Paroxetine effective for intractable, persistent cough in cancer patients

Paroxetine shows promise as an effective, off-label treatment for intractable and persistent cough in patients with advanced cancer, a study has shown.

The authors conducted a single-centre review of paroxetine use in patients with advanced malignancy and cough at an Australia tertiary referral cancer centre between 1 October 2012 and 1 October 2017. They obtained data on cough type and severity, response, and adverse events from medical records.

Cough type was characterized as nonproductive dry cough, productive chesty cough, or cough exhibiting both nonproductive and productive features (mixed cough).

Thirty-four patients were identified, of whom 24 (71 percent) had a major or moderate reduction in their cough severity following treatment with paroxetine, while almost half (47 percent) showed a major improvement and a quarter (24 percent) moderate improvement. Sixteen of 34 patients (47 percent) had a lung primary cancer, while 17 of 18 patients without lung cancer had lung metastases from another primary cancer.

Twenty-two patients (65 percent) received 10-mg paroxetine, while the rest (n=14; 35 percent) initiated at 20 mg. Paroxetine appeared to show better response from those with dry cough. Of the 19 patients (56 percent) with nonproductive dry cough, 15 (80 percent) reported an improvement in symptoms post-treatment. The remaining 15 patients (44 percent) presented with either a productive chesty cough (n=9; 27 percent) or mixed cough (n-6; 18 percent). Of these, nine (60 percent) reported an improvement in symptoms.

“Intractable and persistent cough is experienced by more than a third of patients with advanced cancer, with a significant negative impact on quality of life,” the authors said.