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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, tablets, and capsules. ## Primary Indications * Symptomatic relief of cough due to minor throat and bronchial irritation. ## Adult Dosing * **Oral Solution/Syrup:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours. * **Extended-Release Capsules:** 60 mg every 12 hours. * **Maximum Dose:** Generally not to exceed 120 mg in 24 hours, though some extended-release formulations may allow higher single doses per prescribing information. ## Pediatric Dosing * **Ages 12 years and older:** Same as adult dosing. * **Ages 6 to under 12 years:** * **Oral Solution/Syrup:** 5 mg to 10 mg every 4 hours, or 15 mg every 6 to 8 hours. * **Maximum Dose:** Generally not to exceed 60 mg in 24 hours. * **Ages 2 to under 6 years:** * **Oral Solution/Syrup:** 2.5 mg to 5 mg every 4 hours, or 7.5 mg every 6 to 8 hours. * **Maximum Dose:** Generally not to exceed 30 mg in 24 hours. * **Ages under 2 years:** Use is generally not recommended due to risk of serious side effects. Consult a pediatrician. ## Dose Adjustments No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. ## Contraindications * Hypersensitivity to dextromethorphan. * Use within 14 days of MAO inhibitors or within 14 days of stopping MAO inhibitors. * Patients with respiratory depression. ## Adverse Effects * **Common:** Dizziness, drowsiness, nausea, vomiting, stomach upset. * **Serious:** Serotonin syndrome (especially with coadministration of serotonergic agents), confusion, hallucinations, respiratory depression (at supratherapeutic doses). ## Key Drug Interactions * **MAO Inhibitors:** Risk of serotonin syndrome, hypertensive crisis. * **Serotonergic Agents (e.g., SSRIs, SNRIs, triptans, tramadol):** Increased risk of serotonin syndrome. * **CNS Depressants (e.g., alcohol, benzodiazepines, opioids):** Additive CNS depression. * **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, increasing risk of adverse effects. ## Monitoring * Monitor for efficacy (cough reduction). * Monitor for adverse effects, particularly dizziness, drowsiness, and signs of serotonin syndrome. ## Clinical Pearls * Dextromethorphan is present in many combination cough and cold products; careful review of all ingredients is necessary to avoid duplicative therapy and excessive dosing. * It is not an opioid, but abuse potential exists at supratherapeutic doses. * Effectiveness in children under 6 years of age is debated, and safety concerns exist. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions. This information does not replace professional medical judgment.*