ASCORIL-D

For Dry Cough

 One of the most common symptoms for which patient seeks care-about 30
million physician visits per year.
 Recurrent cough in up to 40 percent population.
 Coughing indicates underlying disease or disorder.
 Major Health concern

 Dry cough at night is associated with poor quality of sleep / life

 Productive cough associated with Post nasal drip often leads to complications or LRTIs

Shadkam MN. J Alt Com Med 2010;16(7): 787-793

 Cough
 Sudden noisy expulsion of air from the lungs
 Cough could be Dry or Productive
 Dry cough is without expectoration.
 Cough
 Productive cough is with Expectoration of mucus
from the bronchi.

 Reflex cough - may be produced by disease of

the ear or irritation from stomach disorder.
 Mechanism of Cough
 It is a protective reflex which serves to remove the
blockage by producing a churning action which assists
in the upward propulsion of particles from smaller
Bronchioles and Alveoli.
 Cough reflex is so powerful that a single cough can
theoretically expel a lead bullet placed in the bronchi.
 Mechanism of Cough
 Initial act in coughing is deep inspiration followed by
reflex closure of glottis (Upper end of larynx).

 There is resultant in intra-throracic pressure, which

in turn produces a forced expiratory effort and whole
respiratory airway may be markedly compressed.
 Mechanism of Cough
 At this stage glottis suddenly opens and air is forced
through constricted trachea at a speed of about 760
miles/hour.

 Strong expiration leads to stronger succeeding

inspiration thus a vicious cycle is produced, leading
to a bout of coughing.
 Mechanism of Cough
Cough reflex consist of 3 components
 Afferent or Sensory nerves.
 Cough Centre situated in Medulla Oblongata &
 Efferent or Motor nerves.
 Mechanism of Cough
CNS
Sensory/Afferent Motor/Efferent
Receptors Receptors
Cerebral


Pharynx
Cortex


Larynx


Trachea


Bronchi


Bronichioles


Pleura


Alveoli


Diaphragm
Cough centre Respiratory


Pericardium
in medulla muscles


External auditory
oblongata Cough
meatus (Ear) Irritation Stimulates
Glottis
 Common Causes of Cough
A. Inflammatory disorders
 Viral URTI  Bronchiectasis
 Allergic Rhinitis  Aspiration (of gastric contents)
 Sinusitis  Diffuse Pulmonary Interstital
 Asthma Fibrosis
 Pneumonia (bacterial,  Neoplasms
viral)
 Common Causes of
Cough
B. Chemical Irritants

 Tobacco smoke, other smoky products

 Sulphur-dioxide & others
 Capsaicin (from all capsicum peppers)
 Metabisulfites
 Common Causes
of Cough
C. Mechanical Stimulants
 Foreign Body Aspiration
 Substernal Thyroid
 Mediastinal Fibrosis
 Irritation of External Auditory Canal

D. Thermal Irritants
 Very Hot Air or Very Cold Air
 Common Causes of Cough
Other causes-
Congestive Cardiac Failure
Drugs like ACE inhibitors, beta blockers.
Drug induced hypersensitivity, pneumonitis or pleuritis
(NSAID, nitrofurantoin, others).
 Basic Principles of
Treatment of Cough
 Removal of Cause
 Symptomatic
 Treatment of Cough
Removal of Cause
 Definitive treatment depends on determinig its
precise cause and then initiating specific therapy
 Smoking cessation, antibiotic therapy for specific
bacterial infection or by eliminating
gastroesophageal reflux.
 Treatment of Cough
Symptomatic
Symptomatic or non specific therapy should be considered
when :
 Cause is not known.
 Specific treatment is not possible.
 Cough performs no useful function.
 Represents a potential hazard or causes marked discomfort.
 Treatment of Cough
Symptomatic
 An irritative, (non-productive cough) may be
suppressed by an antitussive agent, which
the latency or threshold of the cough centre
 Treatment of Cough
Symptomatic
 Productive cough with significant quantities of
sputum should usually not be suppressed since
retention of sputum in the tracheobronchiole tree
may interfere with ventilation, alveolar aeration
and ability of lung to resist infection.
 Drugs Used for
Treatment of Cough
A. Demulcents
 When cough arises above larynx,
 Syrups and lozenges that coat pharynx forming a
soothing film over a mucous membrane, relieving
minor pain and inflammation eg. Linctus.
 Drugs Used for
Treatment of Cough
B. Antitussives
 Drugs that act on pathways of cough reflex
in medulla eg. Dextromethorphan.

C. Mucolytics and Expectorants

 Drugs Used for Treatment
of Cough
D. Decongestants
 Many times cough is associated with nasal
congestion and stuffiness.
 In such cases decongestant like pseudoephedrine or
phenylpropanolamine is added.
Drugs Used for Treatment
of Cough
E. Antihistamines
 Antihistamine find place in cough therapy to take
care of allergic symptoms associated with cough
eg. Triprolidine, Chlorpheniramine Maleate.
F. Bronchodilators eg. Salbutamol, Terbutaline.
 Ascoril-D Cough Syrup
Composition
Each 5 ml contains
Dextromethorphan HBr U.S.P. 10 mg
Phenylephrine HCl B.P. 5 mg
Triprolidine HCl B.P. 1.25 mg
Mentholated syrup base q.s

Flavour
Raspberry Flavour
 Pharmacology
Dextromethorphan
 Is a cough suppressant which has central action on
cough centre in medulla.
 Acts within half an hour of administration by mouth
and exerts effect for upto 6 hours.
 Rapidly absorbed from G.I. tract.
 Pharmacology
Dextromethorphan
 Metabolised in liver, excreted in urine as unchanged
Dextromethorphan and demethylated metabolites
including dextrorphan which has cough suppressant
activities.
 Adverse effects are rare & may include dizziness,
GI disturbances.
 Pharmacology
Dextromethorphan v/s Levodropropizine
 Pharmacology
Nasal Decongestants
 Belong to the pharmacological class of
sympathomimetic amines.
 Decongestant stimulates alpha-adrenergic receptor as
an agonist, by constriction of blood vessels, reducing
its supply to the nose, decrease the amount of blood
in sinusoid vessels & decrease mucosal edema.
 Pharmacology
Phenylephrine Hydrochloride

 Is an alpha 1 adrenergic receptor agonist used

primarily as a decongestant
 Marketed as a substitute for pseudoephedrine
& Phenylpropanolamine
 Pharmacology
Phenylephrine Hydrochloride
 Phenylephrine is a direct selective α1-adrenergic receptor agonist, it
does not cause release of endogenous noradrenaline, as
pseudoephedrine does. Therefore, phenylephrine is less likely to
cause side-effects such as CNS stimulation, insomnia , anxiety,
irritability, & restlessness.
 Is extensively metabolised by MAO ( monoamine oxidase), an
enzyme present in G.I tract & liver.
 Pharmacology
Mode of Action : Phenylephrine Hydrochloride
Less action on Phenylephrine Hydrochloride stimulates (agonist)

CNS compared
to ephedrine

Alpha 1 adrenergic receptors with weak Beta-adrenergic activity

Vasoconstriction

Acts as Nasal Decongestant

 Pharmacology
Allergy
 Is an abnormal reaction to an ordinarily
harmless substance.
 Is a state of abnormal sensitivity to foreign
material - called an allergen in susceptible
individuals.
Allergens
 Dust
Nasal Allergy
 Smoke
 Pollution Stage 1 Stage 2
 Grass Allergen antibody
 Weeds IgE
 Moulds
 Dander
 Feather
Degranulation
 Pollen grains

Histamine Release
MAST CELLS

Acts on H1 receptors
(Nose / Eyes / Throat)
 Symptoms
Histamine

BLOCKS
Anti -Histamines H 1 Receptors
(Nose / Throat / Eyes)
 Swelling (oedema)  Itching
 Inflammation
 Swelling
 Rhinitis
 Lacrimation
 Rhinorrhoea

 Sneezing  Photophobia

 Itching  Conjunctivitis
 Antihistamines
First-generation antihistamines (reserved for those patients not controlled
with Second-generation antihistamines)

Ethanolamines (diphenhydramine, clemastine),

hydroxyzine,

Chlorpheniramine and dexchlorpheniramine,

Piperidines (cyproheptadine, azatadine and ketotifen)

Triprolidine
Second-generation
antihistamines Metabolite
Cetrizine Levocetirizine
Terfenadine Fexofenadine
Loratadine Desloratadine
Rupatadine
21 Jauregui I et al. J Investig Allergol Clin Immunol 2007; 17 (Suppl 2): 41-52.
 Pharmacology
Triprolidine
 Is a histamine H1 receptor antagonist.
 After absorption from G.I. Tract, is metabolised.
 A carboxylated derivative accounts for about half
the dose excreted in urine.
 May cause drowsiness, G.I. disturbances and
headache.
 Pharmacology
Menthol
 Is a universally preferred medication used
for soothing and counter-irritant effects on
upper respiratory mucosa.
 Ascoril-D Cough Syrup
Composition
Each 5 ml contains
Dextromethorphan HBr U.S.P. 10 mg
Phenylephrine HCl B.P. 5 mg
Triprolidine HCl B.P. 1.25 mg
Mentholated syrup base q.s

Flavour
Raspberry Flavour
 Indications

 Dry or non-productive cough, cough associated

with viral or bacterial inflammation of URT,
sinusitis, laryngitis, tracheitis and pharyngitis
 Dosage &
Administration
 Adults and children over 12 years:
10 ml 3 times daily.

 Children under 12 years

6 - 12 years : 5 ml 3 times daily
2 - 5 years : 2.5 ml 3 times daily
 Contraindications
 Hypersensitivity.
 In severe hypertension or severe CAD, patients
on MAO inhibitors.
 Cough associated with asthma & with excessive
secretion & patients with respiratory failure.
 Precautions
 May cause drowsiness and impair performance
in tests of auditory vigilance.
 Patients should not drive or operate machinery
until they have determined their own response.
 Drug Interactions
 Concomitant use with sympathomimetic agents
such as tricyclic antidepressants, appetite
suppressants, amphetamine -like psychostimulants
or MAO inhibitors which interfere with the
catabolism of sympathomimetic amines, & may
also occasionally elevate B.P.
 Side Effects
 Generally mild and rare.
 CNS depression or excitation may occur,
drowsiness reported frequently, Skin rashes,
tachycardia, dryness of mouth, nose and
throat have occasionally been reported.
Presentation
Bottle of 100 ml
 Brand Rationale
 Dry Cough or non-productive cough is cough
without sputum, hence therapy must contain a
good antitussive like Dextromethrophan which
is centrally acting cough suppressant with
minimal side effects.
 Brand Rationale
 As Dry Cough is often a component of
Upper Respiratory Disorder like Rhinitis,
Sinusitis, Laryngitis, Pharyngitis
 Therapy should also ideally include a proven
nasal decongestant like phenylephrine to
relieve nasal congestion and stuffiness.
 Brand Rationale
 An effective antihistamine like Triprolidine to take
care of allergic symptoms associated with coughs
and Menthol for soothing irritated respiratory tract.

Thus

ASCORIL-D
Is ideal therapy for dry irritating or Non Productive Cough