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# Dextromethorphan
## Overview
Dextromethorphan is an antitussive agent that acts centrally on the cough center in the medulla oblongata. It is available in various formulations, often in combination with other ingredients for symptomatic relief of cough and cold symptoms.
## Primary Indications
* Symptomatic relief of cough due to common cold, upper airway cough syndrome, or other minor throat and bronchial irritations.
## Adult Dosing
* **Immediate-release:** 10-20 mg every 4 hours, or 30 mg every 6-8 hours. Maximum daily dose is typically 120 mg.
* **Extended-release:** 60 mg every 12 hours. Maximum daily dose is typically 120 mg.
* Specific dosing may vary significantly based on the product formulation and combination products. Always refer to the product label.
## Pediatric Dosing
* **6 years to less than 12 years:** 5-10 mg every 4 hours, or 15 mg every 6-8 hours. Maximum daily dose is typically 60 mg.
* **12 years and older:** Dosing is the same as adults.
* **Less than 6 years:** Dextromethorphan is generally not recommended for children under 6 years of age due to safety concerns 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 the lowest effective dose should be used.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAO inhibitor therapy.
* Use in patients with significant respiratory impairment, such as asthma or COPD, as cough suppression can be detrimental.
## Adverse Effects
* Drowsiness, dizziness, nausea, vomiting, nervousness, confusion.
* High doses can lead to euphoria, hallucinations, and respiratory depression.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of serotonin syndrome.
* **SSRIs, SNRIs, Tricyclic Antidepressants, Opioids, Triptans, Buspirone, Tramadol:** Increased risk of serotonin syndrome due to additive serotonergic effects.
* **CYP2D6 Inhibitors (e.g., quinidine, fluoxetine, paroxetine):** May increase dextromethorphan plasma concentrations, leading to increased risk of toxicity.
## Monitoring
* Monitor for effectiveness in cough suppression.
* Monitor for adverse effects, especially confusion, agitation, and signs of serotonin syndrome.
## Clinical Pearls
* Dextromethorphan is often found in combination products; assess all ingredients to avoid duplication and ensure appropriate therapy.
* Advise patients to avoid driving or operating heavy machinery until they know how dextromethorphan affects them.
* Be aware of the potential for abuse of dextromethorphan, particularly in liquid formulations.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult with a pharmacist or physician for specific patient care decisions.*
