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# Dextromethorphan
## Overview
Dextromethorphan is an antitussive (cough suppressant) agent. It acts centrally on the cough center in the medulla oblongata.
## Primary Indications
Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Oral:** 10-20 mg every 4 hours as needed, or 30 mg every 6-8 hours as needed.
* **Maximum:** 120 mg in 24 hours.
## Pediatric Dosing
* **6 to <12 years:** 5-10 mg every 4 hours as needed, or 15 mg every 6-8 hours as needed.
* **Maximum:** 60 mg in 24 hours.
* **4 to <6 years:** 2.5-5 mg every 4 hours as needed, or 7.5 mg every 6-8 hours as needed.
* **Maximum:** 30 mg in 24 hours.
* **Under 4 years:** Not recommended due to risk of serious adverse effects. Safety and efficacy not established.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution and monitoring are advised.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAOI therapy (risk of serotonin syndrome).
* Patients taking selective serotonin reuptake inhibitors (SSRIs) or other serotonergic drugs (increased risk of serotonin syndrome).
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting, stomach pain.
* **Serious:** Serotonin syndrome (especially with concomitant serotonergic agents), respiratory depression (rare at therapeutic doses), abuse/dependence.
## Key Drug Interactions
* **Monoamine Oxidase Inhibitors (MAOIs) and other serotonergic drugs (e.g., SSRIs, SNRIs, triptans, tramadol):** Increased risk of serotonin syndrome.
* **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, potentially leading to increased adverse effects.
* **Alcohol and CNS Depressants:** Additive sedative effects.
## Monitoring
* Monitor for cough suppression effectiveness.
* Monitor for signs and symptoms of serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, muscle rigidity, incoordination, nausea, vomiting, diarrhea).
* Monitor for signs of CNS depression.
## Clinical Pearls
* Dextromethorphan is available in many over-the-counter (OTC) combination products; it is crucial to review the active ingredients of all medications to avoid unintentional overdose or drug interactions.
* Effectiveness for chronic cough is limited.
* Abuse potential exists, particularly with higher doses or formulations with other substances.
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**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider for any medical condition or treatment.
