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Old School Cough Management


“I can’t stop coughing,” said the hacking patient. “I’ve tried Robitussin and Triaminic [hack hack]. They don’t help.”
“I also saw my doctor [hack hack] and got a prescription for Tessalon. That didn’t help either [hack].”
“I went back to my doctor and got a prescription for Cheratussin with codeine. That [hack] helped a little, but I’m out [hack hack]. I’m coughing so hard that I can’t sleep. Is there something [hack] stronger you can give me?”

You’re in luck. Several studies have shown that nebulized lidocaine helps to control intractable coughing. Let’s get you started on a treatment.

Three mls of a 1% solution of lidocaine via nebulizer usually works well. Sometimes I’ll even add 1 ml of 0.5% bupivicaine to the solution to extend the duration of its effect.

After about 10 minutes, the symptoms were gone. Success!

“Well, aren’t you going to give me something for home?”
“We can give you a little more Cheratussin with codeine, although I don’t prescribe that too often.”
“I don’t want that. I already told you it didn’t help.”
“I’m assuming you don’t want Tessalon, either.”
“That doesn’t work on me.”
“Honey is shown to improve coughs in kids. You can try that.”
Then he pounds his fist on the counter.
“Jesus! Don’t you people give Dilaudid for coughs any more?”

Nope. No we don’t. Ricola drops. Those help, too.


  1. Haha. Haven’t heard that one yet. Mostly it’s a similar conversation culminating in a request for tussionex

  2. Try some mag citrate. Guaranteed to suppress any cough.

  3. Welcome back. You were thoroughly missed.

    I read this post in a hurry, waiting for the part where you prescribed a laxative and the patient stopped coughing like magic.

    Wish I’d heard of the lidocaine trick, though. Last month I coughed so much that I cracked my ribs. Currently living in terror of sneezes, hiccups, and jokes that could lead to guffaws.

  4. WC
    Last year at Christmas, everyone got the flu but me. Spouse was prescribed a codeine cough medicine : 1t every 12 hours. Since he’s a man, who cannot see because he won’t get an eye exam…ahem…he thought he read “every four hours”! When I went to find the medicine that should have been left, there was none! He was a miserable schmuck because he was going through withdrawals!!! He didn’t believe me until I showed him the bottle with the RX! I served up a nice plate of crow!😎

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