dextromethorphan (dex-troe-meth-or-fan) Balminil DM, Benylin DM, Bronchophan Forte DM, Buckley’s DM, Cough Syrup DM, Creo-Terpin, Creomulsion Adult Formula, Creomulsion for Children, Delsym, Delsym DM, DM Children’s Cough Syrup, DM Cough Syrup, Dry Cough Syrup, Father John’s, Hold DM, Koffex DM, Neocitran Thin Strips Cough, 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, Sedatuss DM, Sucrets Cough Control, Sucrets DM, Triaminic DM, Triaminic Long-Acting Cough, Triaminic Thin Strips Children’s Long-Acting Cough, Triaminic Children’s Cough Long-Acting, Vicks 44 Cough Relief, Vicks Custom Care Dry Cough, Vicks DayQuil Cough, Vicks Nature Fusion Cough

 Indications

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 and 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.

Contraindications/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); OB: Pregnancy (has been

used safely); Lactation: Lactation; Pedi: Children 4 yr

(OTC cough and cold products containing this medication

should be avoided).

Adverse Reactions/Side Effects

CNS: high dose—dizziness, sedation. GI: nausea.

Interactions

Drug-Drug: Use with MAO inhibitors may result in

serotonin syndrome (nausea, confusion, changes in

BP); concurrent use should be avoided.qCNS depression

with antihistamines, alcohol, antidepressants,

sedative/hypnotics, or opioids. Amiodarone,

fluoxetine, or quinidine mayqblood levels

and adverse reactions from dextromethorphan.

Route/Dosage

PO (Adults and Children 12 yr): 10–20 mg q 4 hr

or 30 mg q 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 q 4 hr or 15 mg q

6–8 hr or 30 mg of extended-release preparation q 12

hr (not to exceed 60 mg/day).

PO (Children 4–6 yr): 2.5–5 mg q 4 hr or 7.5 mg q

6–8 hr or 15 mg of extended-release preparation q 12

hr (not to exceed 30 mg/day).

Availability (generic available)

Gelcaps: 30 mgOTC. Lozenges (cherry): 2.5 mgOTC, 5

mgOTC. Liquid (cherry, grape): 3.5 mg/5 mLOTC, 5

mg/5 mL, 7.5 mg/5 mLOTC, 15 mg/5mLOTC, 30 mg/5

mLOTC. Syrup (cherry, cherry bubblegum): 7.5 mg/

5 mLOTC, 15 mg/15 mLOTC, 10 mg/5 mLOTC. Extendedrelease

suspension (orange): 30 mg/5 mLOTC.

Drops (Grape): 7.5 mg/0.8 mLOTC, 7.5 mg/1 mLOTC.

Orally-disintegrating strips (cherry, grape): 7.5

mgOTC, 15mgOTC. In combination with: antihistamines,

decongestants, and expectorants in cough and

cold preparationsOTC, quinidine sulfate (Nuedextra).

See Appendix B.