Duloxetine lowers refractory chronic cough
Duloxetine reduced cough frequency and improved cough-related quality of life versus placebo in adults with refractory chronic cough.
*Randomized double-blind placebo-controlled trial; Level 1b (OCEBM).

Citation

Wang S, Wu H, Zhou Y, et al. The efficacy and safety of duloxetine in treating refractory chronic cough: a randomized clinical trial. BMC Medicine. 2026;24:82. doi:10.1186/s12916-025-04613-x

Background

Many patients with chronic cough continue to cough despite careful evaluation and usual treatments. Medicines that reduce nerve “over-response” may help, but options remain limited.

Patients

98 adults (18–70 years) with refractory chronic cough at one outpatient center in Shanghai, China; all had no anxiety or depression symptoms and had not improved with gabapentin. Key exclusions included smoking within 2 years, recent respiratory infection, major heart disease, and significant liver or kidney disease.

Intervention

Duloxetine, titrated to 20 mg three times daily for 8 weeks, then tapered.

Control

Matching placebo.

Outcome

Cough frequency (coughs per hour) and Leicester Cough Questionnaire score (higher is better). Safety: adverse events.

Follow-up Period

11 weeks (8-week treatment + 3-week follow-up).

Results

Outcome (end of follow-up) Duloxetine Placebo
Coughs per hour (primary) 33.12 (from 83.96) 80.36 (from 87.67)
Leicester Cough Questionnaire total score (primary) 14.88 (from 12.75) 12.81 (from 12.17)
Nausea 11.36% (NNH 9) 0%
Dizziness 15.91% (NNH 8) 2.33%
Sleepiness 9.09% (NNH 11) 0%
85/98 participants completed the trial; cough frequency was measured from 24-hour audio recordings reviewed by clinicians.

Limitations

Single-center study in China may limit generalizability. Participants had already failed gabapentin and had no mood symptoms, so results may not apply to broader chronic cough populations. Follow-up was short, so long-term benefit and stopping strategy are uncertain.

Funding

Chinese national and Shanghai municipal research grants; funders had no role.

Clinical Application

For refractory chronic cough after standard workup and failed gabapentin, consider duloxetine with slow dose increase; counsel about nausea, dizziness, and sleepiness.