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A phase II study of hydrocodone for cough in advanced cancer

Harry R. Horvitz Center for Palliative Medicine (a World Health Organization Demonstration Project in Palliative Medicine), Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Declan Walsh, MSc, FACP

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Kristine A. Nelson, MD

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Nabeel Sarhill, MD

Vincent Charity Hospital/St. Luke’s Medical Center, Internal Medicine Department, Cleveland, Ohio

Lisa Rybicki, MS

Department of Biostatistics and Epidemiology, Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Susan B. LeGrand, MD

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Mellar P. Davis, MD

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Purpose:Cough is a common symptom in advanced cancer. The use of hydrocodone as an antitussive has not been studied previously in this setting. This study evaluates hydrocodone for cough in advanced cancer.

Methods: The results presented are from a phase II study with dose titration.

Setting: Palliative medicine program in a tertiary referral center.

Patients: 25 consecutive patients with cough from irreversible causes, on a stable opioid regimen for the prior 24 hours, and no previous or current use of hydrocodone for cough.

Intervention: 5 mg hydrocodone was administered twice daily. The dose was then titrated daily (maximum: 60 mg/24 h), if needed, until a³50 percent improvement of the frequency of cough was achieved and then maintained for three consecutive days.

Measurements: Cough severity, frequency, complications, and hydrocodone side effects.

Results:20 persons (10 women and 10 men) completed study evaluation. Median age was 63 years (range: 42-82). Nine patients had lung cancer and seven had lung or pleura metastases; 19 patients had at least 50 percent improvement of their cough frequency. The median best response was 70 percent improvement in the cough frequency (range: 50-90 percent). Median hydrocodone dose associated with the best response was 10 mg/day (range: 5-30 mg/day). Cough severity, frequency, associated symptoms and complications, and activities of daily living improved significantly. Side effects of hydrocodone (dry mouth, nausea, and drowsiness) were tolerable and rated as mild.

Conclusions: Hydrocodone is effective and safe to treat cough in advanced cancer. A starting dose of 10 mg per day in divided doses seems effective. Dose escalation may be required. Most improved within one day.

Key Words: advanced cancer • antitussive • chronic cough • dihydrocodeinone • hydrocodone • palliative care • symptom management

American Journal of Hospice and Palliative Medicine®, Vol. 19, No. 1, 49-56 (2002)
DOI: 10.1177/104990910201900110


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