dextromethorphan/phenylephrine/guaifenesin (OTC)

Brand and Other Names:Children's Mucinex Multi-Symptom Cold, Robitussin Peak Cold Multi-Symptom Cold, more...Robitussin Peak Cold Maximum Strength Multi-Symptom Cold, Children's Robitussin Cough & Cold CF, Robafen CF Liquid, Broncotron-D Suspension, Deconex DMX Tablets, Mucinex Fast-Max Severe Congestion & Cough, Q-Tussin CF Liquid
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

dextromethorphan/phenylephrine/guaifenesin

liquid

  • (5mg/2.5mg/100mg)/5mL
  • (5mg/2.5mg/50mg)/5mL
  • (10mg/5mg/200mg)/5mL
  • (20mg/10mg/200mg)/5mL
  • (10mg/5mg/100mg)/5mL

tablet

  • 20mg/10mg/400mg

syrup

  • (10mg/5mg/100mg)/5mL
more...

Temporary Relief of Nasal Congestion, Cough & Bronchial Irritation

1 tab PO q4-6hr; not to exceed 4 tabs/day

10 mL [(10mg/5mg/200mg)/5mL] PO q4hr; not to exceed 60 mg/day

Dosage Forms & Strengths

dextromethorphan/phenylephrine/guaifenesin

liquid

  • (5mg/2.5mg/100mg)/5mL
  • (5mg/2.5mg/50mg)/5mL
  • (10mg/5mg/200mg)/5mL
  • (20mg/10mg/200mg)/5mL
  • (10mg/5mg/100mg)/5mL

tablet

  • 20mg/10mg/400mg

syrup

  • (10mg/5mg/100mg)/5mL
more...

Temporary Relief of Nasal Congestion, Cough & Bronchial Irritation

4-6 years

  • 5 mL [(5mg/2.5mg/100mg)/5mL] PO q4hr; not to exceed 30 mL/day
  • 5 mL [(5mg/2.5mg/50mg)/5mL] PO q4hr; not to exceed 30 mL/day

6-12 years

  • ½ tablet PO q4-6hr; not to exceed 2 tablets/day
  • 10 mL [(5mg/2.5mg/100mg)/5mL] PO q4hr; not to exceed 30 mL/day
  • 10 mL [(5mg/2.5mg/50mg)/5mL] PO q4hr; not to exceed 30 mL/day

>12 years

  • 1 tab PO q4-6hr; not to exceed 4 tabs/day
  • 10 mL [(10mg/5mg/200mg)/5mL] PO q4hr; not to exceed 60 mg/day
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Interactions

Interaction Checker

and dextromethorphan/phenylephrine/guaifenesin

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            Adverse Effects

            Frequency Not Defined

            Hypertension

            Severe peripheral and visceral vasoconstriction

            Tachycardia

            Dizziness

            Drowsiness

            Excitability

            Headache

            Restlessness

            Tremor

            Nausea

            Vomiting

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            Warnings

            Contraindications

            Documented hypersensitivity to any of the drugs or component of the formulations

            Severe hypertension; coronary artery disease; use within 14 days of a MAO inhibitor; prostatic hypertrophy

            Cautions

            Guaifenesin may increase renal clearance of urate and lower serum uric acid levels; may interfere with urine laboratory tests for 5-hydroxyindoleacetic acid and urine testing for catecholamines

            Guanethidine may increase pressor response of direct-acting vasopressors, like phenylephrine, possibly resulting in severe hypertension

            Quinidine may inhibit the metabolism of dextromethorphan increasing its toxicity (adjust dose); concurrent use of dextromethorphan with MAO inhibitors may cause hyperpyrexia, abnormal muscle movement, hypotension, coma, and death (avoid use for 2 weeks after stopping the MAO inhibitor; coadministration of dextromethorphan with sibutramine may cause serotonin syndrome (concomitant use not recommended)

            Caution in diabetes, cardiovascular disease, increased intraocular pressure, thyroid dysfunction

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Excretion in milk unknown; use with caution

            Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs

            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.

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            Pharmacology

            Mechanism of Action

            Dextromethorphan is a cough suppressant that acts centrally on the cough center in the medulla.

            Guaifenesin increases respiratory tract fluid secretions and helps to loosen phlegm and bronchial secretions.

            Phenylephrine is a vasoconstrictor and a decongestant that relieves symptoms resulting from irritation of upper respiratory tract tissue. It shrinks swollen mucous membranes, reduces nasal congestion and tissue hyperemia.

            Pharmacokinetics

            Dextromethorphan

            • Onset: 15-30 min
            • Duration: 3-6 hr
            • Metabolism: Hepatic P450 enzyme CYP2D6
            • Excretion: Urine
            • Half-life: 2-4 hr (extensive metabolizers); 24 hr (poor metabolizers)
            • Peak plasma time: 2-3 hr

            Guaifenesin

            • Half-Life: 1 hr
            • Onset: 30 min
            • Duration: 4-6 hr
            • Metabolism: Liver
            • Metabolite: b-(2-methoxyphenoxy) lactic acid
            • Excretion: Urine

            Phenylephrine

            • Half-life: 2-3 hr
            • Onset: 10-15 min
            • Duration: 15 min
            • Bioavailability: < 38%
            • Excretion: Urine (80-90%)
            • Peak plasma time: 0.75-2 hr
            • Vd: 26-61 L
            • Vdss: 340 L
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            Images

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