Gabapentin as a potential treatment for cough syncope.

Chronic cough, defined as cough lasting for 8 weeks, is one of the most common symptoms of medical importance, and the prevalence in the community is 9–33%.1 A subgroup of patients suffer from the debilitating and distressing disorder of cough syncope, which is difficult to effectively manage and treat. The approach in clinic is to determine an underlying etiology for cough syncope and to treat the underlying cause with the hope that cough syncopal episodes will improve. In a situation in which cough syncope is idiopathic, current treatments are addressed directly at suppressing the sensory cough reflex. These include codeine, dextromethorphan, levodropropizine, moguisteine, local anesthetics (eg, lidocaine, mepivacaine) and low-dose morphine, yet the effects of these therapies are rather disappointing in alleviating this condition in patients. Indeed, there is a real unmet need for effective treatments in patients suffering from cough.2 It has been suggested that chronic cough is a neuropathic disorder,3 and gabapentin, a treatment for neuropathic pain, has recently shown evidence of efficacy. A recent randomized controlled trial demonstrated an improvement in cough-specific quality of life when gabapentin was used at high doses of up to 1,800 mg.4 This teaching case for health-care professionals describes the clinical assessment and medical management of a patient with cough syncope and highlights the effectiveness of low-dose gabapentin in controlling our patient’s difficult-to-manage cough.