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# Dextromethorphan / Guaifenesin (D%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520cold)
## Overview
This combination product contains dextromethorphan, a cough suppressant, and guaifenesin, an expectorant.
## Primary Indications
* Symptomatic relief of cough associated with the common cold.
* Aids in loosening mucus (expectoration).
## Adult Dosing
* **Dextromethorphan:** Typically 10-20 mg every 4 hours, or 30 mg every 6-8 hours. Maximum 120 mg/day.
* **Guaifenesin:** Typically 200-400 mg every 4 hours. Maximum 2400 mg/day.
* **Combination Products:** Dosing varies significantly by product formulation. Always refer to the specific product label. Common strengths for extended-release formulations may include dextromethorphan 30 mg and guaifenesin 600 mg every 12 hours.
## Pediatric Dosing
Dosing is weight-based and age-dependent. Refer to specific product labeling or pediatric dosing resources. Many products are not recommended for children under 4 or 6 years of age.
* **Dextromethorphan:**
* Ages 6-12 years: Typically 5-10 mg every 4 hours, or 15 mg every 6-8 hours. Maximum 60 mg/day.
* Ages 2-6 years: Dosing is highly variable and should be guided by product labeling or prescriber. Use with caution.
* **Guaifenesin:**
* Ages 6-12 years: Typically 100-200 mg every 4 hours. Maximum 1200 mg/day.
* Ages 2-6 years: Dosing is highly variable and should be guided by product labeling or prescriber. Use with caution.
## Dose Adjustments
* No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, especially in severe impairment, due to potential accumulation.
## Contraindications
* Hypersensitivity to either component.
* Concurrent use or within 14 days of MAOI inhibitors (dextromethorphan).
* Use in patients with severe asthma or persistent cough (dextromethorphan).
* Use in patients with significant respiratory depression (dextromethorphan).
## Adverse Effects
* **Dextromethorphan:** Drowsiness, dizziness, nausea, vomiting, confusion, respiratory depression (especially at high doses or in combination with other CNS depressants). Serotonin syndrome is a rare but serious risk, particularly with co-administration of other serotonergic agents.
* **Guaifenesin:** Nausea, vomiting, dizziness, headache, rash.
## Key Drug Interactions
* **Dextromethorphan:**
* MAOIs: Risk of hypertensive crisis or serotonin syndrome.
* SSRIs, SNRIs, tricyclic antidepressants, other serotonergic drugs: Increased risk of serotonin syndrome.
* CNS depressants (alcohol, benzodiazepines, opioids, sedatives): Increased risk of sedation and respiratory depression.
* CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine): May increase dextromethorphan plasma concentrations, increasing risk of adverse effects.
* **Guaifenesin:** Generally considered to have few significant drug interactions.
## Monitoring
* Assess for cough suppression and mucus expectoration.
* Monitor for adverse effects, including sedation, dizziness, and signs of serotonin syndrome.
## Clinical Pearls
* Combination products can lead to over-administration of individual ingredients if multiple products are used concurrently.
* Dextromethorphan can be abused for its psychoactive effects at higher than recommended doses.
* Adequate hydration is important to facilitate guaifenesin's effectiveness in thinning mucus.
* Effectiveness of guaifenesin in thinning mucus is debated.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information with the official product labeling and consult relevant clinical guidelines before making any treatment decisions. Dosing may vary based on specific product formulation, patient factors, and local protocols.
