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dextromethorphan (OTC)Brand and Other Names:Balminil DM, Benylin DM, more...Bronchophan, Buckleys DM, Calmylin #1, Delsym, Koffex DM, Novahistex DM, Robitussin Lingering Cold Long-Acting Cough, Robitussin Lingering Cold Long-Acting CoughGels, Children's Robitussin Cough Long-Acting, Sucrets 8 Hour Cough Relief DM Cough Formula

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 15mg

capsule

  • 15mg

gel, oral

  • 7.5mg/5mL

liquid, oral

  • 7.5mg/5mL
  • 10mg/5mL
  • 15mg/5mL

syrup, oral

  • 5mg/5mL
  • 7.5mg/5mL
  • 10mg/5mL
  • 15mg/5mL
  • 20mg/15mL

liquid, extended release

  • 30mg/5mL

lozenge

  • 5mg
  • 7.5mg
  • 15mg

strip, oral

  • 7.5mg
more...

Cough

Liquid and syrup: 10-20 mg PO q4hr OR 30 mg q6-8hr

Gel: 30 mg PO q6-8hr; not to exceed 120 mg/24hr

Extended release: 60 mg PO q12hr; not to exceed 120 mg/24hr

Lozenges: 5-15 mg PO q1-4hr; not to exceed 120 mg/day

Strips: 30 mg PO q6-8hr; not to exceed 120 mg/day

Dosing considerations

  • Abuse potential much lower than codeine
  • About 15-30 mg dextromethorphan equal to 8-15 mg codeine as an antitussive

Dosage Forms & Strengths

tablet

  • 15mg

capsule

  • 15mg
  • 25mg

gel, oral

  • 7.5mg/5mL

syrup

  • 5mg/5mL
  • 7.5mg/5mL
  • 10mg/5mL
  • 15mg/5mL
  • 20mg/15mL

liquid, extended release

  • 30mg/5mL

lozenge

  • 5mg
  • 7.5mg
  • 15mg

strip, oral

  • 7.5mg
more...

Cough

<4 years

  • Prescription only

Extended release

  • 4-6 years: 15 mg PO twice daily; not to exceed 30 mg/24hr
  • 6-12 years: 30 mg PO twice daily; not to exceed 60 mg/24hr
  • >12 years: 60 mg PO q12hr; not to exceed 120 mg/24hr

Liquid/Syrup

  • 4-6 years: 7.5 mg q6-8hr (not to exceed 30 mg/day)
  • 6-12 years: 15 mg PO q6-8hr; not to exceed 60 mg/24hr
  • 12 years: 10-20 mg PO q4hr or 30 mg q6-8hr not to exceed 120 mg/24hr

Gel

  • >12 years: 30 mg PO q6-8hr; not to exceed 120 mg/24hr

Lozenges

  • 6-12 years: 5-10 mg q1-4hr; not to exceed 60 mg/day
  • >12 years: 5-15 mg PO q1-4hr; not to exceed 120 mg/day

Strips

  • 6-12 years: 15 mg PO q6-8hr; not to exceed 60 mg/day
  • >12 years: 30 mg PO q6-8hr; not to exceed 120 mg/day

Dosing considerations

  • Potential toxic dose <6 years: 10 mg/kg 
  • About 15-30 mg dextromethorphan equal to 8-15 mg codeine as an antitussive
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Interactions

Interaction Checker

dextromethorphan and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Common

            Nausea

            Vomiting

            Constipation

            Drowsiness

            Dizziness

            Sedation

            Confusion

            Nervousness

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            Warnings

            Contraindications

            Concurrent nonselective MAO inhibitors: Serotonin syndrome

            Cautions

            Phenylketonuria: Contains aspartame

            Hallucinations, confusion, agitation, hyper-reflexia, shivering, myoclonus, and tachycardia may occur

            Caution in children younger than 6 years

            Not for use in children <4 years

            Use caution in patients who are sedated, debilitated or confined to supine posiiton

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Not known if excreted in breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Acts on cough center in medulla; decreases sensitivity of cough receptors and interrupts cough impulse transmission

            Derivative of levorphanol

            Absorption

            Onset: 15-30 min

            Duration: ≤6 hr

            Time to peak: 2-3hr

            Metabolism

            Hepatic P450 enzyme CYP2D6

            Elimination

            Half-life: 2-4hr (extensive metabolizers); 24 hr (poor metabolizers)

            Excretion: Urine

            Pharmacogenomics

            CYP2D6 substrate

            Approximately 7-10% of Caucasians and 3-8% of African Americans lack the capacity to metabolize CYP2D6 substrates and are classified as poor metabolizers

            Genetic testing laboratories

            • Genotyping tests for CYP2D6 variants are commercially available through the following companies:
            • Applied Biosystems (http://www.appliedbiosystems.com/)
            • GenPath Diagnostics (http://www.genpathdiagnostics.com/)
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