Please check your internet connection and try again.
# Dextromethorphan
## Overview
Dextromethorphan is an antitussive (cough suppressant) that acts on the cough center in the medulla oblongata. It is available in various formulations, including oral tablets, capsules, liquids, and lozenges.
## Primary Indications
* Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Oral:** Typically 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours.
* **Maximum Dose:** Generally not to exceed 120 mg in 24 hours.
## Pediatric Dosing
* **Ages 12 years and older:** Same as adult dosing.
* **Ages 6 to under 12 years:**
* Oral: 5 mg to 10 mg every 4 hours, or 15 mg every 6 to 8 hours.
* Maximum Dose: Generally not to exceed 60 mg in 24 hours.
* **Ages 4 to under 6 years:** Consult product labeling or healthcare provider. Dosing is highly variable.
* **Under 4 years:** Dextromethorphan is generally not recommended due to potential for serious adverse effects.
## Dose Adjustments
* **Hepatic Impairment:** No specific dose adjustment is typically recommended, but caution is advised. Monitor for increased adverse effects.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of monoamine oxidase inhibitor (MAOI) therapy.
* Use in patients with respiratory depression.
## Adverse Effects
* **Common:** Dizziness, drowsiness, nausea, vomiting, constipation.
* **Serious:** Serotonin syndrome (especially with concurrent serotonergic agents), abuse potential (hallucinations, euphoria, confusion), respiratory depression (rare at therapeutic doses, more common with overdose or in combination products).
## Key Drug Interactions
* **MAOIs (including linezolid, methylene blue):** Risk of serotonin syndrome. Avoid concurrent use.
* **SSRIs, SNRIs, tricyclic antidepressants, triptans, certain opioids (e.g., tramadol), lithium, St. John's Wort:** Increased risk of serotonin syndrome. Monitor closely.
* **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, potentially leading to increased adverse effects.
## Monitoring
* Effectiveness of cough suppression.
* Signs and symptoms of serotonin syndrome.
* Signs of abuse or misuse.
## Clinical Pearls
* Dextromethorphan is often found in combination products with other ingredients (e.g., acetaminophen, decongestants, antihistamines). Ensure the patient is not taking duplicative therapy.
* Dextromethorphan has a potential for abuse, particularly in higher doses. Counsel patients on appropriate use.
* For extended-release formulations, do not crush or chew.
***
*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.*
