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# Dextromethorphan
## Overview
Dextromethorphan is an antitussive agent that acts centrally on the cough center in the medulla. It is available in various formulations, including oral solutions, tablets, and capsules, often in combination with other ingredients.
## Primary Indications
* Suppression 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, no more than 60 mg per 24 hours for immediate-release products, though specific product labeling should be consulted. Extended-release maximum is 120 mg per 24 hours.
## Pediatric Dosing
* **Ages 6 to under 12 years:** 7.5 to 15 mg every 4 hours, or 15 mg every 6-8 hours. Extended-release: 30 mg every 12 hours.
* **Ages 4 to under 6 years:** 7.5 mg every 4 hours.
* **Ages 2 to under 4 years:** 5 mg every 4 hours.
* **Note:** Use in children under 2 years is generally not recommended due to risk of serious adverse events. Always consult product labeling for specific age restrictions and dosing.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised, and closer monitoring may be necessary in patients with severe impairment.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAOI therapy (risk of serotonin syndrome).
* Use in children under 4 years of age (specific product labeling should be consulted).
## Adverse Effects
* Drowsiness, dizziness, confusion, nausea, vomiting, constipation.
* At higher doses: hallucinations, euphoria, ataxia, respiratory depression, seizures.
* Serotonin syndrome with coadministration of serotonergic agents.
## Key Drug Interactions
* **MAOIs, SSRIs, SNRIs, triptans, St. John's wort:** Increased risk of serotonin syndrome. Avoid concurrent use or use with extreme caution.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, leading to increased risk of toxicity.
* **Alcohol:** May potentiate CNS depressant effects.
## Monitoring
* Assess cough frequency and severity.
* Monitor for adverse effects, particularly CNS effects and signs of serotonin syndrome.
## Clinical Pearls
* Dextromethorphan is widely available over-the-counter, but it's crucial to be aware of potential drug interactions, especially with serotonergic agents.
* Dextromethorphan abuse is a concern; educate patients on appropriate use and potential dangers of overdose.
* Combination products may contain other active ingredients (e.g., acetaminophen, decongestants, antihistamines) which have their own dosing and safety profiles. Always check the full ingredient list.
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**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 literature before making clinical decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.
