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# Dextromethorphan
## 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 medications.
## Primary Indications
Symptomatic relief of cough due to minor throat and bronchial irritation.
## Adult Dosing
* **Immediate-release:** 10-20 mg every 4 hours, or 30 mg every 6-8 hours.
* **Extended-release:** 60 mg every 12 hours.
* **Maximum dose:** Generally not to exceed 120 mg per 24 hours for immediate-release products. Specific maximums vary by product and formulation.
## Pediatric Dosing
* **Ages 12 years and older:** Same as adult dosing.
* **Ages 6 to under 12 years:** 7.5-15 mg every 4 hours, or 20 mg every 6-8 hours. Maximum dose generally not to exceed 60 mg per 24 hours.
* **Ages 4 to under 6 years:** 5-10 mg every 4 hours, or 15 mg every 6-8 hours. Maximum dose generally not to exceed 30 mg per 24 hours.
* **Ages under 4 years:** **Contraindicated** in many products. Use with extreme caution and only under medical supervision. Consult specific product labeling; many are not recommended for this age group due to safety concerns.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised in severe disease.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Use within 14 days of MAOI therapy (risk of serotonin syndrome).
* Many products are contraindicated or not recommended in young children (see Pediatric Dosing).
## Adverse Effects
Common: Dizziness, drowsiness, nausea, vomiting, constipation.
Serious: Serotonin syndrome (especially with co-administration of serotonergic agents), respiratory depression (at high doses), abuse/misuse potential.
## Key Drug Interactions
* **MAOIs, SSRIs, SNRIs, triptans, other serotonergic agents:** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., quinidine, fluoxetine, paroxetine, sertraline):** May increase dextromethorphan plasma concentrations, potentially leading to increased adverse effects.
* **CNS depressants (e.g., alcohol, benzodiazepines, opioids):** Additive CNS depression.
## Monitoring
* Monitor for cough effectiveness.
* Monitor for adverse effects, particularly CNS effects and signs of serotonin syndrome.
## Clinical Pearls
* Dextromethorphan is often found in combination products; review all ingredients to avoid duplication and excessive dosing.
* The abuse potential of dextromethorphan, particularly in high doses, is a significant concern.
* Effectiveness for chronic cough is limited; assess underlying cause if cough persists.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any therapeutic decisions. Dosing and safety information can vary significantly between different product formulations.
