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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, including oral solutions, syrups, capsules, and lozenges, often in combination with other ingredients like decongestants, antihistamines, or expectorants. ## Primary Indications * Suppression of cough due to minor throat and bronchial irritation. * Temporary relief of cough associated with the common cold, bronchitis, or other respiratory conditions. ## Adult Dosing * **Immediate-release formulations:** * 10 mg to 20 mg every 4 hours, or 30 mg every 6-8 hours. * Maximum dose: 120 mg in 24 hours. * **Extended-release formulations:** * 60 mg every 12 hours. * Maximum dose: 120 mg in 24 hours. Dosing for combination products will vary based on the active ingredients and their respective dosages. Consult specific product labeling. ## Pediatric Dosing Dextromethorphan is **not recommended** for cough in children under 4 years of age due to the risk of serious adverse effects. * **Children 4-6 years:** 5 mg to 10 mg every 4 hours, or 15 mg every 6-8 hours. Maximum dose: 60 mg in 24 hours. (Dosing may vary by product, consult specific labeling). * **Children 6-12 years:** 10 mg to 20 mg every 4 hours, or 30 mg every 6-8 hours. Maximum dose: 120 mg in 24 hours. (Dosing may vary by product, consult specific labeling). * **Children 12 years and older:** Use adult dosing. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, and prolonged use should be avoided in patients with severe impairment. ## Contraindications * Hypersensitivity to dextromethorphan. * Use within 14 days of an MAOI (monoamine oxidase inhibitor) or within 14 days of discontinuing an MAOI. * Use in children under 4 years of age for cough suppression. ## Adverse Effects Common adverse effects include dizziness, drowsiness, nausea, vomiting, and nervousness. Less common but serious adverse effects include respiratory depression, serotonin syndrome (especially with co-administration of other serotonergic agents), and abuse/misuse. ## Key Drug Interactions * **MAOIs:** Risk of hypertensive crisis and serotonin syndrome. * **SSRIs, SNRIs, triptans, tramadol, lithium, St. John's Wort:** Increased risk of serotonin syndrome. * **CYP2D6 inhibitors (e.g., quinidine, fluoxetine, paroxetine, sertraline):** May increase dextromethorphan plasma concentrations, leading to increased risk of adverse effects. ## Monitoring * Monitor for signs and symptoms of serotonin syndrome, particularly when used with other serotonergic agents. * Assess for cough relief and presence of adverse effects. ## Clinical Pearls * Dextromethorphan is primarily effective for symptomatic relief of cough and does not treat the underlying cause. * Dextromethorphan-containing products should be used with caution in patients with a history of substance abuse. * Avoid concomitant use of other centrally acting agents that may potentiate CNS depression. * Extended-release formulations should not be crushed or chewed. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Product availability and recommendations may vary by region.