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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 formulations, often combined with other ingredients for symptomatic relief of cold and cough symptoms.
## Primary Indications
Symptomatic relief of cough due to common cold, bronchitis, or other minor respiratory irritations.
## Adult Dosing
* **Oral:** 10 mg to 20 mg every 4 hours, or 30 mg every 6-8 hours.
* **Maximum dose:** 120 mg in 24 hours.
## Pediatric Dosing
* **Ages 6-11 years:** 5 mg to 10 mg every 4 hours, or 15 mg every 6-8 hours.
* **Maximum pediatric dose (6-11 years):** 60 mg in 24 hours.
* **Ages under 6 years:** Use is generally not recommended due to risk of serious side effects. Consult product labeling or pediatrician.
## Dose Adjustments
No specific dose adjustments are routinely recommended for renal or hepatic impairment, however, caution and potentially reduced dosing may be considered in severe hepatic impairment.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of a monoamine oxidase inhibitor (MAOI) due to risk of serotonin syndrome.
* Use in children under 6 years of age for cough suppression.
## Adverse Effects
Common adverse effects include dizziness, drowsiness, nausea, and vomiting. Less common effects include confusion, hallucinations, and respiratory depression (especially at higher doses or in combination products).
## Key Drug Interactions
* **Monoamine Oxidase Inhibitors (MAOIs):** Risk of serotonin syndrome.
* **Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs), Triptans, Opioids, St. John's Wort:** Increased risk of serotonin syndrome.
* **CYP2D6 Inhibitors (e.g., quinidine, fluoxetine, paroxetine, bupropion):** May increase dextromethorphan plasma concentrations, leading to increased risk of adverse effects.
## Monitoring
Monitor for cough suppression effectiveness and for signs/symptoms of adverse effects, particularly serotonin syndrome (agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, tremors, sweating, diarrhea).
## Clinical Pearls
* Dextromethorphan is often found in combination products with decongestants, antihistamines, and expectorants; ensure appropriate selection based on patient symptoms and avoid duplication of ingredients.
* Overuse or abuse can lead to psychoactive effects and potential toxicity.
* In children, serious adverse effects like central nervous system depression, hallucinations, and respiratory depression have been reported, especially with large ingestions or in younger children.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions. Drug availability and dosing may vary by region and formulation.
