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# Dextromethorphan ## Overview Dextromethorphan is an antitussive (cough suppressant) agent that acts centrally on the cough center in the medulla. It is available in various formulations, often combined with other ingredients in over-the-counter (OTC) cold and cough products. ## Primary Indications Symptomatic relief of cough due to minor throat and bronchial irritation. ## Adult Dosing * **Oral:** * Immediate-release: 10-20 mg every 4 hours, or 30 mg every 6-8 hours. * Extended-release: 60 mg every 12 hours. * **Maximum daily dose:** Generally 120 mg for immediate-release and 120 mg for extended-release formulations, but consult product labeling. ## Pediatric Dosing * **Oral:** Dosing varies significantly by age and product formulation. Strict adherence to product labeling is essential. * **Children 2 to under 6 years:** Dosing typically ranges from 2.5 mg to 7.5 mg every 4-6 hours, or 15 mg every 6-8 hours for extended-release. Maximum daily dose not to exceed 30 mg for immediate-release. **Consult specific product labeling.** * **Children 6 to under 12 years:** Dosing typically ranges from 5 mg to 15 mg every 4-6 hours, or 30 mg every 6-8 hours for extended-release. Maximum daily dose not to exceed 60 mg for immediate-release. **Consult specific product labeling.** * **Children under 2 years:** **Contraindicated or use with extreme caution and under medical supervision due to risk of serious adverse effects, including respiratory depression.** ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Dose reduction may be considered, though specific guidelines are lacking. * **Renal Impairment:** No specific dose adjustments are typically recommended, but monitor for adverse effects. ## Contraindications * Hypersensitivity to dextromethorphan. * Use in children under 2 years of age is generally contraindicated due to risk of serious adverse effects. * Concurrent use with or within 14 days of stopping a monoamine oxidase inhibitor (MAOI) due to risk of serotonin syndrome. * Patients with asthma or chronic cough where excessive sputum production is present. ## Adverse Effects * **Common:** Dizziness, drowsiness, nausea, vomiting, nervousness, restlessness. * **Serious:** Serotonin syndrome (especially with co-administration of other serotonergic agents), respiratory depression (particularly in young children or with overdose), confusion, hallucinations, abuse potential. ## Key Drug Interactions * **Monoamine Oxidase Inhibitors (MAOIs):** Contraindicated. Risk of serotonin syndrome. * **Serotonergic Agents (e.g., SSRIs, SNRIs, tricyclic antidepressants, triptans, opioids):** Increased risk of serotonin syndrome. * **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine, ritonavir):** May increase dextromethorphan plasma concentrations, leading to increased risk of toxicity. * **Alcohol:** Additive CNS depression. ## Monitoring * Assess cough frequency and severity. * Monitor for adverse effects, particularly CNS effects and signs of serotonin syndrome. * Evaluate for potential drug interactions. ## Clinical Pearls * Dextromethorphan is primarily for symptomatic relief of cough and does not treat the underlying cause. * Be aware of the potential for abuse and diversion, especially with higher doses or liquid formulations. * Many OTC combination products contain dextromethorphan; carefully review all ingredients to avoid inadvertent duplication or interactions. * Extended-release formulations provide longer-lasting cough suppression. *** **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 product labeling for complete details, including specific contraindications, warnings, precautions, and adverse effects, before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.