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# Dextromethorphan
## Overview
Dextromethorphan is an antitussive agent that acts centrally on the cough center in the medulla. It is available in various formulations, including tablets, capsules, liquids, and lozenges.
## Primary Indications
* Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Oral:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours.
* **Maximum:** Do not exceed 120 mg in 24 hours. Extended-release formulations have different dosing schedules and maximums.
## 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:** Do not exceed 60 mg in 24 hours.
* **Ages under 6 years:** Use is generally not recommended due to increased risk of adverse effects and lack of established efficacy. Consult 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.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of starting or stopping a monoamine oxidase inhibitor (MAOI) due to risk of serotonin syndrome.
* Use in patients with respiratory depression.
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting.
* **Serious:** Serotonin syndrome (especially with concomitant serotonergic agents), confusion, hallucinations, abuse potential.
## Key Drug Interactions
* **Monoamine Oxidase Inhibitors (MAOIs):** Risk of serotonin syndrome.
* **Serotonergic agents (SSRIs, SNRIs, triptans, tramadol):** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan levels, increasing the risk of adverse effects.
* **Alcohol:** May increase CNS depressant effects.
## Monitoring
* Monitor for signs and symptoms of serotonin syndrome, especially in patients on other serotonergic medications.
* Assess cough relief and for adverse effects.
## Clinical Pearls
* Dextromethorphan is often found in combination products for cold and cough symptoms. Be aware of the active ingredients in combination products to avoid duplication and excessive dosing.
* The abuse potential of dextromethorphan, particularly in higher doses, is a significant concern.
* Effectiveness may vary between individuals.
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*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information with the latest official drug product labeling and consult with a qualified healthcare provider for any medical decisions.*
