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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, capsules, and lozenges. ## Primary Indications * Symptomatic relief of cough due to minor throat and bronchial irritation. ## Adult Dosing * **Oral:** 10 mg to 30 mg every 4 to 12 hours as needed. * **Maximum:** Generally not to exceed 120 mg in 24 hours. Specific maximums may vary by product formulation. ## Pediatric Dosing * **Ages 12 years and older:** Same as adult dosing. * **Ages 6 to under 12 years:** 5 mg to 15 mg every 4 to 12 hours as needed. Maximum generally not to exceed 60 mg in 24 hours. * **Ages 4 to under 6 years:** 2.5 mg to 7.5 mg every 4 to 12 hours as needed. Maximum generally not to exceed 30 mg in 24 hours. * **Ages 2 to under 4 years:** 2.5 mg to 5 mg every 4 to 12 hours as needed. Maximum generally not to exceed 15 mg in 24 hours. * **Note:** Use in children under 4 years of age should be at the discretion of a healthcare provider due to potential for serious adverse effects. Many products are not recommended for children under 6 years. ## Dose Adjustments * No dose adjustment is typically required for renal or hepatic impairment, but caution and potential dose reduction may be warranted, especially in severe impairment. ## Contraindications * Hypersensitivity to dextromethorphan. * Use within 14 days of monoamine oxidase inhibitor (MAOI) therapy (risk of serotonin syndrome). * Patients currently taking or who have recently taken certain antidepressants (e.g., SSRIs, SNRIs, TCAs, bupropion) may be at increased risk for serotonin syndrome. ## Adverse Effects * Dizziness, drowsiness, nausea, vomiting, constipation, nervousness. * At higher doses or in cases of abuse: confusion, hallucinations, euphoria, respiratory depression, coma. * Serotonin syndrome (rare but serious) when used with serotonergic agents. ## Key Drug Interactions * **Monoamine Oxidase Inhibitors (MAOIs):** Contraindicated due to risk of serotonin syndrome. * **Serotonergic Agents (SSRIs, SNRIs, TCAs, triptans, tramadol, St. John's Wort):** Increased risk of serotonin syndrome. * **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, leading to enhanced adverse effects. * **Alcohol:** Additive CNS depression. ## Monitoring * Monitor for effectiveness in cough suppression. * Monitor for signs and symptoms of serotonin syndrome (agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, sweating, diarrhea). * Monitor for central nervous system adverse effects, especially at higher doses. ## Clinical Pearls * Dextromethorphan is available in many combination products; assess all ingredients to avoid duplication and potential adverse effects. * Risk of abuse and misuse exists, particularly with liquid formulations and high doses. * Effectiveness in suppressing chronic cough is not well established. * Dosing for children under 4 years of age requires careful consideration and healthcare provider supervision. *** *Disclaimer: This information is intended for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information with the official drug product labeling or a reliable drug information resource before making any clinical decisions.*