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Dextromethorphan Cough Syrup - Uses, Side effects, Brands

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
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.
Oral capsule:
- Children ≥12 years and Adolescents:
  - 30 mg as needed, spaced no more than four hours apart, every 6 to 8 hours.
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.

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)
Ajmaline	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Antiemetics (5HT3 Antagonists)	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
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.
CloBAZam	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Cobicistat	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
CYP2D6 Inhibitors (Moderate)	May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors).
Darunavir	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Imatinib	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Lumefantrine	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Memantine	The harmful or toxic effects of memantine may be increased by NMDA Receptor Antagonists.
Metaxalone	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Methylphenidate	Serotonin modulators' harmful or toxic effects could be exacerbated. In particular, there may be an increased risk of serotonin syndrome or serotonin poisoning.
Metoclopramide	Serotonin modulators may intensify Metoclopramide's harmful or hazardous effects. This could appear as signs of neuroleptic malignant syndrome or serotonin syndrome.
Opioid Agonists	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Panobinostat	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Parecoxib	May raise the level of dextromethorphan in the serum.
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).
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).
QuiNINE	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
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.
TraMADol	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.
Risk Factor D (Consider therapy modification)
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.
Asunaprevir	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
CYP2D6 Inhibitors (Strong)	CYP2D6 substrate metabolism may be decreased (High risk with Inhibitors).
Dacomitinib	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.
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.
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.
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)
Dapoxetine	Serotonin modulators' harmful or toxic effects could be exacerbated.
Methylene Blue	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
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
Bactocef	Swiss Pharmaceuticals (Pvt) Ltd.

Dextromethorphan Syrup 13.5 mg
Dextromethorphan	Neutro Pharma (Pvt) Ltd.
Ztromed	Drug Pharm (Pvt) Ltd.

Dextromethorphan Syrup 5 mg/5ml
Brintyl	Dr. Raza Pharma (Private) Limited

Dextromethorphan Syrup 10 mg/5ml
Askorex	Ideal Pharmaceutical Industries
Cough-Dm	Weather Folds Pharmaceuticals
Dextromethorphan	Ethical Laboratories (Pvt) Ltd.
Texcol-Dm	Raazee Theraputics (Pvt) Ltd.

Dextromethorphan Syrup 12.5 mg/5ml
Dextrophan	Masfa Industries (Pvt) Ltd
Pacifics-Dm	Pacific Pharmaceuticals Ltd.
Pacifics-Dm Decongestant	Pacific Pharmaceuticals Ltd.

Dextromethorphan Cough Syrup - Uses, Side effects, Brands

Dextromethorphan Uses:

Dextromethorphan dose in Adults:

Dextromethorphan dose as a cough suppressant:

Dextromethorphan dose in Children

Dextromethorphan dose as a Cough Suppressant:

Dextromethorphan Pregnancy Risk Category: C

Dextromethorphan use during breastfeeding:

Dose in Kidney Disease:

Dose in Liver disease:

Side effects of Dextromethorphan:

Contraindications to Dextromethorphan:

Dextromethorphan: Drug Interaction

Risk Factor C (Monitor therapy)

Risk Factor D (Consider therapy modification)

Risk Factor X (Avoid combination)

How to administer Dextromethorphan?

Mechanism of action of Dextromethorphan:

International Brands of Dextromethorphan:

Dextromethorphan Brand Names in Pakistan:

Dextromethorphan Injection 500 mg

Dextromethorphan Syrup 13.5 mg

Dextromethorphan Syrup 5 mg/5ml

Dextromethorphan Syrup 10 mg/5ml

Dextromethorphan Syrup 12.5 mg/5ml

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