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# Dextromethorphan
## Overview
Dextromethorphan is a cough suppressant (antitussive) that acts on the cough center in the medulla oblongata. It is available in various oral formulations, including solutions, syrups, capsules, and lozenges.
## Primary Indications
* Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Immediate-release formulations:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours.
* **Maximum dose:** 120 mg per 24 hours.
* **Extended-release formulations:** Dosing varies by product; follow manufacturer instructions. Common doses include 60 mg every 12 hours.
## Pediatric 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 dose:** 60 mg per 24 hours.
* **Ages under 6 years:** Use is generally not recommended due to risk of serious adverse effects and lack of established safety/efficacy. Consult product labeling or pediatrician.
## Dose Adjustments
* No specific dose adjustments are typically required for renal or hepatic impairment, but caution and lower doses may be considered in patients with severe impairment.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of initiating or discontinuing a monoamine oxidase inhibitor (MAOI), including certain antidepressants and antiparkinsonian agents.
* Use in young children (generally under 6 years).
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting, constipation.
* **Serious:** Serotonin syndrome (especially with coadministration of serotonergic agents), confusion, hallucinations, respiratory depression (at high doses).
## Key Drug Interactions
* **MAOIs:** Potentially fatal serotonin syndrome. Avoid coadministration.
* **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.
## Monitoring
* Monitor for signs and symptoms of serotonin syndrome (agitation, confusion, rapid heart rate, dilated pupils, loss of muscle coordination, muscle rigidity, heavy sweating, diarrhea).
* Assess cough severity and relief.
## Clinical Pearls
* Dextromethorphan is often combined with other ingredients in over-the-counter cold and cough preparations (e.g., acetaminophen, guaifenesin, decongestants, antihistamines). Be aware of the active ingredients in combination products to avoid duplication and potential overdose.
* Dextromethorphan has potential for abuse; counsel patients on appropriate use and storage.
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**Disclaimer:** This information is intended for clinical use and does not replace comprehensive drug information resources. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.
