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## Dextromethorphan (DM) Cold
### Overview
Dextromethorphan is an antitussive (cough suppressant) that acts on the cough center in the medulla.
### Primary Indications
Suppression of cough due to minor throat and bronchial irritation.
### Adult Dosing
* **Oral:** 10-20 mg every 4 hours or 20-30 mg every 6-8 hours.
* **Maximum:** 120 mg per 24 hours.
### Pediatric Dosing
* **Ages 12 years and older:** Same as adult dosing.
* **Ages 6 to under 12 years:** 7.5 mg to 15 mg every 4 hours or 15 mg every 6-8 hours. Maximum: 60 mg per 24 hours.
* **Ages 2 to under 6 years:** 7.5 mg every 4 hours. Maximum: 30 mg per 24 hours.
* **Ages under 2 years:** Use is generally not recommended due to potential for serious adverse effects. Consult a pediatrician.
### Dose Adjustments
No specific dose adjustments are generally required for hepatic or renal impairment, but caution and monitoring are advised due to potential accumulation.
### Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAOI therapy or stopping an MAOI.
* Patients with asthma, persistent or chronic cough, or cough with excessive secretions.
### Adverse Effects
* Dizziness, drowsiness, lightheadedness
* Nausea, vomiting
* Constipation
* Confusion, hallucinations (at high doses)
* Respiratory depression (at very high doses)
### Key Drug Interactions
* **MAOIs:** Potentially life-threatening serotonin syndrome.
* **SSRIs, SNRIs, TCAs, triptans, other serotonergic agents:** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** Increased dextromethorphan levels, potentially leading to toxicity.
* **Alcohol and CNS depressants:** Additive CNS depression.
### Monitoring
* Monitor for cough relief.
* Assess for adverse effects, especially CNS effects and respiratory depression at higher doses or in susceptible individuals.
* Monitor for signs of serotonin syndrome when used with serotonergic agents.
### Clinical Pearls
* Dextromethorphan is available in numerous over-the-counter combination products; careful review of all ingredients is essential to avoid inadvertent overdose or drug interactions.
* It is not effective for cough associated with asthma or excessive mucus.
* Abuse potential exists, particularly with concentrated formulations, leading to euphoric and hallucinogenic effects.
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*This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment, and refer to the most current prescribing information for complete details.*
