Management of CPT-induced Cough: A New Application of Rotundin


By Jingdong Wang

Guang Rao Peoples Hospital, Shandong, China, 257300

中國  山東省廣饒縣人民醫院  王敬東

     [ ABSTRACT ]  7 cases of severe irritable dry cough were treated with oral application of Rotundin (30-60 mg, three times a day, plus 30mg before sleep), in conjunction with CPT-an Angiotesin-Coverting Enzyme Inhibitors. CPT was widely used in hypertension and heart failure with its side effect of causing irritable and spasmodic cough. The result was highly positive. It was suggested by the author that Rotundin be used to control the cough induced by CPT.


     CPT is ACEI (Angiotensin-Coverting Enzyme Inhibitors), which was used widely in treatment of hypertension and heart failure nowadays. However its side effects, irritable dry cough and spasmodic cough, were stubborn, violent and difficult to tolerant. Thus, it is the main reason that limits the application of CPT in clinic (Intermediate Medical Journal, 1994;29:46). I have used Indomethacin, which inhibits the release of prostaglandin, to treat the coughs in 2 cases. The results were significantly effective (Compilation of National Angiotensin-Renin System and ACEI Academic Reports, 1994;89). In view of that inhibiting prostaglandin does not benefit hypertension, so a long period utilizing of Indomethacin should be avoided. I have tried using Rotundin to treat 7 cases with stubborn and violent cough induced by CPT, and the significant clinical effect has been observed as following.

General Data

    7 cases were outpatients including 1 male and 6 female. Age: 52~74, average: 63.3. Duration of hypertension was 3~22 years. All cases had irritable dry cough or spasmodic cough induced by CPT at least two times; most of them felt worse at night. They were treated as “Acute Upper Respiratory Inflammation” or “Bronchitic Infection”, all of them were given antibiotic, antibechic and apophlegmatic medicines, etc., but no curative effects observed. Coughs were released after stopping administration of CPT. All patients have normal X-ray photograph in the chest. The longest period of using CPT was almost 1 month. The dose of CPT: oral taking 25~50mg, t.i.d.

Therapeutic Methods

     Without apophlegmatic and antibechic, antibiotic, CPT was given continuously, Rotundin was administered at the dosage of 30~60mg, t.i.d., additional dosage of 30mg was given before sleep for no more than 2 weeks.


     Rotundin had effect for all cases. Cough of 6 cases was stopped, and 1 case had occasional dry cough. Among of them, one case's cough was stopped after administering CPT on day 1, one on day 3, two on day 4, one on day 6, one on day 8, another on week 2 with occasional dry cough. While effect presented, the B.P. level dropped, the dosage of CPT were reduced or stopped for all cases. For some of them, changed to or continued other antihypertensive to maintain the B.P. level. In the treatment of 7 cases of the cough with Rotundin, two cases felt sleepy, one felt fatigue, no more adverse reaction occurred.


     Cough is a kind of protecting action of human body. While respiratory tract mucous membrane is stimulated by adverse factors thus as physical, chemical, inflammatory and congestive blood etc., the ends of nervi vagus, nervi glossopharyngeus and nervi trigeminus in mucosa surface layer were irritated and the signal will be transported to medulla oblongata coughing center, so that the cough will be induced. The incidence of cough induced by CPT was 0.58~10% in general cases, as high as 15% in some cases (Clinical Complements. 1994:9:426). Most of them were female. The mechanism of the adverse reaction is relating to that CPT promotes to release more prostaglandin and bradykinin, which they can stimulate respiratory tract mucosa (Medical Guide. 1993; 12:187).

     Rotundin is L-tertrahydropalmatine. The therapeutic mechanism is not only related to its analgesic action and sedation, but may associate with that it can decrease excitability of vagus, glossopharyngeus, trigeminus nervus, and inhibit medulla oblongatal coughing center. I used Rotundin to treat the stubborn and violent cough in 7 cases, effective result was showed and there was no apparent side effect along with CPT administered, and no adverse effect to hypertension, so that it may be fit for a long duration of application. Thus, it is an ideal medicine for treating cough induced by CPT. Also, in view of its action mechanism and characteristic, Rotundin is suitable to be applied more widely for preventing and treating this type of cough induced by angiotesin-coverting enzyme inhibitors in clinic.


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