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# Dextromethorphan (as in "D%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520cold")
## Overview
Dextromethorphan is a cough suppressant (antitussive). It acts centrally on the cough center in the medulla oblongata.
## Primary Indications
Temporary relief of cough due to minor throat and bronchial irritation associated with the common cold and similar conditions.
## Adult Dosing
* **Immediate-release:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours.
* **Extended-release:** 60 mg every 12 hours.
* Maximum: Generally not to exceed 120 mg in 24 hours for immediate-release products, or as directed by product labeling for extended-release.
## Pediatric Dosing
Dextromethorphan is **not recommended for cough associated with the common cold in children under 6 years of age**.
* **Ages 6 to 11 years:**
* **Immediate-release:** 5 mg to 10 mg every 4 hours, or 15 mg every 6 to 8 hours.
* **Extended-release:** 30 mg every 12 hours.
* **Ages 12 years and older:** Dosing as per adult recommendations.
Dosing may vary based on specific product formulation and local pediatric protocols. Always consult product labeling or pediatric guidelines.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, however, caution may be advised in severe impairment.
## Contraindications
* Use in children under 6 years of age.
* Concurrent use with MAO inhibitors or within 14 days of discontinuing MAO inhibitors.
* Hypersensitivity to dextromethorphan.
## Adverse Effects
Common: Dizziness, drowsiness, nausea, vomiting, constipation.
Less Common: Confusion, nervousness, restlessness, hallucinations.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of serotonin syndrome.
* **SSRIs, SNRIs, Tricyclic Antidepressants, Triptans, Opioids:** Increased risk of serotonin syndrome.
* **CYP2D6 Inhibitors (e.g., quinidine, fluoxetine, paroxetine):** May increase dextromethorphan plasma concentrations, potentially leading to increased adverse effects.
* **CNS Depressants (e.g., alcohol, benzodiazepines):** Additive CNS depression.
## Monitoring
* Monitor for effectiveness of cough suppression.
* Monitor for adverse effects, especially CNS effects and signs of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, muscle stiffness, loss of coordination).
## Clinical Pearls
* Dextromethorphan is available in many over-the-counter combination products. Be aware of other active ingredients (e.g., acetaminophen, decongestants, antihistamines) and their potential interactions and side effects.
* For children under 6 years, non-pharmacological measures or consultation with a healthcare provider is recommended for cough.
* While generally considered safe, abuse potential exists with higher doses for recreational purposes.
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*This information is intended for clinical decision support and does not replace comprehensive drug information resources. Always verify current prescribing information and consult relevant guidelines before making therapeutic decisions.*
