[Milnacipran for the treatment of refractory chronic cough: a report of two cases]

Refractory chronic cough (RCC) is defined as a chronic cough that persists despite thorough evaluation and appropriate treatment of potential underlying causes, for which effective therapeutic options remain limited. This article reports two female patients with RCC and disease durations of 11 years and 2 years, respectively. Both patients underwent comprehensive evaluations to exclude common causes of chronic cough, such as cough variant asthma, gastroesophageal reflux-induced chronic cough, and upper airway cough syndrome. They failed to respond to conventional empirical therapies. After psychiatric assessment in the department of psychosomatic medicine, common mental disorders were ruled out, and both patients were subsequently treated with milnacipran. A marked improvement in cough symptoms was observed after four weeks of treatment, with the symptoms nearly resolving after eight weeks. No recurrence was noted during an eight-week follow-up after drug withdrawal. These cases suggest that, in the absence of psychiatric disorders, milnacipran may effectively relieve cough symptoms in patients with RCC and could represent a promising therapeutic option for this condition.