D%25252525252525252525252525252525252525252525252525252525252525252525252525252525252520cold

# 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 immediate-release and extended-release, and as a combination product with other ingredients. ## Primary Indications * Symptomatic relief of cough. ## Adult Dosing * **Immediate-release:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours. Maximum: 120 mg per day. * **Extended-release:** 60 mg every 12 hours. Maximum: 120 mg per day. Dosing for combination products will vary based on the specific formulation and co-administered ingredients. ## Pediatric Dosing * **Children 6 to 12 years:** 5 mg to 10 mg every 4 hours, or 15 mg every 6 to 8 hours. Maximum: 60 mg per day. * **Children 2 to 6 years:** Dosing is generally not recommended for this age group without physician guidance. If used, typically 2.5 mg to 5 mg every 4 hours, or 7.5 mg every 6 to 8 hours. Maximum: 30 mg per day. * **Children under 2 years:** Generally contraindicated due to risk of serious adverse effects. Always refer to product-specific labeling for pediatric dosing, as recommendations can vary significantly. ## Dose Adjustments No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Monitor patients closely for increased adverse effects. ## Contraindications * Hypersensitivity to dextromethorphan. * Concurrent use with or within 2 weeks of MAO inhibitors. * Use in children under 2 years of age. ## Adverse Effects Common: Dizziness, drowsiness, nausea, vomiting, constipation. Less Common: Confusion, hallucinations, serotonin syndrome (especially with concomitant serotonergic agents). ## Key Drug Interactions * **MAO Inhibitors:** Risk of hypertensive crisis. Avoid concurrent use. * **Serotonergic Agents (e.g., SSRIs, SNRIs, triptans, tramadol):** Increased risk of serotonin syndrome. Use with caution and monitor for symptoms. * **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 * Effectiveness of cough suppression. * Signs and symptoms of adverse effects, particularly serotonin syndrome. ## Clinical Pearls * Dextromethorphan is found in many over-the-counter (OTC) combination cold and cough products. Carefully review all ingredients to avoid inadvertent duplication and potential adverse events. * Consider non-pharmacologic measures for cough relief (e.g., hydration, honey for adults and children over 1 year). * Advise patients to avoid alcohol and other CNS depressants while taking dextromethorphan. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and safety information can change.*