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# Dextromethorphan (DM) Cold ## 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 agents for cold and cough relief. ## Primary Indications * Symptomatic relief of cough due to minor throat and bronchial irritation. ## Adult Dosing * **Immediate-release:** 10-20 mg every 4 hours, or 30 mg every 6-8 hours. * **Extended-release:** 60 mg every 12 hours. * **Maximum:** Generally 120 mg per 24 hours for immediate-release formulations, or as directed by product labeling. ## Pediatric Dosing * **Ages 12 years and older:** Same as adult dosing. * **Ages 6 to under 12 years:** 7.5-10 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 10 mg every 6-8 hours. Maximum: 30 mg per 24 hours. * **Ages 2 to under 4 years:** Dosing varies significantly by product and is often not recommended by manufacturers. Consult specific product labeling or a pediatrician. **Not recommended for children under 2 years of age.** ## Dose Adjustments * **Hepatic Impairment:** Caution may be advised, but specific dose adjustments are not well-established for over-the-counter use. ## Contraindications * Hypersensitivity to dextromethorphan. * Use within 14 days of a monoamine oxidase inhibitor (MAOI) or within 14 days of stopping an MAOI. * Use in children under 2 years of age. ## Adverse Effects * Drowsiness, dizziness, nausea, vomiting, constipation. * Potential for abuse and dependence, especially at higher doses. * Serotonin syndrome (rare, but increased risk with concurrent serotonergic agents). ## Key Drug Interactions * **MAOIs (e.g., phenelzine, selegiline):** Contraindicated due to risk of serotonin syndrome. * **SSRIs (e.g., fluoxetine, sertraline), SNRIs (e.g., venlafaxine, duloxetine), triptans, other serotonergic agents:** Increased risk of serotonin syndrome. * **Alcohol, CNS depressants:** Additive sedative effects. * **CYP2D6 inhibitors (e.g., quinidine, fluoxetine):** May increase dextromethorphan plasma concentrations, potentially increasing adverse effects. ## Monitoring * Monitor for effectiveness in cough suppression. * Monitor for adverse effects, particularly drowsiness and signs of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, muscle stiffness, tremors). ## Clinical Pearls * Dextromethorphan is commonly found in combination products for cough and cold symptoms. Ensure patients are aware of all active ingredients in multi-symptom formulations to avoid duplicate therapy or unintended side effects. * Extended-release formulations should not be crushed or chewed. * While effective for cough suppression, it does not treat the underlying cause of the cough. * Advise patients to consult a healthcare provider if cough persists for more than 7 days, is accompanied by fever, rash, or persistent headache. *** *Please verify current prescribing information and local protocols before initiating treatment.*