Nipaxon (Noscapine)
Oral suspension for temporary dry cough relief
Nipaxon is an over-the-counter cough suppressant containing noscapine, available as an oral suspension (2.5 mg/mL). It works by suppressing the cough reflex through action on the cough center in the brainstem, without affecting other brain functions. Nipaxon is indicated for the relief of temporary, short-term dry cough in adults and children aged 2 years and older. Unlike opioid-based cough suppressants such as codeine, noscapine does not cause significant respiratory depression or dependence at therapeutic doses.
Quick Facts
Key Takeaways
- Nipaxon contains noscapine, a non-opioid cough suppressant that acts on the brainstem cough center without causing significant sedation or respiratory depression.
- Suitable for adults and children aged 2 years and older for temporary relief of dry, non-productive cough.
- Important interaction with warfarin (blood thinners) — always consult a physician before combining these medications.
- May cause drowsiness and dizziness; avoid driving or operating machinery if affected.
- Consult a physician if cough persists, is chronic, or productive (with mucus), as Nipaxon is intended only for short-term dry cough.
What Is Nipaxon and What Is It Used For?
Nipaxon is a cough suppressant (antitussive) medication that contains the active ingredient noscapine at a concentration of 2.5 mg per milliliter in an oral suspension form. Noscapine is a naturally occurring alkaloid originally derived from the opium poppy (Papaver somniferum), but unlike other opium-derived compounds such as codeine or morphine, it has no significant analgesic, sedative, or euphoric properties at therapeutic doses. This makes it a particularly suitable option for managing dry cough without the risk of dependence or significant central nervous system depression.
The primary mechanism of action of noscapine involves suppression of the cough reflex through direct action on the cough center located in the medulla oblongata of the brainstem. Research has shown that noscapine interacts with sigma receptors, which play a role in modulating the cough reflex. Unlike codeine and dextromethorphan, noscapine does not bind to opioid receptors, which accounts for its favorable safety profile regarding respiratory depression, constipation, and abuse potential.
Nipaxon is specifically indicated for the relief of temporary, short-term dry cough (also called non-productive or irritative cough). Dry cough is characterized by the absence of mucus production and is often triggered by viral upper respiratory infections, environmental irritants, or post-nasal drip. It is important to distinguish dry cough from productive cough (with mucus), as cough suppression in productive cough may impair the body's natural mechanism for clearing airways.
Nipaxon is available without a prescription (over-the-counter) in many European countries and is manufactured by Kenvue (formerly Johnson & Johnson Consumer Health). The oral suspension formulation makes it particularly convenient for pediatric use, as the liquid form allows for precise dose adjustment based on the child's age. The suspension is sugar-free (does not contain sucrose), making it suitable for individuals who need to monitor sugar intake.
Clinical studies have demonstrated that noscapine is effective in reducing cough frequency and severity in patients with acute upper respiratory infections. A systematic review published in the Cochrane Database of Systematic Reviews found that antitussive agents, including noscapine, can provide symptomatic relief in patients with acute cough, although the evidence base for many over-the-counter cough medications remains limited. Nevertheless, noscapine has a well-established safety record spanning several decades of clinical use.
What Should You Know Before Taking Nipaxon?
Contraindications
Nipaxon should not be used if you have a known allergy (hypersensitivity) to noscapine or any of the other ingredients in the formulation. The inactive ingredients include glycerol, ethanol, poloxamer, xanthan gum, locust bean gum, disodium phosphate dihydrate, sodium dihydrogen phosphate dihydrate, fennel oil, methylparahydroxybenzoate (E218), propylparahydroxybenzoate (E216), and purified water. If you have previously experienced an allergic reaction to any of these substances, do not take Nipaxon.
Additionally, Nipaxon should not be given to children under 2 years of age. The safety and efficacy of noscapine have not been established in this age group, and cough in very young children should always be evaluated by a healthcare professional to rule out serious underlying conditions.
Warnings and Precautions
Before taking Nipaxon, consult a physician or pharmacist if you have any of the following conditions:
- Chronic or persistent cough: Cough lasting more than two weeks may indicate an underlying condition such as asthma, chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD), or medication side effects (e.g., ACE inhibitors). Suppressing this type of cough without medical evaluation may delay diagnosis and treatment.
- Productive cough (with mucus): Nipaxon is designed for dry cough only. Suppressing a productive cough may impair the body's ability to clear mucus from the airways, potentially worsening respiratory conditions.
- Asthma or reactive airway disease: Cough in asthma patients may be a symptom of poorly controlled disease and should be addressed by treating the underlying asthma rather than suppressing the cough.
If no improvement is observed after a reasonable period of treatment, consult a physician for further evaluation. Persistent cough in adults may require investigation for conditions such as lung malignancy, tuberculosis, or other serious respiratory disorders.
Nipaxon may cause dizziness and drowsiness. If you experience these effects, do not drive motor vehicles or operate machinery that requires alertness. You are personally responsible for assessing whether you are fit to drive or perform tasks requiring concentration. Read all information in this guide for further guidance, and discuss any concerns with your physician or pharmacist.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, suspect you may be pregnant, or are planning to become pregnant, consult a healthcare provider before using Nipaxon.
Pregnancy: No adverse effects on the fetus have been demonstrated with noscapine use during pregnancy. Available epidemiological data and animal reproductive studies have not shown an increased risk of congenital malformations or other adverse developmental effects. However, as with all medications during pregnancy, Nipaxon should only be used when the expected benefit to the mother outweighs any potential risk to the fetus. Consult your healthcare provider for personalized advice.
Breastfeeding: Noscapine passes into breast milk but is unlikely to affect nursing infants when used at recommended therapeutic doses. The amount transferred to breast milk is considered clinically insignificant. However, for use beyond occasional doses, consult a physician. If you notice any unusual symptoms in your breastfed infant (such as excessive drowsiness or feeding difficulties), discontinue use and seek medical advice.
Important Information About Excipients
Nipaxon oral suspension contains several excipients that some individuals may need to be aware of:
- Ethanol (alcohol): This medicine contains 2.05 mg of alcohol (ethanol) per mL. The amount in a standard dose corresponds to less than 0.05 mL of beer or 0.02 mL of wine. The low alcohol content in this medicine is not expected to produce any noticeable effects.
- Parabens: Contains methylparahydroxybenzoate (E218) and propylparahydroxybenzoate (E216) as preservatives. These may cause allergic reactions (possibly delayed) in some individuals.
- Sodium: Contains less than 1 mmol (23 mg) sodium per 20 mL dose, meaning it is essentially sodium-free.
How Does Nipaxon Interact with Other Drugs?
Before taking Nipaxon, inform your physician or pharmacist about all medications you are currently using, have recently used, or plan to use. This includes prescription medicines, over-the-counter drugs, herbal supplements, and vitamins. Drug interactions can alter how medications work or increase the risk of side effects.
Major Interactions
The most clinically significant drug interaction with noscapine involves warfarin, a commonly prescribed oral anticoagulant (blood thinner). Research has demonstrated that noscapine can inhibit the cytochrome P450 enzyme CYP2C9, which is primarily responsible for metabolizing the more potent S-enantiomer of warfarin. This inhibition leads to increased warfarin plasma concentrations and a prolonged international normalized ratio (INR), which increases the risk of bleeding complications.
A pharmacokinetic study published in the European Journal of Clinical Pharmacology confirmed that even short courses of noscapine can significantly increase the INR in patients stabilized on warfarin therapy. Consequently, patients taking warfarin should consult their physician before starting Nipaxon, and INR monitoring may be recommended during concurrent use.
If you are taking warfarin or other vitamin K antagonist anticoagulants, consult your physician before using Nipaxon. Noscapine can significantly increase the anticoagulant effect of warfarin, raising the risk of bleeding. Your physician may need to adjust your warfarin dose or recommend an alternative cough medication.
Other Potential Interactions
While the interaction with warfarin is the most well-documented, there are theoretical considerations for other drug interactions:
- Other CYP2C9 substrates: Since noscapine inhibits CYP2C9, it may theoretically affect the metabolism of other drugs processed by this enzyme, including certain NSAIDs (e.g., ibuprofen, diclofenac), phenytoin, and some sulfonylurea antidiabetic drugs. However, clinically significant interactions with these drugs have not been extensively studied.
- CNS depressants: Although noscapine has minimal sedative effects at therapeutic doses, combining it with other medications that cause drowsiness (such as antihistamines, benzodiazepines, or opioids) may have additive effects on drowsiness and dizziness.
- Other antitussives: Concurrent use with other cough suppressants is generally unnecessary and may increase the risk of side effects without additional benefit.
| Interacting Drug | Severity | Effect | Recommendation |
|---|---|---|---|
| Warfarin | Major | Increased anticoagulant effect, raised INR, increased bleeding risk | Consult physician before use; INR monitoring recommended |
| Other CYP2C9 substrates (NSAIDs, phenytoin) | Moderate (theoretical) | Potentially increased plasma levels of these drugs | Monitor for increased effects; consult physician if concerned |
| CNS depressants (antihistamines, benzodiazepines) | Minor | Additive drowsiness and dizziness | Use caution; avoid driving if affected |
| Other antitussives | Minor | No additional benefit; increased side effect risk | Avoid concurrent use |
What Is the Correct Dosage of Nipaxon?
Always use Nipaxon exactly as described in this guide or as directed by your physician, pharmacist, or nurse. If you are unsure about the correct dose, consult a healthcare professional. The oral suspension should be taken between meals for optimal absorption and effect.
Adults and Adolescents Over 14 Years
Standard Adult Dose
20 mL (50 mg noscapine) taken 3 times daily, between meals.
This provides a total daily dose of 60 mL (150 mg noscapine). Your physician may prescribe a different dose based on your individual circumstances.
Children (2–14 Years)
Nipaxon can be given to children aged 2 years and older. The dose is determined by the child's age. Always use the measuring device supplied with the product for accurate dosing.
| Age Group | Single Dose | Frequency | Daily Dose (Noscapine) |
|---|---|---|---|
| Adults & children >14 years | 20 mL | 3 times daily | 150 mg |
| 10–14 years | 10 mL | 3 times daily | 75 mg |
| 4–10 years | 5 mL | 3–4 times daily | 37.5–50 mg |
| 2–4 years | 2.5 mL | 3–4 times daily | 18.75–25 mg |
Nipaxon should not be administered to children under 2 years of age. Cough in very young children should always be evaluated by a healthcare professional, as it may indicate a serious underlying condition requiring specific treatment.
Elderly Patients
No specific dose adjustment is generally required for elderly patients. However, older adults may be more susceptible to the drowsiness and dizziness that can occur with noscapine. If these effects are experienced, consider reducing the dose and consult a healthcare provider. Elderly patients who are taking multiple medications should have potential interactions reviewed by their physician or pharmacist, particularly if they are on warfarin or other anticoagulants.
Missed Dose
If you forget to take a dose of Nipaxon, take it as soon as you remember, unless it is nearly time for your next scheduled dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Overdose
If you or someone else has taken too much Nipaxon, or if a child has accidentally ingested the medicine, contact a physician, hospital emergency department, or poison control center immediately for risk assessment and advice. Symptoms of noscapine overdose may include nausea, vomiting, drowsiness, and dizziness. Keep the medicine container available to provide information about the ingested product.
What Are the Side Effects of Nipaxon?
Like all medicines, Nipaxon can cause side effects, although not everyone experiences them. Most side effects are mild and resolve on their own. However, some reactions require immediate medical attention.
Stop taking Nipaxon and contact a physician immediately if you experience any of the following symptoms: rash, itching, swelling of the face, lips, mouth, tongue, or other parts of the body, shortness of breath, wheezing, or difficulty swallowing or breathing. These may be signs of a serious allergic reaction such as angioedema (may affect up to 1 in 100 users) or anaphylaxis (may affect up to 1 in 1,000 users).
The following side effects have been reported with Nipaxon use, organized by frequency:
Common
May affect up to 1 in 10 users
- Headache
- Drowsiness
Uncommon
May affect up to 1 in 100 users
- Dizziness
- Chest pain
- Nausea
- Vomiting
- Abdominal pain
- Urticaria (hives)
- Angioedema (swelling of face, lips, or throat)
Rare
May affect up to 1 in 1,000 users
- Shortness of breath (dyspnea)
- Rhinitis (runny nose)
- Hallucinations
- Conjunctivitis (eye inflammation)
- Anaphylactic reaction
Frequency Not Known
Cannot be estimated from available data
- Chest discomfort
In some individuals, noscapine may cause intense abdominal and/or chest pain that develops 30 minutes to 4 hours after ingestion. This pain resolves spontaneously within 1 to 3 hours without treatment. The mechanism is not fully understood but may be related to smooth muscle effects. If you experience this reaction, discontinue Nipaxon and consult your physician about alternative cough treatments.
If you experience any side effect not listed here, or if any side effect becomes severe, please report it to your healthcare provider. Reporting suspected adverse reactions after the medicine has been authorized is important, as it allows continuous monitoring of the medicine's benefit-risk balance.
How Should You Store Nipaxon?
Proper storage of Nipaxon ensures the medicine maintains its effectiveness and safety throughout its shelf life. Follow these guidelines:
- Temperature: Store at or below 25°C (77°F). Do not freeze the oral suspension.
- Light and moisture: Keep the bottle tightly closed when not in use. Store in the original packaging to protect from light.
- Child safety: Keep this medicine out of the sight and reach of children. The bottle is equipped with a child-resistant screw cap.
- Expiration date: Do not use Nipaxon after the expiration date printed on the bottle (Exp.). The expiration date refers to the last day of that month.
Do not dispose of medicines via wastewater or household waste. Return unused or expired medicines to your local pharmacy for proper disposal. These measures help protect the environment.
What Does Nipaxon Contain?
Understanding the composition of Nipaxon can help identify potential allergens and understand the formulation characteristics.
Active Ingredient
Each milliliter of Nipaxon oral suspension contains 2.5 mg noscapine as the active substance. Noscapine (also known as narcotine) is a benzylisoquinoline alkaloid with antitussive properties.
Inactive Ingredients (Excipients)
- Glycerol (85%): Used as a sweetening agent and humectant
- Ethanol (96%): Solvent, present in very small amounts (2.05 mg/mL)
- Poloxamer: Emulsifying and solubilizing agent
- Xanthan gum (E415) and Locust bean gum (E410): Thickening agents that provide the suspension's viscosity
- Disodium phosphate dihydrate and Sodium dihydrogen phosphate dihydrate: pH buffers
- Fennel oil: Flavoring agent
- Methylparahydroxybenzoate (E218): Preservative
- Propylparahydroxybenzoate (E216): Preservative
- Purified water: Vehicle
Appearance and Packaging
Nipaxon oral suspension is a white to grey, slightly yellowish, viscous liquid. It is supplied in glass bottles with child-resistant polypropylene/polyethylene screw caps, available in pack sizes of 100 mL and 250 mL.
The suspension does not contain ordinary sugar (sucrose), making it suitable for patients monitoring their sugar intake, including those with diabetes. The fennel oil flavoring provides a mild, pleasant taste.
Frequently Asked Questions About Nipaxon
References & Medical Sources
This article is based on the following peer-reviewed sources and authoritative medical guidelines:
- World Health Organization (WHO). WHO Model List of Essential Medicines. 23rd Edition, 2023. Available at: who.int
- European Medicines Agency (EMA). Summary of Product Characteristics: Noscapine-containing medicinal products. EMA assessment reports on antitussive agents, 2020-2024.
- British National Formulary (BNF). Cough suppressants. National Institute for Health and Care Excellence (NICE), 2024. Available at: bnf.nice.org.uk
- Empey DW, et al. Comparison of the antitussive effects of noscapine and codeine using citric acid-induced cough in normal subjects. European Journal of Clinical Pharmacology. 1979;16(6):393-397.
- Mahmoudian M, Rahimi-Moghaddam P. The anti-cancer activity of noscapine: a review. Recent Patents on Anti-Cancer Drug Discovery. 2009;4(1):92-97.
- Coyle S, et al. Noscapine and warfarin: a clinically significant drug interaction. European Journal of Clinical Pharmacology. 2004;60(9):637-638.
- Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database of Systematic Reviews. 2014;(11):CD001831.
- Morice AH, et al. ERS guidelines on the assessment of cough. European Respiratory Journal. 2007;29(6):1256-1276.
Medical Editorial Team
This article was prepared and reviewed by the iMedic Medical Editorial Team, consisting of licensed specialist physicians with expertise in pharmacology, respiratory medicine, and clinical therapeutics.
Content created by medical professionals with clinical experience in prescribing and advising on antitussive medications. All drug information is cross-referenced with official product labeling and international pharmacological databases.
Independently reviewed by the iMedic Medical Review Board according to international guidelines (WHO, EMA, BNF). Evidence level: Grade 1A based on systematic reviews and peer-reviewed pharmacological literature.
Editorial Standards: All content follows the iMedic Editorial Standards, including evidence-based sourcing, medical accuracy verification, and conflict-of-interest disclosure. No pharmaceutical company funding or sponsorship is involved in the creation of this content.