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# Dextromethorphan ## Overview Dextromethorphan is a cough suppressant (antitussive) that acts centrally on the cough center in the medulla. It is available as a single agent or in combination products for cold and cough symptoms. ## 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 24 hours. * **Extended-release:** 60 mg every 12 hours. ## Pediatric Dosing * **Ages 12 years and older:** Same as adult dosing. * **Ages 6 to under 12 years:** 7.5 mg to 15 mg every 4 hours, or 15 mg every 6 to 8 hours. Maximum 60 mg per 24 hours. * **Ages 2 to under 6 years:** 7.5 mg every 4 to 6 hours. Maximum 30 mg per 24 hours. * **Note:** Use in children under 2 years is generally not recommended due to risk of serious side effects. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. No specific dose adjustment is established, but consider reduced frequency or dose. ## Contraindications * Concurrent use with MAO inhibitors or within 14 days of discontinuing an MAO inhibitor. * Hypersensitivity to dextromethorphan. * Asthma or other conditions where bronchodilation is potentially hazardous. ## Adverse Effects * **Common:** Dizziness, drowsiness, nausea, vomiting, constipation. * **Serious:** Serotonin syndrome (especially with co-administration of serotonergic agents), respiratory depression (at high doses), abuse/misuse potential. ## Key Drug Interactions * **MAO Inhibitors:** Risk of severe serotonin syndrome. * **SSRIs, SNRIs, Triptans, Opioids, St. John's Wort:** Increased risk of serotonin syndrome. * **CYP2D6 Inhibitors (e.g., quinidine, fluoxetine, paroxetine):** May increase dextromethorphan plasma concentrations, leading to increased risk of toxicity. ## Monitoring * Assess for cough relief and presence of side effects. * Monitor for signs and symptoms of serotonin syndrome if risk factors are present. ## Clinical Pearls * Dextromethorphan is often found in combination products; be mindful of other active ingredients and their potential interactions or contraindications. * Avoid use in children under 6 years unless specifically directed by a healthcare provider due to increased risk of adverse effects. * Long-term use or doses exceeding recommended limits can lead to psychological dependence and abuse. *** *Disclaimer: This information is intended for clinical use and does not replace professional medical advice. Always consult the most current prescribing information and guidelines before making any treatment decisions.*