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# D%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520cold
## Overview
Dextromethorphan hydrobromide is a cough suppressant (antitussive) that acts on the cough center in the medulla oblongata. It is available over-the-counter in various formulations, often combined with other ingredients for symptomatic relief of cold and cough symptoms.
## Primary Indications
* Symptomatic relief of cough.
## Adult Dosing
* **Immediate-release:** 10-20 mg every 4 hours, or 30 mg every 6-8 hours.
* **Maximum:** 120 mg per 24 hours.
* Specific dosing may vary based on product formulation and combination ingredients. Follow product labeling or local protocol.
## Pediatric Dosing
* **Ages 12 years and older:** Same as adult dosing.
* **Ages 6 to under 12 years:** 5-10 mg every 4 hours, or 15 mg every 6-8 hours.
* **Maximum:** 60 mg per 24 hours.
* **Ages 4 to under 6 years:** 5 mg every 4 hours, or 7.5 mg every 6-8 hours.
* **Maximum:** 30 mg per 24 hours.
* **Ages under 4 years:** **Not recommended** due to potential for serious adverse effects. Use should be guided by a healthcare professional.
## Dose Adjustments
* No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, and lower doses may be considered, especially in severe impairment.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of initiating or discontinuing an MAO inhibitor.
* Concurrent use with SSRIs, SNRIs, tricyclic antidepressants, or other serotonergic drugs may increase the risk of serotonin syndrome.
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting, constipation.
* **Serious:** Serotonin syndrome (especially with concomitant serotonergic agents), confusion, hallucinations, respiratory depression (at high doses). Abuse potential exists.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of hypertensive crisis and serotonin syndrome.
* **SSRIs, SNRIs, Tricyclic Antidepressants, Bupropion:** Increased risk of serotonin syndrome.
* **CYP2D6 Inhibitors (e.g., quinidine, fluoxetine, paroxetine):** May increase dextromethorphan plasma concentrations, increasing risk of toxicity.
* **Alcohol:** Additive CNS depression.
## Monitoring
* Monitor for efficacy in cough suppression.
* Monitor for adverse effects, particularly CNS effects and signs of serotonin syndrome.
## Clinical Pearls
* Dextromethorphan is often combined with other agents (e.g., decongestants, antihistamines, expectorants, analgesics) in over-the-counter products. Be aware of the total daily dose of each component and potential drug interactions.
* Advise patients to avoid driving or operating machinery until they know how dextromethorphan affects them.
* Educate on the risks of abuse and diversion.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. Dosing and recommendations may vary.*
