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# Dextromethorphan
## Overview
Dextromethorphan is an antitussive (cough suppressant) that acts centrally on the cough center in the medulla. It is available in various over-the-counter formulations, often in combination with other ingredients.
## Primary Indications
* Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Immediate-release:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours.
* **Maximum dose:** 120 mg in 24 hours.
* **Extended-release:** 60 mg every 12 hours.
* **Maximum dose:** 120 mg in 24 hours.
Dosing for combination products will vary based on the other active ingredients.
## Pediatric Dosing
Dextromethorphan is not recommended for use in children under 2 years of age due to potential for serious adverse effects.
* **Ages 2-5 years:** 2.5 mg to 7.5 mg every 4-6 hours as needed. Maximum 30 mg in 24 hours. (Often available in pediatric liquid formulations).
* **Ages 6-11 years:** 5 mg to 10 mg every 4-6 hours as needed. Maximum 60 mg in 24 hours.
* **Ages 12 years and older:** Dosing as per adult recommendations.
Specific dosing for children depends on the product formulation and concentration. Always use the provided measuring device.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, though caution may be advised in severe disease.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Concomitant use with MAO inhibitors (within 14 days).
* Use in children under 2 years of age.
## Adverse Effects
* Dizziness
* Drowsiness
* Nausea
* Vomiting
* Constipation
* Nervousness
* Agitation
Higher doses can lead to central nervous system depression, hallucinations, respiratory depression, and serotonin syndrome.
## Key Drug Interactions
* **MAO Inhibitors:** Increased risk of serotonin syndrome, hypertensive crisis.
* **SSRIs, SNRIs, TCAs, triptans, other serotonergic agents:** Increased risk of serotonin syndrome.
* **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, leading to increased risk of adverse effects.
* **CNS Depressants (e.g., alcohol, benzodiazepines, opioids):** Additive CNS depression.
## Monitoring
* Monitor for efficacy in cough suppression.
* Monitor for signs and symptoms of serotonin syndrome, especially with concomitant serotonergic agents.
* Monitor for adverse effects such as dizziness and drowsiness.
## Clinical Pearls
* Dextromethorphan is often found in combination products; always review all active ingredients to avoid duplication and potential adverse effects.
* Extended-release formulations should not be crushed or chewed.
* Consider the potential for abuse, especially in adolescents and young adults.
* Discontinue use if cough persists for more than 7 days, recurs, or is accompanied by fever, rash, or persistent headache.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant guidelines before making any clinical decisions. Dosing and recommendations may vary based on specific product formulations, patient factors, and local protocols.*
