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## Overview
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## Primary Indications
* Symptomatic relief of cough associated with the common cold or other upper respiratory conditions.
* Aids in loosening mucus in the airways.
## Adult Dosing
* **Dextromethorphan/Guaifenesin:** Typically administered orally every 4 to 12 hours as needed. Specific dosing varies widely by product formulation (e.g., immediate-release, extended-release).
* **Example (typical immediate-release):** 10-20 mg dextromethorphan/200-400 mg guaifenesin every 4 hours.
* **Maximum Dextromethorphan:** Generally 120 mg in 24 hours.
* **Maximum Guaifenesin:** Generally 2400 mg in 24 hours, though formulations and specific product labeling should be consulted.
## Pediatric Dosing
* Dosing in children under 12 years of age is highly dependent on the specific product formulation and age/weight. **Always consult product labeling or pediatric-specific guidelines.**
* **General Age Restrictions:** Products containing dextromethorphan are generally not recommended for children under 4 years of age due to the risk of serious adverse events. Some sources recommend avoiding in children under 6 years of age.
* **Example (children 6-11 years):** May receive half the adult dose, but precise dosing must be confirmed with product labeling.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary, particularly for dextromethorphan, as it is metabolized by the liver. Consult product labeling.
* **Renal Impairment:** No specific dose adjustments are typically listed, but caution is advised, especially with high doses or prolonged use.
## Contraindications
* Hypersensitivity to dextromethorphan or guaifenesin.
* Concurrent use with MAO inhibitors or within 14 days of discontinuing MAO inhibitors (for dextromethorphan).
* Use in children under 4 years of age (generally).
* Certain formulations may be contraindicated in patients with specific conditions (e.g., severe asthma).
## Adverse Effects
* **Common:** Drowsiness, dizziness, nausea, vomiting, constipation.
* **Less Common/Serious:** Confusion, hallucinations, respiratory depression (especially with overdose or in susceptible individuals), serotonin syndrome (with co-administration of serotonergic agents), paradoxical excitation, rash.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe hypertension and serotonin syndrome.
* **Serotonergic Agents (e.g., SSRIs, SNRIs, triptans, tramadol):** Increased risk of serotonin syndrome.
* **CNS Depressants (e.g., alcohol, benzodiazepines, opioids):** Additive sedation and respiratory depression.
* **CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine, quinidine):** May increase dextromethorphan levels and risk of toxicity.
## Monitoring
* Monitor for signs and symptoms of adverse effects, particularly CNS depression and serotonin syndrome.
* Assess for effectiveness in reducing cough and loosening secretions.
## Clinical Pearls
* Ensure patients understand the difference between immediate-release and extended-release formulations, as dosing intervals vary significantly.
* Advise patients to avoid alcohol and other CNS depressants while taking this medication.
* Inform patients about the risk of serotonin syndrome, especially if taking other medications that affect serotonin levels.
* For persistent or severe cough, or cough with fever or purulent sputum, patients should seek medical attention.
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*This information is intended for clinical use and does not replace comprehensive drug information resources. Always verify current prescribing information, product labeling, and institutional protocols before use.*
