# Chronic Cough (Unexplained / Hypersensitivity) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d · ERS Guidelines on the diagnosis and treatment of chronic cough 2020 · Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph) · GINA 2023 · Egyptian National Drug Formulary - Nervous system disorders 2025 (gabapentin monograph) · Pregabalin DailyMed label, SetID 11034861-eef2-4996-8082-afc3c1769171, section 2 - Verified date: 2026-08 ## Verified against - DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d - Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph) - Chronic Cough - disease-level clinical article (chronic-cough-clinical.txt) - Egyptian National Drug Formulary - Respiratory System 2026 (fluticasone monograph, oral inhalation, asthma indication) - Chronic cough - disease-level clinical article (chronic-cough-full.txt) ## Treatment metadata - Dextromethorphan — 15 mg — oral.solid - Fluticasone — 0.1 mg — oral.inhalation - Montelukast — 10 mg — oral.solid - Referral & safety-netting (no drug therapy) - Gabapentin — 300 mg — oral.solid - Pregabalin — 75 mg — oral.solid ## Complete treatment card ```text CHRONIC COUGH (UNEXPLAINED / HYPERSENSITIVITY) Sources: DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d · ERS Guidelines on the diagnosis and treatment of chronic cough 2020 · Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph) · GINA 2023 · Egyptian National Drug Formulary - Nervous system disorders 2025 (gabapentin monograph) · Pregabalin DailyMed label, SetID 11034861-eef2-4996-8082-afc3c1769171, section 2 Review status: REVIEWED against DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d, Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph), Chronic Cough - disease-level clinical article (chronic-cough- clinical.txt), Egyptian National Drug Formulary - Respiratory System 2026 (fluticasone monograph, oral inhalation, asthma indication), Chronic cough - disease-level clinical article (chronic-cough- full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - A full history records how long the cough has lasted, whether it produces sputum, and features like runny/blocked nose, sneezing, fever, coughing blood, breathlessness, weight loss, voice change, or trouble swallowing [blocked nose · breathlessness · cough · difficulty swallowing · fever · hoarseness · sneezing · sputum · weight loss] - Smoking, vaping, work exposures, and travel history matter, since they raise the chance of chronic bronchitis and lung cancer - Ask specifically about ACE-inhibitor use, since it is a recognized medication cause of chronic cough [cough] - In silent post-nasal-drip cough, the cough itself may be the only symptom, with just a subtle throat-irritation sensation underneath it [cough] - Fever, night sweats, or weight loss alongside the cough should raise concern for chronic infection, cancer, or a rheumatic disease [cough · fever · night sweats · weight loss] - Coughing up pus-like sputum needs further work-up [cough · pus · sputum] - Coughing up blood can point to infection, cancer, rheumatic disease, heart failure, or an inhaled foreign object [coughing up blood · foreign body] - Breathlessness alongside the cough can point to airway blockage or underlying lung tissue disease [breathlessness · cough] SIGNS - what you find (1) - Throat exam in silent post-nasal-drip cough can show inflammation with a cobblestone texture [cough] TESTS (8) - A chest x-ray is generally ordered once a cough has lasted more than 8 weeks - When asthma or post-nasal-drip cough is suspected, empiric treatment can be tried instead of imaging first - Chest CT is skipped when the exam and x-ray are both normal, but is used to work up an abnormal finding or to catch disease invisible on plain film, such as bronchiectasis - Spirometry before and after a bronchodilator can help assess for asthma or COPD - When breathing tests are normal, an inhaled-trigger challenge can be tried to test airway sensitivity, though how useful this is remains debated - Airway eosinophil counts over 3% on sputum or lavage testing, without airway hyperreactivity, point to eosinophilic bronchitis, found in up to 13% of cough-clinic patients - How useful exhaled nitric oxide or blood eosinophils are for diagnosing or predicting treatment response in chronic cough is still unsettled - An unexplained cough lasting beyond 3 weeks despite treatment trials defines idiopathic chronic cough, sometimes with raised lymphocytes on lavage IF NOT THIS - what else fits (1) - Other causes to weigh include bronchiolitis, lung cancer, chronic aspiration, heart failure, an inhaled foreign object, nerve or muscle disease, or a psychogenic cough Source StatPearls "Chronic Cough" - disease-level clinical article Status traced to the source above Rx: Symptomatic antitussive | Cough-variant asthma | Main treatment | Refractory cough that has not settled - neuromodulator | Refractory cough - neuromodulator given with speech and language cough therapy SYMPTOMATIC ANTITUSSIVE 1. DEXTROMETHORPHAN [1st line] Adult 10-20 mg every 4-6 hours as needed for a dry cough (maximum 80 mg in 24 hours) - short- term PRN Peds 6 to 11 years: 5 mL of the syrup up to four times daily. The syrup is contraindicated under 6 years and the tablets under 12 years. (Syrup is contraindicated under 6 years and tablets under 12 years. Child 6-11 years: 5 mL of syrup up to four times daily.) Source Egyptian National Drug Formulary - Respiratory System 2026 (dextromethorphan monograph) Why 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. Caution Systematically rule out common causes (ACE inhibitors, GERD, asthma, upper airway cough syndrome) before symptomatic suppression. Do not use with monoamine oxidase inhibitors (MAOIs) or SSRIs due to serotonin syndrome risk. Egypt TUSSILAR 10 MG 20 TABS. KAHIRA 2.85 EGP (0.14/unit) -> ? strength differs CODIPHAN 10MG/5ML SYRUP 120ML EL NILE. 10.00 EGP -> ? strength differs, ? different route - not oral solid COUGH-VARIANT ASTHMA - choose one 2. FLUTICASONE [1st line] Adult 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 Peds Over 16 years: Inhaled: 50 to 100 micrograms twice daily, to a maximum of 200 mcg twice daily if not sufficiently controlled. No inhaled figure is given below this age. (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.) Choice 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. Source Egyptian National Drug Formulary - Respiratory System 2026 (fluticasone monograph, oral inhalation, asthma indication) Why 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. Caution Severe hypersensitivity to milk proteins (oral inhalation) Do not use oral inhalation as a primary treatment of acute asthma attacks needing intensive care or status asthmaticus. The starting dose should depend on severity and be titrated down to the lowest dose at which effective control of asthma is maintained. Egypt FLIXOTIDE DISKUS 100MCG/DOSE 60 DOSES GLAXO SMITHKLINE 107.00 EGP RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSE ARAB DRUG COMPANY (ADCO) 32.00 EGP -> ? strength differs, ? different route - not oral.inhalation FLIXOTIDE 0.5MG/2ML 10 INH. NEBULES GLAXO SMITHKLINE 63.00 EGP -> ? strength differs, ? different route - not oral.inhalation 3. MONTELUKAST [1st line] Adult 10 mg once daily in the evening x 4-8 weeks trial Peds 6 months to 5 years: 4 mg once daily in the evening 6 to 14 years: 5 mg once daily in the evening (Age 6 months to 5 years: 4 mg once daily in evening; Age 6 to 14 years: 5 mg once daily in evening) Source DailyMed SINGULAIR (montelukast sodium) Package Insert, SetID 0fdfdf28-1b25-4c07-b210-672152864f1d Why 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. Caution There is an FDA black box warning for serious neuropsychiatric events (agitation, depression, sleep disturbance). Discontinue immediately if mood or behavioral changes occur. Egypt PIRONTAGONIST 10MG 20 F.C. TABS. EGPI > ADVANC... 60.00 EGP (3.00/unit) ASMALAIR 10MG 10 TAB. HI-PHARM 40.00 EGP (4.00/unit) MONTEKAL 10MG 10 TAB. EUROPEAN EGYP... 40.00 EGP (4.00/unit) INLETAIR 10 MG 10 F.C.TAB. ORGANOPHARMA 47.00 EGP (4.70/unit) MONTELOSAB 10 MG 14 F.C. TABS. P&C > VERCURE 82.00 EGP (5.86/unit) LELIPEL 10 MG 20 F.C. TABS. EGPI > GLOBE ... 120.00 EGP (6.00/unit) OPIKAST 10 MG 14 SCORED F.C. TABS. EL-OBOUR 22.20 EGP STATUKAST 10 MG 10 SCORED F.C. TABS. ADWIA 41.50 EGP MAIN TREATMENT 4. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Chronic Cough - disease-level clinical article (chronic-cough-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Chest radiograph and PFT assessment are needed for adults with cough persisting over 8 weeks, to evaluate for underlying malignancy or lung disease. REFRACTORY COUGH THAT HAS NOT SETTLED - NEUROMODULATOR 5. GABAPENTIN [2nd line] Adult 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 Peds No paediatric dose in the sources opened - the cough trial was in adults only. Source 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) Why 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. Caution Drowsiness, dizziness and unsteadiness are common at the start and worse with alcohol; warn the patient before they drive. The dose must be cut in renal impairment and in the elderly, because the kidney clears the drug. Never stop it abruptly - come off it gradually over at least a week, whatever it was given for. Combining it with an opioid or another sedative can depress breathing. This is an off-licence use for cough; say so to the patient, and stop it if a fair trial brings no benefit. Egypt EZAPENTIN 300MG 10 CAPS. MULTI-APEX 11.00 EGP (1.10/unit) PENTALIPSY 300MG 10 CAPS. SAFE PHARMA 14.40 EGP (1.44/unit) OCTOCONVAL 300 MG 30 CAPS. OCTOBER PHARMA 72.00 EGP (2.40/unit) NEUROGLOPENTIN 300 MG 30 CAPS. GLOBAL NAPI P... 111.00 EGP (3.70/unit) SHALGATEN 300MG 30 CAPS. EGPI > MASH P... 126.00 EGP (4.20/unit) GABALEPSY 300MG 30 CAPS. EL-OBOUR 135.00 EGP (4.50/unit) GABAVERONA 300 MG 30 H.G. CAPS. AVERROES PHARMA 126.00 EGP SAJALIPSY 300 MG 30 H.G. CAPS. SAJA PHARMACE... 126.00 EGP STABLENTIN 6MG/120ML SYRUP MEPACO 21.60 EGP -> ? strength differs, ? different route - not oral solid ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML EUROPEAN EGYPTIAN PHARM. IND. 37.00 EGP -> ? strength differs, ? different route - not oral solid REFRACTORY COUGH - NEUROMODULATOR GIVEN WITH SPEECH AND LANGUAGE COUGH THERAPY 6. PREGABALIN [2nd line] Adult 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 Peds No paediatric dose in the sources opened - the cough trial was in adults only. Source 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) Why 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. Caution Dizziness, sleepiness and weight gain are the usual reasons patients stop it; warn them before they drive. The kidney clears it, so reduce the dose when renal function is poor. Taper it off over at least a week rather than stopping suddenly. It is misused and diverted; be careful in anyone with a history of substance misuse, and do not combine it casually with opioids. This is an off-licence use for cough; say so to the patient. Egypt FORPREGAB 75 MG 30 CAPS. GRAND PHARMA ... 45.00 EGP (1.50/unit) SNAPGAB 75 MG 30 CAPS. MASH PREMIERE... 49.50 EGP (1.65/unit) LYRIBALIN 75MG 10 CAPS. BORG 18.00 EGP (1.80/unit) NEURAGABALIN 75 MG 10 CAPS. DELTA GRAND P... 23.00 EGP (2.30/unit) NERVATYCA 75 MG 20 CAPS. ALFACURE PHAR... 48.75 EGP (2.44/unit) QUEENLEPT 75 MG 30 CAPS. FUTURE PHARMA... 93.00 EGP (3.10/unit) LYRICA 75MG 20 CAPS. PFIZER 232.00 EGP (11.60/unit) PREGABEDIUM 75 MG 20 H.G. CAPS. SABAA > ACTIV... 56.66 EGP LOCIKASWAB 100MG/5ML 20 UNIDOSE ORAL SOLN. UNISWAB > VODACHEM 43.50 EGP -> ? strength differs, ? different route - not oral solid AVEROPREG 100MG/5ML SYRUP 60 ML AVERROES PHAR... 55.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)