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# Dextromethorphan ## Overview Dextromethorphan is an antitussive (cough suppressant) that acts centrally on the cough center in the medulla. It is available in various formulations, often combined with other medications for cold and cough symptoms. ## 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 as needed. * **Maximum:** 120 mg in 24 hours. * **Extended-release:** 60 mg every 12 hours. * **Maximum:** 120 mg in 24 hours. ## Pediatric Dosing * **Ages 12 years and older:** Same as adult dosing. * **Ages 6 to under 12 years:** * Immediate-release: 5-10 mg every 4 hours or 15 mg every 6-8 hours as needed. * Maximum: 60 mg in 24 hours. * Extended-release: 30 mg every 12 hours. * Maximum: 60 mg in 24 hours. * **Ages 4 to under 6 years:** * Immediate-release: 2.5-5 mg every 4 hours or 7.5 mg every 6-8 hours as needed. * Maximum: 30 mg in 24 hours. * **Ages 2 to under 4 years:** Dosing should be guided by a healthcare provider. *Note: Use in children under 6 years of age should be under the guidance of a healthcare provider due to potential for serious side effects.* ## Dose Adjustments No specific dose adjustments are typically required for renal or hepatic impairment, but caution and closer monitoring may be warranted in severe cases. ## Contraindications * Hypersensitivity to dextromethorphan. * Use within 14 days of MAO inhibitor therapy. ## Adverse Effects * Common: Drowsiness, dizziness, nausea, vomiting, constipation. * Serious: Serotonin syndrome (especially with co-administration of serotonergic agents), abuse potential leading to euphoria, hallucinations, respiratory depression, and coma at very high doses. ## Key Drug Interactions * **MAO inhibitors:** Risk of hypertensive crisis or serotonin syndrome. * **Serotonergic agents (SSRIs, SNRIs, triptans, etc.):** Increased risk of serotonin syndrome. * **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, increasing the risk of toxicity. * **CNS depressants (e.g., alcohol, benzodiazepines, opioids):** Additive CNS depression. ## Monitoring * Assess effectiveness for cough suppression. * Monitor for signs and symptoms of serotonin syndrome, especially in patients taking other serotonergic medications. * Monitor for CNS side effects like drowsiness and dizziness. * Assess for signs of abuse or misuse. ## Clinical Pearls * Dextromethorphan is an effective cough suppressant but does not treat the underlying cause of the cough. * Extended-release formulations should not be crushed or chewed. * Be aware of the potential for abuse and dependence, particularly with higher doses or concentrated formulations. * Many over-the-counter cold and cough preparations contain dextromethorphan; patients should be advised to read labels carefully to avoid duplication and potential overdose. * The risk of serotonin syndrome is significant when combined with other serotonergic drugs. *** **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 a qualified healthcare provider for any questions regarding medication use.