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# Dextromethorphan
## Overview
Dextromethorphan is an antitussive agent that acts centrally on the cough center in the medulla oblongata. It is available in various formulations, including immediate-release and extended-release.
## Primary Indications
* Symptomatic relief of cough.
## Adult Dosing
* **Immediate-release:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours. Maximum daily dose typically 120 mg.
* **Extended-release:** 60 mg every 12 hours. Maximum daily dose typically 120 mg.
## Pediatric Dosing
* **Age 6 to <12 years:** 7.5 mg to 15 mg every 4 hours, or 15 mg every 6 to 8 hours. Maximum daily dose typically 60 mg.
* **Age 12 years and older:** Adult dosing.
* **Under 6 years:** Generally not recommended due to lack of efficacy data and potential for adverse effects. Specific dosing varies by product and is often not established or recommended.
## Dose Adjustments
* No specific dose adjustments are generally required for hepatic or renal impairment, however, caution is advised in severe impairment.
## Contraindications
* Concurrent use with MAO inhibitors.
* Hypersensitivity to dextromethorphan.
* Use within 14 days of discontinuing an MAO inhibitor.
## Adverse Effects
* Dizziness, drowsiness, nausea, vomiting, nervousness, restlessness, confusion.
* High doses can lead to abuse and euphoria, hallucinations, and respiratory depression.
## Key Drug Interactions
* **MAO Inhibitors (including linezolid, methylene blue):** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, increasing the risk of adverse effects.
* **Serotonergic agents (e.g., SSRIs, SNRIs, triptans):** Increased risk of serotonin syndrome.
* **Alcohol:** Additive CNS depression.
## Monitoring
* Monitor for effectiveness of cough suppression.
* Monitor for adverse effects, particularly CNS effects and signs of serotonin syndrome.
## Clinical Pearls
* Dextromethorphan is often found in combination products with other medications (e.g., antihistamines, decongestants, analgesics). Ensure the patient is not duplicating therapy and is aware of all active ingredients.
* Advise patients to avoid alcohol while taking dextromethorphan.
* The abuse potential of dextromethorphan, especially in higher doses, should be recognized.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. Dosing may vary based on product formulation and patient-specific factors.
