dextromethorphan

REMS

Symptomatic relief of coughs caused by minor viral upper respiratory tract infections or inhaled irritants.
Most effective for chronic nonproductive cough.
A common ingredient in nonprescription cough and cold preparations.

Action ⬆ ⬇

Suppresses the cough reflex by a direct effect on the cough center in the medulla. Related to opioids structurally but has no analgesic properties.

Therapeutic effects:

Relief of irritating nonproductive cough.

Pharmacokinetics ⬆ ⬇

Absorption: Rapidly absorbed from the GI tract. Extended-release product is slowly absorbed.

Distribution: Unknown. Probably crosses the placenta and enters breast milk.

Metabolism/Excretion: Metabolized to dextrorphan, an active metabolite. Dextromethorphan and dextrorphan are renally excreted.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(cough suppression)

ROUTE	ONSET	PEAK	DURATION
PO	15–30 min	unknown	3–6 hr‡
PO-ER	unknown	unknown	9–12 hr

‡Up to 8 hr for gelcaps.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Patients taking MAO inhibitors or SSRIs;
Should not be used for chronic productive coughs;
Some products contain alcohol and should be avoided in patients with known intolerance.

Use Cautiously in:

Cough that lasts more than 1 wk or is accompanied by fever, rash, or headache—health care professional should be consulted;
History of drug abuse or drug-seeking behavior (capsules have been abused resulting in deaths);
Diabetes (some products contain sucrose);
Lactation: Lactation;
Pedi: Children 4 yr (OTC cough and cold products containing this medication should be avoided).

Adv. Reactions/Side Effects ⬆ ⬇

GI: nausea

Neuro: high dose:dizziness, sedation

Interactions ⬆ ⬇

Drug-drug:

Use with MAO inhibitors may result in serotonin syndrome (nausea, confusion, changes in BP); concurrent use should be avoided.
↑CNS depression with antihistamines, alcohol, antidepressants, sedative/hypnotics, or opioids.
Amiodarone, fluoxetine, or quinidine may ↑ blood levels and adverse reactions from dextromethorphan.

Route/Dosage ⬆ ⬇

PO (Adults and Children >12 yr): 10–20 mg every 4 hr or 30 mg every 6–8 hr or 60 mg of extended-release preparation bid (not to exceed 120 mg/day).
PO (Children 6–12 yr): 5–10 mg every 4 hr or 15 mg every 6–8 hr or 30 mg of extended-release preparation every 12 hr (not to exceed 60 mg/day).
PO (Children 4–6 yr): 2.5–5 mg every 4 hr or 7.5 mg every 6–8 hr or 15 mg of extended-release preparation every 12 hr (not to exceed 30 mg/day).

Availability ⬆ ⬇

(Generic available)

Gelcaps: 30 mg^OTC
Lozengescherry: 2.5 mg^OTC; 5 mg^OTC
Liquidcherry, grape: 3.5 mg/5 mL^OTC; 5 mg/5 mL; 7.5 mg/5 mL^OTC; 15 mg/5 mL^OTC; 30 mg/5 mL^OTC
Syrupcherry, cherry bubblegum: 7.5 mg/5 mL^OTC; 15 mg/15 mL^OTC; 10 mg/5 mL^OTC
Extended-release suspensionorange: 30 mg/5 mL^OTC
DropsGrape: 7.5 mg/0.8 mL^OTC; 7.5 mg/1 mL^OTC
Orally-disintegrating stripscherry, grape: 7.5 mg^OTC; 15 mg^OTC
In combination with: antihistamines, decongestants, and expectorants in cough and cold preparationsOTC; bupropion (Auvelity); quinidine sulfate (Nuedexta). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess frequency and nature of cough, lung sounds, and amount and type of sputum produced. Unless contraindicated, maintain fluid intake of 1500–2000 mL to decrease viscosity of bronchial secretions.

Implementation ⬆ ⬇

PO: Do not give fluids immediately after administering to prevent dilution of vehicle. Shake oral suspension well before administration.

Patient/Family Teaching ⬆ ⬇

Instruct patient to cough effectively: Sit upright and take several deep breaths before attempting to cough.
Advise patient to minimize cough by avoiding irritants, such as cigarette smoke, fumes, and dust. Humidification of environmental air, frequent sips of water, and sugarless hard candy may also decrease the frequency of dry, irritating cough.
Caution patient to avoid taking more than the recommended dose or taking alcohol or other CNS depressants concurrently with this medication; fatalities have occurred. Caution parents to avoid OTC cough and cold products while breastfeeding or to children <4 yrs.
May occasionally cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
Advise patient that any cough lasting over 1 wk or accompanied by fever, chest pain, persistent headache, or skin rash warrants medical attention.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in frequency and intensity of cough without eliminating patient’s cough reflex.

US Brand Names ⬆ ⬇

Creo-Terpin, Creomulsion Adult Formula, Creomulsion for Children, Delsym, Father John's, Hold DM, Pediacare Children's Long-Acting Cough, Robafin Cough, Robitussin Children's Cough Long-Acting, Robitussin Cough Long-Acting, Robitussin CoughGels Long-Acting, Robitussin Lingering Cold Long-Acting CoughGels, Scot-Tussin Diabetes, Triaminic Thin Strips Children's Long-Acting Cough, Triaminic Children's Cough Long-Acting, Vicks 44 Cough Relief, Vicks DayQuil Cough, Vicks Nature Fusion Cough

Canadian Brand Names ⬆

Balminil DM, Benylin DM, Bronchophan Forte DM, Buckley's DM, Cough Syrup DM, Delsym DM, DM Children's Cough Syrup, DM Cough Syrup, Dry Cough Syrup, Koffex DM, Neocitran Thin Strips Cough, Sedatuss DM, Sucrets Cough Control, Sucrets DM, Triaminic DM, Triaminic Long-Acting Cough, Vicks Custom Care Dry Cough

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇