Dextromethorphan is used as a cough suppressant in patients with throat irritation, cold, and mild respiratory tract infections.
Dextromethorphan Uses:
- As a Cough Suppressant:
- It is used to temporarily suppress a cough that results from a minor throat and bronchial irritation as in patients with the common cold or inhaled irritants.
- The extended-release medication is also used to reduce cough impulse temporarily in order to facilitate sleep.
Dextromethorphan dose in Adults:
Dextromethorphan dose as a cough suppressant:
- Orally, take 10 to 20 mg every four hours or 20 to 30 mg every six to eight hours.
- The extended-release formulation is taken as 60 mg two times a day.
- The maximum dose is 120 mg/24 hours
Dextromethorphan dose in Children
Dextromethorphan dose as a Cough Suppressant:
- Oral syrup (immediate-release):
- Children: 4 years to <6 years:
- 5 mg every four hours as necessary, with a maximum of six doses per day.
- Children 6 years to <12 years:
- 10 mg every four hours as necessary, but no more than six doses in a day
- Children ≥12 years and Adolescents:
- 20 mg every four hours as necessary, but no more than six doses in a day
- Children: 4 years to <6 years:
- Long-acting liquid:
- Children 6 years to <12 years:
- 15 mg every 6 to 8 hours as necessary, but no more than four doses in a 24-hour period.
- Children ≥12 years and Adolescents:
- 30 mg every 6 to 8 hours as necessary, with a maximum of four doses per day.
- Children 6 years to <12 years:
- Oral capsule:
- Children ≥12 years and Adolescents:
- 30 mg as needed, spaced no more than four hours apart, every 6 to 8 hours.
- Children ≥12 years and Adolescents:
- Extended-release suspension (dextromethorphan polistirex):
- Children 4 years to <6 years:
- 15 mg twice daily, as needed, with a maximum of 30 mg per day.
- Children 6 years to <12 years:
- 30 mg twice daily, as needed, with a maximum of 60 mg per day.
- Children ≥12 years and Adolescents:
- 60 mg twice daily, as necessary, with a maximum of 120 mg per day.
- Children 4 years to <6 years:
Dextromethorphan Pregnancy Risk Category: C
- It is processed in the liver by the CYP2D6 and CYP3A enzymes, whose activity is elevated during pregnancy.
- However, the activity of CYP2D6 is very low in the fetus and the activity of CYP3A4 is noted at about the 17th week of gestation.
- At the standard OTC dose, it is generally considered acceptable for use during pregnancy.
- However, products that contain alcohol should be avoided.
Dextromethorphan use during breastfeeding:
- Data regarding the excretion or presence of the drug in breastmilk is not available.
- There aren't any recommendations regarding its safety in breastfeeding women.
- However, products that contain alcohol should be avoided.
Dose in Kidney Disease:
In the manufacturer's labeling, an adjustment in the dose has not been provided in patients with kidney disease.
Dose in Liver disease:
In the manufacturer's labeling, an adjustment in the dose has not been provided in patients with liver disease.
Side effects of Dextromethorphan:
- Central nervous system:
- Dizziness
- Drowsiness
- Nervousness
- Restlessness
- Gastrointestinal:
- Gastrointestinal distress
- Nausea
- Stomach pain
- Vomiting
Contraindications to Dextromethorphan:
Usage of the drug within two weeks of stopping an MAO inhibitor or concurrent use of an MAO inhibitor
Dextromethorphan: Drug Interaction
Note: Drug Interaction Categories:
- Risk Factor C: Monitor When Using Combination
- Risk Factor D: Consider Treatment Modification
- Risk Factor X: Avoid Concomitant Use
Risk Factor C (Monitor therapy) |
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Ajmaline |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
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Antiemetics (5HT3 Antagonists) |
May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
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Antipsychotic Agents |
Serotonin modulators might make antipsychotic drugs more harmful or toxic. Serotonin modulators, in particular, may enhance dopamine blockade, potentially raising the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. Serotonin syndrome might occur from this. |
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CloBAZam |
May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors). |
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Cobicistat |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
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CYP2D6 Inhibitors (Moderate) |
May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors). |
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May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
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Imatinib |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
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Lumefantrine |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
| The harmful or toxic effects of memantine may be increased by NMDA Receptor Antagonists. | |
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Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this. |
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Serotonin modulators' harmful or toxic effects could be exacerbated. In particular, there may be an increased risk of serotonin syndrome or serotonin poisoning. |
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Serotonin modulators may intensify Metoclopramide's harmful or hazardous effects. This could appear as signs of neuroleptic malignant syndrome or serotonin syndrome. |
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Opioid Agonists |
May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
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May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
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Parecoxib |
May raise the level of dextromethorphan in the serum. |
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Peginterferon Alfa-2b |
May lower the serum level of CYP2D6 substrates (High risk with Inhibitors). The concentration of CYP2D6 Substrates in the serum may rise when using Peginterferon Alfa-2b (High risk with Inhibitors). |
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Perhexiline |
CYP2D6 Substrates (High risk with Inhibitors) may increase the serum concentration of Perhexiline. Perhexiline may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
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May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
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Serotonin Modulators |
The negative or hazardous effects of other serotonin modulators might be increased. Serotonin syndrome may start to develop. Nicergoline and Tedizolid are exceptions. |
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Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
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Risk Factor D (Consider therapy modification) |
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Abiraterone Acetate |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity. |
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Asunaprevir |
May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors). |
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CYP2D6 Inhibitors (Strong) |
CYP2D6 substrate metabolism may be decreased (High risk with Inhibitors). |
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May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors). Management: Steer clear of using dacomitinib at the same time as CYP2D6 subtrates with a limited therapeutic index. |
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QuiNIDine |
May raise the level of dextromethorphan in the serum. Management: When feasible, avoid using these medications concurrently unless you specifically want dextromethorphan's more potent psychedelic effects. Since quinidine also inhibits codeine activation, codeine is probably not a good alternative antitussive. |
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Selective Serotonin Reuptake Inhibitors |
Dextromethorphan's serotonergic effects might be improved. The serum levels of dextromethorphan may rise in response to selective serotonin reuptake inhibitors. Management: When feasible, refrain from taking SSRIs, particularly fluoxetine and paroxetine, and dextromethorphan together. After stopping fluoxetine or paroxetine, the risk for this interaction may linger for a number of weeks. Instances: FluvoxaMINE. |
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Tipranavir |
May raise the level of dextromethorphan in the serum. Treatment: Patients receiving tipranavir may want to think about avoiding dextromethorphan. If coupled, keep a watchful eye out for any potential effects or toxicities of dextromethorphan. |
Risk Factor X (Avoid combination) |
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Dapoxetine |
Serotonin modulators' harmful or toxic effects could be exacerbated. |
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Methylene Blue |
Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this. |
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Monoamine Oxidase Inhibitors |
Dextromethorphan's serotonergic effects might be improved. It might result in serotonin syndrome. |
Monitoring parameters:
Monitor the response. Seek healthcare advice in cases of fever and sputum production.
How to administer Dextromethorphan?
Shake the extended-release suspension thoroughly before using. the dose should be measured using the supplied dosing cup.
Mechanism of action of Dextromethorphan:
- By stimulating sigma receptors, it suppresses the medullary cough centre and functions as an antitussive.
- As a result, it lessens the sensitivity of cough receptors and prevents the cough impulse from being sent. Its structural makeup is comparable to codeine.
The onset of action: Antitussive:
- 15-30 minutes
Duration:
- ≤ 6 hours
Metabolism:
- It undergoes demethylation in the liver to be metabolised (via CYP2D6 to the active metabolite dextrorphan and via CYP3A4 and CYP3A5 form smaller amounts of 3-hydroxy and 3-methoxy derivatives)
Half-life elimination:
- Extensive metabolizers: 2-4 hours;
- poor metabolizers: 24 hours
Time to peak:
- 2 - 3 hours
Excretion:
- It is excreted primarily via urine as metabolites
International Brands of Dextromethorphan:
- Buckleys Cough
- Cough DM
- Creomulsion Adult
- Creomulsion for Children
- Delsym Cough Childrens
- Delsym
- ElixSure Cough
- GoodSense Cough DM Childrens
- GoodSense Cough DM
- Hold
- Little Colds Cough Formula
- PediaCare Childrens Long-Act
- Robafen Cough
- Robitussin 12 Hour Cough Child
- Robitussin 12 Hour Cough
- Robitussin Childrens Cough LA
- Robitussin Lingering CoughGels
- Robitussin Lingering LA Cough
- Scot-Tussin Diabetes CF
- Silphen DM Cough
- Triaminic Long Acting Cough
- Trocal Cough Suppressant
- Acodin
- Acough
- Actifed New
- Adult Dry Cough
- Alex
- Altec
- Antus
- Arilcodiltosse
- Aritos
- Astomari
- Athos
- Atos
- Atuxane
- Balsedrina
- Bechilar
- Bei Ke Er
- Benylin Dry Coughs Syrup
- Benylin Non-Drowsy Dry Cough
- Biocadextro
- Bioquidan
- Bisoltussin
- Bisolvon Dry
- Bisolvon Tosse Sed
- Brocolan
- Brofex
- Bronchenolo Tosse
- Bronchetab
- Bronchosedal
- Bronchydex
- Broncogrip
- Brudex
- Cinfatos
- Codiphan
- Coldflu
- Contrasal
- Cortuss
- Couldetos
- Curatos
- Daro Retard
- Dekesi
- Depan-F
- Dexatussin
- Dexcophan
- Dexir
- Dexof
- Dexofan
- Dexsol
- Dextonil
- Dextro Toss
- Dextrocough
- Dextrokuf
- Dextrome
- Dextrophan
- Dextrotos
- Diacol
- DM
- Drikof
- Eascof-DM
- Ergix Toux Seche
- Exedexe
- Exophan
- Fluditec Dry Cough
- Formitrol
- Formulatus
- Garde
- Hihustan
- Humisec
- Hustenstiller-ratiopharm
- Icolid
- Jiang Ke
- Kafosed
- Ke Le Er
- KeDi
- Kofban
- Kofrid
- Lafedar
- Laitos
- Larentel
- Lastuss LA
- Lexatussin
- Lexcof
- Libolar
- MedDex
- Meddex
- Metodex
- Metorfan
- Metorfan Forte
- Mugotussol
- Mytusan DM
- Nodex
- Numark Adult Dry Cough Linctus
- PCD Dry Cough
- Promedin
- Pusiran
- Quimofan
- Resilar
- Riaphan
- Robitussin
- Robitussin Antitussicum
- Robitussin Dry Cough
- Robitussin Dry Cough Forte
- Robitussin Junior
- Rodilar
- Rofedex
- Rometor
- Romilar
- Romin
- Setustop
- Shu De
- Silomat DMP
- Sisaal
- Stopex
- Strepsils Dry Cough
- Sumentol
- Teratos Miel Adultos
- Tilodrin
- Tip
- Tomephen
- Tositec
- Tossoral
- Touxium Antitussivum
- Trimedal Tosse
- Tusifan
- Tusminal
- Tuspulmin
- Tussal Antitussicom
- Tussastopp
- Tussidane
- Tussidex
- Tussidril
- Tussidrill
- Tussilar
- Tussils
- Tussin
- Tussin Forte
- Tussipect
- Tussis Om
- Tussopront
- Tussoral
- Tussycalm
- Tuxium
- Vicks MedDex
- Vicks Tosse Pastiglie
- Vicks Tosse Sedativo
- Vicks Vaposyrup Antitussif
- Wick Formel 44 Husten-Pastillen S
- Wick Formel 44 Hustenstiller
Dextromethorphan Brand Names in Pakistan:
Dextromethorphan Injection 500 mg |
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Bactocef |
Swiss Pharmaceuticals (Pvt) Ltd. |
Dextromethorphan Syrup 13.5 mg |
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Dextromethorphan |
Neutro Pharma (Pvt) Ltd. |
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Ztromed |
Drug Pharm (Pvt) Ltd. |
Dextromethorphan Syrup 5 mg/5ml |
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Brintyl |
Dr. Raza Pharma (Private) Limited |
Dextromethorphan Syrup 10 mg/5ml |
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Askorex |
Ideal Pharmaceutical Industries |
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Cough-Dm |
Weather Folds Pharmaceuticals |
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Dextromethorphan |
Ethical Laboratories (Pvt) Ltd. |
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Texcol-Dm |
Raazee Theraputics (Pvt) Ltd. |
Dextromethorphan Syrup 12.5 mg/5ml |
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Dextrophan |
Masfa Industries (Pvt) Ltd |
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Pacifics-Dm |
Pacific Pharmaceuticals Ltd. |
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Pacifics-Dm Decongestant |
Pacific Pharmaceuticals Ltd. |
 Injection.webp)