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## Dextromethorphan ### Overview Dextromethorphan is a cough suppressant that acts centrally on the cough center in the medulla. It is available in various formulations, including oral solutions, syrups, tablets, and capsules, often in combination with other medications for cold and cough symptoms. ### Primary Indications * Symptomatic relief of cough. ### Adult Dosing * **Immediate-release:** 10 mg to 20 mg every 4 hours as needed, or 30 mg every 6 to 8 hours as needed. * **Extended-release:** 60 mg every 12 hours. * **Maximum:** Typically 120 mg per day for immediate-release, but may vary by product. Extended-release maximum is product-dependent. ### Pediatric Dosing * **Ages 2 to <6 years:** 7.5 mg to 15 mg every 4 hours as needed, or 15 mg every 6 to 8 hours as needed. *Use is generally not recommended in children under 6 years old for cough unless specifically directed by a healthcare provider.* * **Ages 6 to <12 years:** 15 mg to 30 mg every 4 hours as needed, or 30 mg every 6 to 8 hours as needed. * **Ages 12 years and older:** Same as adult dosing. * **Note:** Dosing can vary significantly by product formulation and specific age bands. Always consult the product labeling or local protocol for precise pediatric dosing. ### Dose Adjustments * No specific dose adjustments are typically required for hepatic or renal impairment, but caution may be advised in patients with severe impairment. ### Contraindications * Use in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing an MAOI. * Hypersensitivity to dextromethorphan. * Use in children under 2 years of age for cough unless specifically directed by a healthcare provider. ### Adverse Effects * Dizziness, drowsiness, nausea, vomiting, constipation, nervousness, confusion. * At high doses: hallucinations, euphoria, abuse potential. ### Key Drug Interactions * **MAOIs:** Potentially life-threatening serotonin syndrome. * **SSRIs, SNRIs, tricyclic antidepressants, triptans, buspirone, tramadol, fentanyl, lithium, St. John's Wort:** Increased risk of serotonin syndrome. * **CYP2D6 inhibitors (e.g., quinidine, fluoxetine, paroxetine):** May increase dextromethorphan plasma concentrations, leading to increased risk of adverse effects. ### Monitoring * Monitor for effectiveness in cough suppression. * Monitor for adverse effects, particularly CNS effects and signs of serotonin syndrome if co-administered with serotonergic agents. ### Clinical Pearls * Dextromethorphan is often found in combination products; review all components to avoid duplicate therapy and assess for drug interactions. * Higher doses can produce dissociative and euphoric effects, leading to abuse potential. * Be aware of the risk of serotonin syndrome when used with other serotonergic medications. *** **Disclaimer:** This information is intended for healthcare professionals and does not replace a thorough review of current prescribing information, clinical guidelines, or individual patient assessment. Always verify the most up-to-date drug information before making clinical decisions.