Levodropropizine vs. dextromethorphan: Which one to recommend to your patients and why?
Reducing cough intensity and nighttime awakenings, rapid onset of action, simple dosing regimen, and good treatment tolerance—these are the properties we expect from antitussive drugs, not only in pediatrics. So which of these wins in these parameters compared to other commonly used over-the-counter antitussives?
Peripheral antitussives − a safer choice for children
Peripheral antitussives are considered a safer option in the pediatric population. However, parents often get their hands on over-the-counter central antitussives. So, what are the practical differences between the commonly used central antitussive dextromethorphan and the peripheral levodropropizine?
Dextromethorphan
- It belongs to codeine antitussives, is an agonist of opioid receptors δ, and an antagonist of N-methyl-D-aspartate (NMDA) receptors.
- Its antitussive effect is similar to codeine; the analgesic effect is very weak.
- It can be administered to children from 6 years of age.
- The recommended dosage interval is every 4 hours.
- Side effects include dizziness, drowsiness, nausea, vomiting, and hypersensitivity.
Levodropropizine
- It belongs to non-codeine antitussives and has an affinity for histamine H1 receptors and α-adrenergic receptors.
- It does not bind to β-adrenergic muscarinic receptors or opioid receptors, which results in a lower risk of side effects and better tolerance.
- In animal models, it also shows mild local anesthetic activity.
- It can be administered to children from 2 years of age.
- The recommended dosage interval is every 6 hours (3 times a day).
- Side effects are very rare (according to SPC, less than 1 in 500,000 patients).
The best tolerated antitussive
The efficacy of levodropropizine is comparable to or slightly better than other antitussives, both codeine and non-codeine types. Experiences with levodropropizine are time-proven. For example, as early as 1997, a study was conducted in Naples, Italy, comparing levodropropizine with dextromethorphan. The results showed that levodropropizine:
- showed better effect in reducing the number of nighttime awakenings;
- had a faster onset of action in terms of reducing cough intensity;
- had a lower sedative effect, with half the number of patients experiencing drowsiness compared to dextromethorphan.
Studies repeatedly documented a lower sedative effect and exclusion of effects on respiratory functions (respiratory rate, partial pressure of O2 and CO2, and hemoglobin oxygen saturation, etc.). Overall, levodropropizine has a more favorable risk-benefit ratio. For the pediatric population, the favorable dosing regimen (3 times a day) is also a considerable advantage.
(tich)
Sources:
1. Catena E., Daffonchio L. Efficacy and tolerability of levodropropizine in adult patients with non-productive cough. Comparison with dextromethorphan. Pulm Pharmacol Ther 1997; 10 (2): 89−96, doi: 10.1006/pupt.1997.0083.
2. Juřica J. Modern therapy for cough. Practical Pharmacy 2013; 9 (6): 219–224.
3. Hanousek L. Mommy, I'm not feeling well. Vašut, Prague, 2019: 60–61.
4. SPC Levopront. Available at: www.sukl.cz/modules/medication/detail.php?code=0107231&tab=texts
5. SPC Robitussin. Available at: www.sukl.cz/modules/medication/detail.php?code=0221093&tab=texts
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