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# Dextromethorphan (Commonly found in "DXM" Cold Products) ## Overview Dextromethorphan is a synthetic dextrorotatory analog of levorphanol. It acts centrally on the cough center in the medulla to elevate the threshold for coughing. It lacks analgesic or addictive properties at therapeutic doses. ## Primary Indications Temporary relief of non-productive cough caused by minor throat and bronchial irritation (e.g., common cold, inhaled irritants). ## Adult Dosing * **Immediate-release:** 10–20 mg orally every 4 hours OR 30 mg orally every 6–8 hours. * **Extended-release:** 60 mg orally every 12 hours. * **Maximum Dose:** 120 mg/24 hours. ## Pediatric Dosing * **Children 6–12 years:** 5–10 mg orally every 4 hours OR 15 mg every 6–8 hours. Maximum: 60 mg/24 hours. * **Children 4–6 years:** 2.5–5 mg orally every 4 hours. Maximum: 30 mg/24 hours. * **Children <4 years:** Generally not recommended due to lack of efficacy and safety concerns; consult local pediatric guidelines. ## Dose Adjustments * **Hepatic Impairment:** Reduce dose or increase dosing interval in patients with severe hepatic impairment; caution is advised. * **Renal Impairment:** No standard adjustment provided; use with caution. ## Contraindications * Hypersensitivity to dextromethorphan. * Concurrent use with or within 14 days of MAO inhibitors (risk of serotonin syndrome). * Chronic cough (e.g., asthma, emphysema, smoking) without supervision. ## Adverse Effects * **Common:** Nausea, dizziness, drowsiness, stomach pain. * **Serious (High doses):** Serotonin syndrome, confusion, respiratory depression, hallucinations, and dissociative state (abuse potential). ## Key Drug Interactions * **MAO Inhibitors:** Severe, potentially fatal reactions (hyperpyrexia, cardiovascular collapse). * **SSRIs/SNRIs:** Increased risk of serotonin syndrome. * **CNS Depressants (Alcohol, Opioids, Sedatives):** Enhanced CNS depression. * **CYP2D6 Inhibitors (e.g., Fluoxetine, Quinidine):** May increase dextromethorphan serum concentrations. ## Monitoring * Monitor for efficacy (reduction in cough frequency). * Assess for adverse reactions or signs of misuse/abuse (euphoria, agitation). * If cough persists >7 days or is accompanied by fever or persistent headache, reassess diagnosis. ## Clinical Pearls * Dextromethorphan is purely a cough suppressant; it does not treat the underlying cause (e.g., bacterial infection, allergies). * Often marketed in "multi-symptom" cold products (containing acetaminophen, antihistamines, or decongestants)—always check for ingredient duplication to avoid toxicity. * The "Maximum Daily Dose" varies by local protocol and specific product formulation; always check the Medication Facts label. *** **Educational Disclaimer:** This information is for educational purposes only. Drug information, contraindications, and dosing guidelines change frequently. Always verify specific dosing and safety information against current clinical references (e.g., Lexicomp, Micromedex) or institutional prescribing protocols before administration.