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# Dextromethorphan (as part of a "cold" preparation)
## Overview
Dextromethorphan is a cough suppressant that acts centrally on the cough center in the medulla. It is frequently combined with other ingredients in over-the-counter (OTC) cold and cough preparations.
## Primary Indications
Symptomatic relief of cough.
## Adult Dosing
* **Immediate-release formulations:** 10 mg to 20 mg every 4 hours, or 30 mg every 6 to 8 hours.
* **Maximum dose:** Typically 120 mg per 24 hours. Specific maximums may vary based on the combination product.
## Pediatric Dosing
Dosing varies significantly by age and formulation. **Use with extreme caution and generally not recommended for children under 4 years of age.**
* **Ages 4 to 11 years:** 5 mg to 10 mg every 4 hours, or 15 mg every 6 to 8 hours. Maximum dose typically 60 mg per 24 hours.
* **Ages 12 years and older:** Same as adult dosing.
* **Always consult product labeling or local protocol for specific pediatric dosing.**
## Dose Adjustments
No dose adjustment is generally required for hepatic or renal impairment, but caution is advised, especially in severe impairment, due to potential accumulation.
## Contraindications
* Hypersensitivity to dextromethorphan.
* Concurrent use with MAO inhibitors or within 14 days of discontinuing MAO inhibitors.
* Use in children under 4 years of age unless specifically directed by a healthcare provider.
## Adverse Effects
Common: Dizziness, drowsiness, nausea, vomiting, constipation.
Less common/Serious: Serotonin syndrome (especially with co-administration of other serotonergic agents), confusion, hallucinations, respiratory depression (at supratherapeutic doses).
## Key Drug Interactions
* **MAO inhibitors:** Contraindicated due to risk of hypertensive crisis or serotonin syndrome.
* **SSRIs, SNRIs, triptans, other serotonergic drugs:** Increased risk of serotonin syndrome.
* **CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan plasma concentrations, increasing the risk of toxicity.
## Monitoring
Monitor for therapeutic effectiveness (cough suppression) and adverse effects, particularly CNS effects and signs of serotonin syndrome.
## Clinical Pearls
* Dextromethorphan is often part of combination products; ensure no duplication of active ingredients if using multiple cold remedies.
* It is primarily for symptomatic relief and does not treat the underlying cause of the cough.
* Abuse potential exists at supratherapeutic doses.
* Use the lowest effective dose for the shortest duration necessary.
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**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information, product labeling, and local protocols before making any treatment decisions. Dosing and recommendations can vary.
