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# Dextromethorphan Hydrobromide (DM)
## Overview
Dextromethorphan hydrobromide is a cough suppressant (antitussive) that acts on the cough center in the medulla oblongata. It is available in various formulations, including oral solutions, syrups, capsules, and lozenges.
## Primary Indications
Symptomatic relief of cough due to common cold, influenza, or other minor throat and bronchial irritations.
## Adult Dosing
* **Immediate-release:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours.
* **Maximum:** Typically 120 mg per 24 hours. Specific maximums may vary by product formulation.
## 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: Typically 60 mg per 24 hours.
* **Ages 4 to under 6 years:** 5 mg to 10 mg every 4 hours, or 7.5 mg every 6 to 8 hours. Maximum: Typically 30 mg per 24 hours.
* **Ages under 4 years:** Use is generally not recommended due to risks of serious adverse effects. Consult product labeling or a pediatrician.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised, and lower doses may be considered. Consult product labeling.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of starting or stopping a monoamine oxidase inhibitor (MAOI) due to risk of serotonin syndrome.
* Not recommended for chronic cough or as a pre-operative medication.
## Adverse Effects
Common: Drowsiness, dizziness, nausea, vomiting, constipation.
Serious: Serotonin syndrome (especially with concomitant serotonergic agents), respiratory depression (at high doses), abuse potential.
## Key Drug Interactions
* **MAOIs:** Contraindicated.
* **Serotonergic agents (e.g., SSRIs, SNRIs, triptans, tramadol):** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, increasing the risk of adverse effects.
* **Alcohol:** May potentiate CNS depressant effects.
## Monitoring
Monitor for cough suppression effectiveness and for signs and symptoms of adverse effects, particularly serotonin syndrome, especially in patients with risk factors or taking interacting medications.
## Clinical Pearls
* Dextromethorphan is often found in combination products; ensure the patient is not taking other products containing dextromethorphan to avoid exceeding maximum daily doses.
* While effective for symptomatic relief, it does not treat the underlying cause of the cough.
* Abuse potential exists, particularly with higher doses or specific formulations.
* Consider alternatives for patients with significant hepatic impairment or those on MAOIs.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making treatment decisions. Drug formulations and recommendations can change.
