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# Dextromethorphan Hydrobromide
## Overview
Dextromethorphan hydrobromide is a cough suppressant (antitussive) that acts centrally on the cough center in the medulla. It is available in various formulations, including oral tablets, capsules, syrups, and lozenges.
## Primary Indications
* Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Tablets/Capsules:** 10 mg to 30 mg every 4 to 12 hours as needed.
* **Liquid/Syrups:** 10 mg to 20 mg per 5 mL (or equivalent concentration) every 4 to 12 hours as needed.
* **Maximum dose:** Generally 120 mg in 24 hours. Specific product maximums may vary.
## Pediatric Dosing
* **Ages 12 years and older:** Same as adult dosing.
* **Ages 6 to 11 years:** 5 mg to 10 mg every 4 to 12 hours as needed. Maximum 60 mg in 24 hours.
* **Ages 4 to 5 years:** 5 mg every 4 to 12 hours as needed. Maximum 30 mg in 24 hours.
* **Ages 2 to 3 years:** 2.5 mg to 5 mg every 4 to 12 hours as needed. Maximum 15 mg in 24 hours.
* **Dosing for children under 4 years:** Not recommended without physician guidance due to potential for serious adverse effects. Always use product specifically formulated for pediatric use and follow package directions or physician advice.
## Dose Adjustments
* No specific dose adjustments are typically required for renal or hepatic impairment, but caution and monitoring are advised.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAO inhibitor therapy.
* Concomitant use with certain selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and other drugs that affect serotonin levels may increase the risk of serotonin syndrome.
## Adverse Effects
* Dizziness, drowsiness, nausea, vomiting, constipation.
* At higher doses: Confusion, hallucinations, respiratory depression, serotonin syndrome (especially with concurrent serotonergic agents).
## Key Drug Interactions
* **MAO Inhibitors:** Contraindicated; risk of severe hypertensive crisis or serotonin syndrome.
* **SSRIs, SNRIs, TCAs, Bupropion, Tramadol:** Increased risk of serotonin syndrome.
* **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, potentially leading to increased toxicity.
## Monitoring
* Monitor for effectiveness in cough suppression.
* Monitor for signs and symptoms of serotonin syndrome (agitation, confusion, rapid heart rate, dilated pupils, loss of muscle coordination, rigid muscles, sweating, diarrhea, headache, shivering, tremors).
* Monitor for CNS side effects (dizziness, drowsiness) and adjust dose or discontinue if severe.
## Clinical Pearls
* Dextromethorphan is a common ingredient in many combination cold and cough products; be aware of cumulative dosing if multiple products are used.
* Effectiveness for chronic cough is limited.
* Abuse potential exists, particularly with high doses or in combination with other substances.
* Not recommended for use in patients with persistent or chronic cough, or cough accompanied by excessive secretions, unless directed by a physician.
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**Disclaimer:** This information is intended for healthcare professionals and should not replace comprehensive drug information resources or professional judgment. Always consult the most current prescribing information, relevant guidelines, and institutional protocols before making any treatment decisions.
