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# Dextromethorphan ## Overview Dextromethorphan is a cough suppressant (antitussive) that acts on the cough center in the medulla oblongata. It is available in various formulations, often combined with other ingredients in over-the-counter (OTC) cold and cough products. ## Primary Indications Symptomatic relief of cough. ## Adult Dosing * **Immediate-release:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours. * **Extended-release:** 60 mg every 12 hours. * **Maximum:** Typically 120 mg per 24 hours for immediate-release products, but consult specific product labeling as this can vary, especially for combination products. ## Pediatric Dosing Dextromethorphan is generally not recommended for children under 4 years of age for cough suppression. * **Ages 4-11 years:** 7.5 mg to 15 mg every 4 hours, or 15 mg every 6 to 8 hours. Maximum daily dose: 60 mg. * **Ages 12 years and older:** Adult dosing. *Note: Dosing can vary significantly based on the specific product and age recommendations. Always refer to product labeling for the age group and dosing instructions.* ## Dose Adjustments No dose adjustments are typically required for renal or hepatic impairment, but caution may be warranted in severe cases. ## Contraindications * Hypersensitivity to dextromethorphan. * Concurrent use with or within 14 days of MAO inhibitors. * Use in patients receiving certain serotonergic agents (risk of serotonin syndrome). * Use in children under 4 years of age (unless specifically recommended by a healthcare provider for an age-appropriate formulation). ## Adverse Effects Common: Dizziness, drowsiness, nausea, vomiting, constipation. Less common: Confusion, hallucinations, respiratory depression (at very high doses or in combination with other CNS depressants). ## Key Drug Interactions * **MAO inhibitors:** Risk of hypertensive crisis. * **Serotonergic agents (e.g., SSRIs, SNRIs, triptans):** Risk of serotonin syndrome. * **CNS depressants (e.g., alcohol, benzodiazepines, opioids):** Increased sedation and respiratory depression. * **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** Can increase dextromethorphan plasma concentrations, potentially leading to toxicity. ## Monitoring * Assess cough severity and frequency. * Monitor for adverse effects, particularly CNS effects. * Be aware of potential for misuse/abuse at high doses. ## Clinical Pearls * Dextromethorphan is primarily for symptomatic relief of cough and does not treat the underlying cause. * Many OTC cold and cough products contain dextromethorphan in combination with other ingredients (e.g., decongestants, antihistamines, expectorants, acetaminophen, NSAIDs). Care must be taken to avoid duplicating ingredients and exceeding maximum daily doses, especially for acetaminophen and NSAIDs. * Extended-release formulations provide longer duration of action. * High doses of dextromethorphan can cause dissociative effects and are associated with abuse potential. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.*