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# Dextromethorphan
## Overview
Dextromethorphan is an antitussive (cough suppressant) that acts on the cough center in the medulla oblongata. It is available in various formulations, including oral solutions, syrups, tablets, and capsules, often in combination with other ingredients like decongestants, antihistamines, and expectorants.
## Primary Indications
* Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Immediate-release:** 10-20 mg every 4 hours, or 30 mg every 6-8 hours.
* **Extended-release:** 60 mg every 12 hours.
* Maximum dose: Generally not to exceed 120 mg in 24 hours for immediate-release products, or as directed by manufacturer for extended-release.
## Pediatric Dosing
* **Ages 6 to under 12 years:**
* Immediate-release: 5-10 mg every 4 hours, or 15 mg every 6-8 hours.
* Maximum dose: 60 mg in 24 hours.
* **Ages 12 years and older:** Adult dosing.
* **Under 6 years:** Generally not recommended for over-the-counter use without physician guidance due to risk of serious adverse effects.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, however, caution is advised and monitoring for adverse effects is recommended.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAOI therapy (risk of serotonin syndrome).
* Use in patients taking certain other serotonergic drugs (risk of serotonin syndrome).
## Adverse Effects
* Dizziness, drowsiness, confusion, nausea, vomiting, constipation.
* Abuse potential exists, leading to hallucinations and euphoria at supratherapeutic doses.
* Serotonin syndrome can occur, especially when combined with other serotonergic agents.
## Key Drug Interactions
* **MAOIs:** Concurrent use is contraindicated due to risk of hypertensive crisis and serotonin syndrome.
* **SSRIs, SNRIs, TCAs, triptans, St. John's wort, lithium:** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, increasing risk of adverse effects.
## Monitoring
* Monitor for effectiveness of cough suppression.
* Monitor for signs and symptoms of CNS depression, confusion, and abuse.
* Monitor for signs and symptoms of serotonin syndrome, especially with concomitant serotonergic medications.
## Clinical Pearls
* Dextromethorphan is primarily for symptomatic relief and does not treat the underlying cause of the cough.
* Extended-release formulations should not be crushed or chewed.
* Educate patients on the potential for abuse and the risks associated with exceeding recommended doses.
* Consider underlying causes of persistent cough before initiating symptomatic treatment.
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**Disclaimer:** This information is intended for healthcare professionals and should not be a substitute for professional medical advice. Always consult the current prescribing information and relevant guidelines before making any treatment decisions.
