Noscapine

Usage

Noscapine is primarily prescribed for the symptomatic relief of dry, non-productive cough. It belongs to the pharmacological class of antitussives. Its mechanism of action involves suppressing the cough reflex by acting centrally on the cough center in the medulla oblongata, possibly via sigma receptor agonism. It does not possess analgesic (pain-relieving) properties like other opium alkaloids. Noscapine is currently under investigation for potential anticancer properties.

Alternate Names

• Narcotine (older, less common name)
• Noscapine hydrochloride (salt form commonly used in medications)
• Brand names vary by region and include: Coskap -N, Tuxyne, Coscopin Paed Syrup, Cophedrin, Xecouf, Drumcof, Nosthyl, Noscaphene, Cofa, Nospin (India); Asthphyllin, Capval, Demotussil, Longatin, Mercotin, Nipaxon, Noscaflex, Noscapina, Noskapin Aco, Sekiel, Tossamin, Coflin, Hoestdrank Noscapine Hcl, Nosca Mereprine, Noscaflex, Noscapine Hcl Katwijk, Noscapine Hcl Kring, Noscapine Hcl Pch, Noscapine Hcl Ratiopharm, Noscapine Hcl San, Noscapine Hcl Sandoz, Noskapin Dak, Noskapin, Roter Noscapect, Tuscalman Berna, Tuscalman, Tuscalman, Tussanil-N, Nitepax (International).

How It Works

Pharmacodynamics: Noscapine acts centrally on the cough center in the medulla oblongata of the brainstem, suppressing the cough reflex. It is thought to primarily act as a sigma receptor agonist, although the precise mechanism is not fully elucidated. Unlike opioid antitussives, Noscapine does not cause respiratory depression or have addictive potential at therapeutic doses. It may also have mild bronchodilatory and anti-inflammatory effects.

Pharmacokinetics: Noscapine is readily absorbed orally. The bioavailability is approximately 30% and can vary among individuals. It is metabolized in the liver and excreted primarily in the urine. The plasma half-life is about 2.6 to 4.5 hours.

Dosage

Standard Dosage

Adults:

• Oral: 15-30 mg every 4-6 hours, not to exceed 120 mg in 24 hours (syrup); 1-2 tablets every 4-6 hours, not to exceed 10 tablets in 24 hours (tablets).

Children:

• Pediatric dosing should be carefully determined based on the child’s age and weight.
• Consult specific product labeling or pediatric dosage guidelines for accurate recommendations.
• General guidelines (require confirmation with local guidelines):
  • 2-6 years: 3.75-7.5 mg every 4-6 hours, not to exceed 45 mg in 24 hours.
  • 6-12 years: 7.5-15 mg every 4-6 hours, not to exceed 90 mg in 24 hours.
  • 13-18 years: up to 25 mg three times daily.
• Noscapine is contraindicated in children under 2 years of age unless specifically directed by a physician.

Special Cases:

• Elderly Patients: Reduce dosage due to potential age-related decline in renal and hepatic function.
• Patients with Renal Impairment: Dosage reduction may be necessary.
• Patients with Hepatic Dysfunction: Dosage adjustment may be required.
• Patients with Comorbid Conditions: Exercise caution in patients with respiratory conditions like asthma and emphysema, cardiovascular disease, hypertension, hyperthyroidism, diabetes, glaucoma, and prostate problems.

Clinical Use Cases

Noscapine’s clinical use is primarily limited to the symptomatic relief of dry cough. It is not indicated for use in the scenarios you listed (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations).

Dosage Adjustments

Dosage adjustments are necessary for elderly patients and those with renal or hepatic impairment. Consider drug interactions (especially with CNS depressants and warfarin) when determining the appropriate dose.

Side Effects

Common Side Effects:

• Nausea
• Vomiting
• Headache
• Dizziness
• Drowsiness
• Stomach upset
• Loss of coordination
• Constipation
• Skin rash/itching
• Blurred vision

Rare but Serious Side Effects:

• Allergic reactions (rash, itching, swelling, severe dizziness, difficulty breathing)
• Hallucinations
• Loss of sexual drive
• Swelling of the prostate
• Loss of appetite
• Dilated pupils

Long-Term Effects:

Long-term effects are generally not observed with Noscapine as it’s used for short-term symptomatic relief.

Adverse Drug Reactions (ADR):

Significant ADRs are rare but can include severe allergic reactions and other serious side effects mentioned above.

Contraindications

• Hypersensitivity to Noscapine
• Pregnancy (Category X)
• Use with caution during breastfeeding (potential for excretion in breast milk)
• Severe liver or kidney disease
• Productive cough with significant phlegm/mucus
• Children under 2 years of age (unless directed by a physician)

Drug Interactions

• CNS depressants: Noscapine can enhance the sedative effects of alcohol, benzodiazepines, and certain antidepressants.
• Warfarin: Noscapine may potentiate the anticoagulant effect of warfarin, leading to increased INR and bleeding risk.
• MAOIs: Avoid concomitant use due to potential for unknown and potentially fatal interactions.

Pregnancy and Breastfeeding

• Pregnancy: Contraindicated (Category X). Potential for fetal risk and teratogenicity.
• Breastfeeding: Use with caution. Noscapine is excreted in breast milk, though the effect on the infant is not well established.

Drug Profile Summary

• Mechanism of Action: Centrally acting antitussive, likely via sigma receptor agonism.
• Side Effects: Nausea, vomiting, headache, dizziness, drowsiness, stomach upset. Rarely, allergic reactions, hallucinations.
• Contraindications: Hypersensitivity, pregnancy, severe liver/kidney disease.
• Drug Interactions: CNS depressants, warfarin, MAOIs.
• Pregnancy & Breastfeeding: Contraindicated in pregnancy, use with caution during breastfeeding.
• Dosage: Adults: 15-30 mg every 4-6 hours; Children: dose adjusted by age/weight (see detailed section).
• Monitoring Parameters: Monitor cough frequency and severity, INR if co-administered with warfarin.

Popular Combinations

Noscapine is sometimes combined with other ingredients in cough syrups, such as:

• Chlorpheniramine: An antihistamine to relieve associated allergy symptoms.
• Ammonium chloride and Sodium citrate: Expectorants and mucolytics to help thin and loosen mucus.
• Decongestants: To relieve nasal congestion.

Precautions

• Assess for allergies, pre-existing medical conditions (especially renal/hepatic impairment, respiratory conditions).
• Avoid alcohol during treatment.
• Caution when driving or operating machinery due to potential drowsiness.
• Monitor INR closely if using concomitantly with warfarin.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Noscapine?

A: Adults: 15-30 mg orally every 4-6 hours (max 120 mg/day syrup, 10 tablets/day tablets). Children: dose adjusted by age/weight (see detailed Dosage section).

Q2: How does Noscapine work to suppress cough?

A: It acts centrally on the cough center in the brain, possibly via sigma receptor agonism.

Q3: Is Noscapine addictive?

A: Unlike opioid antitussives, Noscapine does not have addictive potential at therapeutic doses.

Q4: Can Noscapine be used for a productive cough?

A: No, it is specifically indicated for dry, non-productive cough.

Q5: Can I take Noscapine if I am pregnant or breastfeeding?

A: It is contraindicated during pregnancy. Use with caution during breastfeeding as it may be excreted in breast milk. Consult your doctor.

Q6: What are the common side effects of Noscapine?

A: Nausea, vomiting, headache, dizziness, drowsiness, and stomach upset.

Q7: Does Noscapine interact with other medications?

A: Yes, it can interact with CNS depressants (like alcohol), warfarin, and MAOIs.

Q8: Are there any special precautions for elderly patients?

A: Yes, dosage reduction may be needed due to decreased renal and hepatic function.

Q9: Can Noscapine be used in children?

A: Yes, but the dosage must be adjusted based on age and weight. Contraindicated in children under 2 years unless prescribed by a doctor.

Q10: What should I do if my cough doesn’t improve after taking Noscapine?

A: Consult a doctor if your cough persists or worsens after a few days of treatment.