Please check your internet connection and try again.
# Dextromethorphan-Containing Products
## Overview
Dextromethorphan is a cough suppressant (antitussive) that acts on the cough center in the medulla. It is available in various formulations, often in combination with other over-the-counter ingredients like decongestants, antihistamines, analgesics, and expectorants.
## Primary Indications
Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Dextromethorphan HBr:** Typical dosage is 10-20 mg every 4 hours, or 30 mg every 6-8 hours.
* **Maximum dose:** Generally 120 mg in 24 hours. Specific product labeling should be consulted.
## Pediatric Dosing
Dosing varies significantly by age and product formulation. Always refer to product labeling.
* **Ages 12 years and older:** Generally follows adult dosing.
* **Ages 6 to under 12 years:** Typically 5-10 mg every 4 hours, or 15 mg every 6-8 hours. Maximum dose is generally 60 mg in 24 hours.
* **Ages 4 to under 6 years:** Typically 2.5-5 mg every 4 hours, or 7.5 mg every 6-8 hours. Maximum dose is generally 30 mg in 24 hours.
* **Under 4 years:** Use is generally not recommended due to increased risk of serious adverse effects. Consult a pediatrician.
## Dose Adjustments
No dose adjustments are typically required for renal or hepatic impairment, but caution may be advised in severe disease.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Concurrent use with MAO inhibitors or within 14 days of discontinuing MAO inhibitors (risk of hypertensive crisis).
* Use in children under 4 years of age is generally contraindicated.
## Adverse Effects
Common: Dizziness, drowsiness, nausea, vomiting.
Less common: Confusion, constipation, respiratory depression (especially with overuse or in combination products).
## Key Drug Interactions
* **MAO Inhibitors:** Contraindicated due to risk of serotonin syndrome and hypertensive crisis.
* **SSRIs, SNRIs, tricyclic antidepressants, triptans, linezolid, St. John's wort:** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, increasing risk of adverse effects.
* **Alcohol and CNS depressants:** Additive sedative effects.
## Monitoring
Monitor for effectiveness in suppressing cough and for signs of adverse effects, particularly confusion, sedation, and respiratory depression, especially in children or with overdose.
## Clinical Pearls
* Dextromethorphan is primarily for symptomatic relief of non-productive cough. It does not treat the underlying cause of the cough.
* Be aware of combination products; patients may inadvertently be taking multiple ingredients with similar effects or interactions.
* Risk of abuse and diversion exists, especially with higher doses or specific formulations.
***
This information is intended for healthcare professionals. Always verify current prescribing information and consult product-specific labeling before use.
