SSRI helps cough in cancer

End-of-life care

By Mardi Chapman

4 Sep 2019

The SSRI antidepressant paroxetine may have a place in the management of persistent cough in patients with advanced cancer, Australian research suggests.

A small retrospective study of 34 patients from the Peter MacCallum Cancer Centre has found most (71%) experienced a resolution of cough or reduction in cough severity with off-label paroxetine.

Almost half the patients (47%) experienced a major clinical improvement while almost a quarter (24%) had a moderate improvement in cough.

Patients with a non-productive dry cough were more likely to report an improvement in symptoms than patients with a productive chesty cough (79% v 60%).

Most the patients had either primary lung cancer or lung metastases from a different cancer.

Palliative care physician Dr Sonia Fullerton told the limbic that she was very excited about the results despite the limitations of the study.

“The weakness of this study is it’s a retrospective analysis but I think the mix of qualitative and quantitative data is valuable.”

She said persistent cough can impact sleep and be extremely debilitating for patients and their families.

“One of the patients I remember had had four admissions for cough. Out of desperation… because he was depressed, I was able to give him paroxetine on-label for depression when in fact my intention was to give it to him off-label as a cough treatment. His cough went in four hours.”

“It’s a meaningless cough. That’s what drives people crazy. It’s not like they’re coughing up sputum or blood. It’s that dry hacking cough without meaning that is so frustrating for them.”

She said the serendipitous discovery that the selective serotonin reuptake inhibitor could help cough dated back decades to its use for chronic itch.

“In palliative care, we do quite a lot off-label because no one designs drugs for us. We often use particular medications with side effects which suit us.”

“The proposed mechanism is there is increased central sensitisation of the cough reflex; the paroxetine winds that down.”

“And we know what the side effects are. It’s a well-tolerated drug used on label quite commonly for depression.”

She said the next step should be a prospective placebo controlled phase 3 trial in patients with intractable cough.

“These people should have already had the standard treatments for cough – asthma treatments, there is evidence for honey as a cough linctus and some people have reflux and microinspiration so I would always go ahead and treat all of those things first.”

“And we make sure they are not on a medication that can cause cough such as an antihypertensive.”

She said antidepressants were also used commonly in palliative care to wind down pain and address problems with appetite and sleeplessness.

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