〔OBSERVATION OF THERAPEUTIC EFFECT療效觀察〕
Management
of CPT-induced Cough: A New Application of Rotundin
顱通定治療琉甲丙脯酸所致頑固性劇烈咳嗽7例
By Jingdong Wang
Guang Rao People’s
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.
Results
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.
Discussion
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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