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# Dextromethorphan and Guaifenesin Combination ## Overview This combination product typically contains dextromethorphan, a cough suppressant, and guaifenesin, an expectorant. Specific formulations and concentrations vary widely by product. ## Primary Indications * **Dextromethorphan:** Temporary relief of cough due to minor throat and bronchial irritation. * **Guaifenesin:** Helps loosen mucus (phlegm) and thin bronchial secretions to make coughs more productive. ## Adult Dosing Dosing varies significantly by product formulation (e.g., liquid, tablet, extended-release). **Consult the specific product's prescribing information for exact dosing recommendations.** * **Typical Dextromethorphan adult dose:** 10-20 mg every 4 hours, or 30 mg every 6-8 hours. Maximum dose typically 120 mg/day. * **Typical Guaifenesin adult dose:** 200-400 mg every 4 hours. Maximum dose typically 2400 mg/day. ## Pediatric Dosing Dosing varies significantly by product formulation and age. **Consult the specific product's prescribing information and pediatric guidelines.** * **Children 6 to under 12 years:** Doses are generally half of the adult dose, but specific recommendations vary by product. * **Children under 6 years:** Use is generally not recommended or requires specific medical guidance due to risk of adverse effects and lack of established dosing. ## Dose Adjustments * **Hepatic Impairment:** Use with caution; consider reduced dosage, though specific recommendations are often not established. Dextromethorphan is metabolized by the liver. ## Contraindications * Hypersensitivity to dextromethorphan or guaifenesin. * Concurrent use with or within 14 days of stopping MAO inhibitors (for dextromethorphan). * Use in children under a certain age (varies by product, often under 4 or 6 years). * Persistent or chronic cough, or cough accompanied by excessive secretions, fever, or severe headache, as these may indicate a more serious condition. ## Adverse Effects * **Dextromethorphan:** Dizziness, drowsiness, nausea, vomiting, constipation. High doses: confusion, hallucinations, respiratory depression, serotonin syndrome (especially with other serotonergic agents). * **Guaifenesin:** Nausea, vomiting, dizziness, rash. ## Key Drug Interactions * **MAO Inhibitors:** Contraindicated with dextromethorphan due to risk of serotonin syndrome or hypertensive crisis. * **SSRIs, SNRIs, Tricyclic Antidepressants, Opioids, Buspirone, Tramadol:** Increased risk of serotonin syndrome with dextromethorphan. * **CNS Depressants (e.g., alcohol, benzodiazepines, sedating antihistamines):** Additive CNS depression may occur. * **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan levels, increasing risk of adverse effects. ## Monitoring * Assess for effectiveness of cough suppression and expectoration. * Monitor for adverse effects, especially CNS effects with dextromethorphan and GI effects. * Evaluate for signs of serotonin syndrome if concurrent serotonergic agents are used. ## Clinical Pearls * These products treat symptoms, not the underlying cause of the cough. * Ensure accurate product selection to avoid unintended dosing or ingredients. * Avoid concurrent use of other products containing dextromethorphan or guaifenesin. * Discontinue use and consult a healthcare provider if cough persists for more than 7 days, recurs, or is accompanied by fever, rash, or persistent headache. *** *Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information and consult with a qualified healthcare professional before making any decisions related to medication use.*