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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 in various oral formulations, including liquids, capsules, and lozenges.
## Primary Indications
* Suppression of cough associated with the common cold, bronchitis, and other minor throat and bronchial irritations.
## Adult Dosing
* **Oral:** 10 mg to 30 mg every 4 hours, or 20 mg to 30 mg every 6 to 8 hours.
* **Maximum Dose:** Typically 120 mg per 24 hours. Extended-release formulations may have different dosing schedules (e.g., 60 mg every 12 hours).
## Pediatric Dosing
* **Ages 6 to under 12 years:** 5 mg to 10 mg every 4 hours, or 15 mg every 6 to 8 hours. Maximum dose typically 60 mg per 24 hours.
* **Ages 4 to under 6 years:** 2.5 mg to 5 mg every 4 hours, or 7.5 mg every 6 to 8 hours. Maximum dose typically 30 mg per 24 hours.
* **Ages under 4 years:** Not recommended for children under 4 years of age due to risk of serious adverse effects, including respiratory depression. Use should be guided by a healthcare professional.
## Dose Adjustments
* No specific dose adjustments are typically required for renal or hepatic impairment, but caution and lower doses may be considered in severe cases.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAO inhibitor therapy.
* Concurrent use with certain selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may increase the risk of serotonin syndrome (discuss in interactions).
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting, nervousness, confusion.
* **Serious:** Respiratory depression (especially at supratherapeutic doses), serotonin syndrome (when combined with serotonergic agents), potential for abuse and misuse.
## Key Drug Interactions
* **MAO Inhibitors:** Potentially fatal serotonin syndrome. Avoid concurrent use.
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome. Monitor closely for signs and symptoms.
* **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, leading to increased risk of adverse effects.
* **Alcohol and CNS Depressants:** Additive CNS depression.
## Monitoring
* Monitor for signs of adverse effects, particularly confusion, dizziness, and respiratory changes.
* In patients taking serotonergic agents, monitor for symptoms of serotonin syndrome (e.g., agitation, hallucinations, rapid heart rate, fever, muscle rigidity, tremor).
## Clinical Pearls
* Dextromethorphan is present in many combination cold and cough products; review ingredients carefully to avoid duplicate therapy and potential overdose.
* Be aware of the potential for abuse and diversion, particularly with liquid formulations and high doses.
* Effectiveness for cough suppression is variable and often modest.
* Consider non-pharmacologic interventions for cough.
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***Disclaimer:** This information is for educational purposes only and does not substitute professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your specific condition. Verify current prescribing information and guidelines before making any treatment decisions.*
