Trade name: Capval®
Other chemical names: narcotin, methoxyhydrastin
(Molecular Formula of Noscapine: C22H23NO7
Capval® belongs to the group of antitussives, also called cough suppressants.
Antitussives can act on the one hand by inhibition of the cough center in the brain stem (= central effect), on the other hand by inhibition of sensitive receptors in the lung (= peripheral effect). It is important that this type of medication is only prescribed if the cough is dry (= without mucus). Since inhibition of the cough center in the brainstem also inhibits the cough reflex, mucus present can not be coughed as a result, which would possibly lead to an aggravation of the clinical picture.
The active ingredient of Capval® is noscapine. Noscapine is a natural constituent of opium, which is obtained as an alkaloid from the plant opium poppy (Papaver somniferum). It has as an antitussive exclusively peripheral action. That is, it acts directly on the bronchi, where it has bronchodilating (= dilating) and respiratory stimulating effects.
Capval® causes no pain relief (analgesia) and therefore does not count to the opiates. In contrast to opiates (such as codeine), it is much better tolerated and has no addictive potential, since it does not trigger any euphoric effects.
The fact that it only works on the periphery gives it another advantage: Capval® has neither sedative effects nor suppresses breathing. Constipation (= constipation), a frequently occurring side effect that is very distressing for those affected by opiate intake, does not occur when taking Capval®. In addition, according to recent studies, it has an antitumoral effect because it inhibits CYP2C9.
The plasma half-life of Capval® is between 2.6 and 4.5 hours. The molar mass is 413. The oral bioavailability, that is, the percentage of the active ingredient, which is unchanged at the site of action (in this case, the bronchi) is available, is about 30%.
Antitussives, such as Capval, are mainly used for the symptomatic treatment of non-productive (= no mucus) nocturnal cough. Since coughing is never a disease of its own but is merely a symptom, the cause of the irritant cough should be examined by a doctor.
One possible cause may be, for example, acute or chronic bronchitis. Pertussis (whooping cough) can also be a prescription as well as COPD (chronic obstructive pulmonary disease). Even through a tumor or other anatomical changes, a cough can develop. If the cough is excessive cardiovascular stress, Capval is equally induced. This is the case, for example, when an aneurysm could burst due to the strong cough.
Common side effects include headache and dizziness. Occasionally nausea and vomiting occur after ingestion. Dizziness, skin and hypersensitivity reactions with itching are also side effects. The development of a Quinke edema (swelling of the face and neck) occurs occasionally. Also spasmodic epigastric pain with tightness and shortness of breath were, although rarely, already described. Overdose may cause seizures.
Capval® should not be co-administered with an expectorant, as the mucus produced can not be coughed off and secretion can accumulate. In addition, the combination with drugs that have central depressant effect (such as sedatives, hypnotics, antidepressants, neuroleptics, opioids or alcohol) is not recommended.
An interaction with the vitamin K antagonist warfarin (coumadin) has been described, presumably because Capval® inhibits the enzyme CYP2C9. Warfarin is a substrate of CYP2C9, that is, warfarin is metabolised via CYP2C9. If Capval® now inhibits CYP2C9, it can happen that warfarin accumulates in the body and thus it comes to an overdose of warfarin, because this can no longer be metabolized. This inhibition of CYP2C9 could therefore also be relevant for other drugs that are metabolised via CYP2C9: These include the drugs Phenprocoumon, phenytoin and losartan.
Capval® must not be taken in case of a known hypersensitivity reaction to the active substance noscapine. In addition, Capval® juice contains the ingredients methyl or propyl 4-hydroxybenzoate, so it should also not be taken if there is an allergy to any of these ingredients. Capval® juice and dragees also contain different types of sugar (dragees contain lactose and sucrose, juice contains the sugar sorbitol). If one of these sugars is intolerable, the product should only be taken after consulting a doctor.
If mucus is formed, Capval® is counterproductive as it prevents the mucus from coughing up. Children under the age of six should not take Capval®, and children under the age of two should only use Capval® on a doctor's prescription.
Some sources suggest that Capval® is contraindicated during pregnancy only in the first trimester. Others advise on abandonment during the entire pregnancy.
To be on the safe side, Capval® should be discouraged during pregnancy as there is not enough data available yet.
Taking Capval® while breast-feeding is unlikely to endanger the baby as noscapine passes into breast milk only in small quantities. Nevertheless, Capval® should be taken during breastfeeding for a maximum of 2-3 days.
After taking Capval®, it is strongly advised not to drive a car or other vehicles. Also, do not operate any electric tools or heavy machinery as Capval® may affect attention and responsiveness. It is not possible to react quickly enough to sudden events. This may be the case especially at the beginning of treatment and when increasing the dose.
Capval® is available in the form of lozenges, drops, capsules, suppositories and as a syrup.
Capval® coated tablets usually contain 25 mg noscapine per one coated tablet.
Capval® juice contains 25 mg of noscapine in 5 g (which is about 5 ml).
In adults, Capval® is cough suppressant at a dose of 50-100 mg.
Capval® is a prescription, therefore only available by prescription.
Sedotussin is also an anti-cough medicine. If you want to resort to purely herbal remedies, you can use preparations from Prospan.