Chronic Cough (Unexplained / Hypersensitivity)

10-20 mg every 4-6 hours as needed for a dry cough (maximum 80 mg in 24 hours) - short-term PRN

(Syrup is contraindicated under 6 years and tablets under 12 years. Child 6-11 years: 5 mL of syrup up to four times daily.)

Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph)

Centrally-acting antitussive that suppresses the cough reflex for symptomatic relief; used only after the common treatable causes of chronic cough have been excluded, since it treats the symptom rather than any underlying cause.

100 to 1000 mcg twice daily by oral inhalation; mild asthma starting dose 100 micrograms twice daily, then titrated down to the lowest dose at which control is maintained

(The ENDF's oral-inhalation asthma indication starts at 12 years of age, and its paediatric inhaled figures are stated for children over 16 years: 50 to 100 micrograms twice daily, maximum 200 mcg twice daily if asthma is not sufficiently controlled. No inhaled fluticasone figure is given below that.)

Sourced preference. The condition's own article says of cough-variant asthma: "In adult patients with chronic cough due to asthma as a sole symptom (cough-variant asthma), we suggest inhaled ICS as a first-line treatment." It adds that "Like in asthma, inhaled corticosteroids (ICS) are the mainstay of therapy for cough due to asthma." Montelukast is the alternative on this line; the article does not mention it.

Egyptian National Drug Formulary - Respiratory System 2026 (fluticasone monograph, oral inhalation, asthma indication)

The disease article suggests an inhaled corticosteroid as first-line treatment when the chronic cough is cough-variant asthma. The card offered montelukast for that same situation and no inhaled steroid at all. The ENDF gives fluticasone by oral inhalation an explicit asthma maintenance and prophylaxis indication.

10 mg once daily in the evening x 4-8 weeks trial

(Age 6 months to 5 years: 4 mg once daily in evening; Age 6 to 14 years: 5 mg once daily in evening)

DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d

Leukotriene receptor antagonist used when chronic cough is driven by cough-variant asthma or an allergic airway component, reducing the airway inflammation mediated by leukotrienes.

Chronic Cough - disease-level clinical article (chronic-cough-clinical.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Start 300 mg on day 1, then 300 mg twice on day 2 and 300 mg three times on day 3; build up over at least a week to no more than 1800 mg a day, split into three doses. - Give it a fair trial and stop it if the cough has not improved

No paediatric dose in the sources opened - the cough trial was in adults only.

Egyptian National Drug Formulary - Nervous system disorders 2025 (gabapentin monograph) - verbatim: "The total daily dose should be divided in three single doses."; the 1800 mg/day ceiling for refractory cough from Chronic Cough - StatPearls - NCBI Bookshelf (NBK430791)

A cough that has outlasted the antitussive and the asthma-directed rows is often a hypersensitivity syndrome, and gabapentin is the neuromodulator in this class with a randomised trial behind it and an Egyptian price a patient can actually pay.

Begin at 150 mg a day in divided doses and increase to 300 mg a day if it is tolerated. - Give it a fair trial and stop it if the cough has not improved

No paediatric dose in the sources opened - the cough trial was in adults only.

Pregabalin DailyMed label, SetID 11034861-eef2-4996-8082-afc3c1769171, section 2 - verbatim: "For adult indications, begin dosing at 150 mg/day."; the 300 mg/day refractory-cough dose from Chronic Cough - StatPearls - NCBI Bookshelf (NBK430791)

The trial behind this used pregabalin together with speech pathology cough-suppression therapy rather than on its own, which is how it should be offered; it is the option for the patient who cannot tolerate gabapentin.