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# Dextromethorphan
## Overview
Dextromethorphan is a cough suppressant (antitussive) that acts centrally on the cough center in the medulla oblongata.
## Primary Indications
Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Oral:** 10 mg to 30 mg every 4 hours, or 60 mg every 6 to 8 hours.
* **Maximum:** 120 mg per 24 hours.
## Pediatric Dosing
* **Ages 12 years and older:** Same as adult dosing.
* **Ages 6 to 11 years:** 7.5 mg to 15 mg every 4 hours, or 30 mg every 6 to 8 hours. Maximum: 60 mg per 24 hours.
* **Ages 2 to 5 years:** 7.5 mg every 4 hours. Maximum: 30 mg per 24 hours.
* **Under 2 years:** Safety and efficacy not established. Consult a pediatrician.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised and prolonged use should be avoided in severe impairment.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAO inhibitors or other serotonergic agents (risk of serotonin syndrome).
* Children under 2 years of age (unless under direct medical supervision).
## Adverse Effects
Common: Dizziness, drowsiness, nausea, vomiting, nervousness.
Serious: Serotonin syndrome (especially with co-administration of serotonergic agents), respiratory depression (at high doses), allergic reactions.
## Key Drug Interactions
* **MAO inhibitors and other serotonergic agents (SSRIs, SNRIs, triptans):** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** Can increase dextromethorphan plasma concentrations, potentially leading to increased adverse effects.
* **Alcohol and CNS depressants:** Potentiate sedative effects.
## Monitoring
* Effectiveness of cough suppression.
* Signs and symptoms of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, loss of coordination, nausea, vomiting, diarrhea).
* Signs of CNS depression.
## Clinical Pearls
* Dextromethorphan is available in various formulations (syrups, lozenges, tablets, capsules). Choose formulation based on patient preference and age.
* While effective for cough suppression, it does not treat the underlying cause of the cough.
* High doses can be abused for their dissociative and euphoric effects; counsel patients on appropriate use.
* Many over-the-counter combination cold products contain dextromethorphan; be aware of total daily dose if multiple products are used.
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*This information is intended for healthcare professionals. Please verify current prescribing information and consult additional resources before making clinical decisions.*
