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# Dextromethorphan
## Overview
Dextromethorphan is a cough suppressant (antitussive) that acts centrally on the cough center in the medulla. It is available in various formulations, including immediate-release and extended-release, and in combination with other medications for cold and cough symptoms.
## Primary Indications
* Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Immediate-Release:**
* 10 mg to 20 mg every 4 hours as needed, OR
* 30 mg every 6 to 8 hours as needed.
* Maximum: 120 mg per 24 hours.
* **Extended-Release:**
* 60 mg every 12 hours.
* Maximum: 120 mg per 24 hours.
## Pediatric Dosing
* **Ages 6 to under 12 years:**
* Immediate-Release: 5 mg to 10 mg every 4 hours as needed, OR 15 mg every 6 to 8 hours as needed.
* Maximum: 60 mg per 24 hours.
* **Ages 4 to under 6 years:**
* Immediate-Release: 5 mg every 4 hours as needed.
* Maximum: 30 mg per 24 hours.
* **Dosing for children under 4 years is generally not recommended due to risk of serious adverse events.**
## Dose Adjustments
* No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Clinical judgment should guide dosing in these populations.
## Contraindications
* Hypersensitivity to dextromethorphan or any component of the formulation.
* Use within 14 days of MAOI therapy (risk of serotonin syndrome).
* Use in patients with severe hepatic impairment.
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting.
* **Less Common:** Confusion, hallucinations, abuse potential.
* **Serious:** Serotonin syndrome (especially with concomitant serotonergic agents), respiratory depression (rare at therapeutic doses).
## Key Drug Interactions
* **Monoamine Oxidase Inhibitors (MAOIs):** Increased risk of serotonin syndrome. Avoid concurrent use and within 14 days of MAOI discontinuation.
* **Serotonergic Agents (e.g., SSRIs, SNRIs, triptans, tramadol):** Increased risk of serotonin syndrome. Monitor closely for signs and symptoms.
* **CYP2D6 Inhibitors (e.g., quinidine, fluoxetine, paroxetine):** May increase dextromethorphan plasma concentrations, potentially leading to increased adverse effects.
## Monitoring
* Monitor for effectiveness (cough suppression).
* Monitor for adverse effects, especially dizziness, drowsiness, nausea, vomiting, and signs of serotonin syndrome.
## Clinical Pearls
* Dextromethorphan is generally considered effective for acute, non-productive cough. Its efficacy for chronic cough is less established.
* Be aware of the abuse potential, particularly in adolescents and young adults, due to dissociative effects at supratherapeutic doses.
* Many over-the-counter combination products contain dextromethorphan. Review all ingredients to avoid duplication and potential drug interactions.
* When using combination products, ensure the dosing aligns with the dextromethorphan component and other active ingredients.
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*This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and safety information may vary by specific product formulation and patient factors.*
