between codeine and levodropropizine. Responses rate between the two groups was presented according to the MCID of VAS and LCQ as well as 50% improvement of CSS.MCID = minimum clinically important difference, VAS = visual analogue scale, CSS = Cough Symptom Score, LCQ = Leicester Cough Questionnaire.*P < 0.05 and **P < 0.01.

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