dextromethorphan hydrobromide
dextromethorphan hydrobromide
Pharmacologic class: Levorphanol derivative
Therapeutic class: Antitussive (nonnarcotic)
Pregnancy risk category C
Action
Depresses cough reflex through direct effect on cough center in medulla. Has no expectorant action and does not inhibit ciliary action. Although related to opioids structurally, lacks analgesic and addictive properties.
Availability
Gelcaps: 15 mg, 30 mg
Liquid: 3.5 mg/5 ml, 5 mg/5 ml, 7.5 mg/5 ml, 15 mg/5 ml
Lozenges: 5 mg, 7.5 mg
Oral suspension (extended-release): 30 mg/5 ml
Syrup: 7.5 mg/5 ml, 10 mg/15 ml
Indications and dosages
➣ Cough caused by minor viral upper respiratory tract infections or inhaled irritants
Adults and children over age 12: 10 to 20 mg P.O. q 4 hours, or 30 mg P.O. q 6 to 8 hours, or 60 mg of extended-release form P.O. b.i.d. (not to exceed 120 mg/day)
Children ages 6 to 12: 5 to 10 mg P.O. q 4 hours, or 15 mg P.O. q 6 to 8 hours, or 30 mg of extended-release form P.O. q 12 hours (not to exceed 60 mg/day)
Children ages 4 to 6: 2.5 to 7.5 mg (syrup) P.O. q 4 to 8 hours or 15 mg (extended-release form) P.O. b.i.d. Not to exceed 30 mg/day.
Dosage adjustment
• Elderly patients
Contraindications
• Hypersensitivity to drug
• Chronic productive cough
• MAO inhibitor use within past 14 days
Precautions
Use cautiously in:
• tartrazine sensitivity
• diabetes mellitus (with sucrose-containing drug products)
• pregnant or breastfeeding patients
• children younger than age 2 (safety not established).
Administration
• Don't administer lozenges to children younger than age 6.
See Don't give within 14 days of MAO inhibitors.
Adverse reactions
CNS: dizziness and sedation
GI: nausea, vomiting, stomach pain
Interactions
Drug-drug. Amiodarone, fluoxetine, quinidine: increased dextromethorphan blood level, greater risk of adverse reactions
Antidepressants, antihistamines, opioids, sedative-hypnotics: additive CNS depression
MAO inhibitors, sibutramine: serotonin syndrome (nausea, confusion, blood pressure changes)
Drug-behaviors. Alcohol use: additive CNS depression
Patient monitoring
• Monitor cough frequency and type, and assess sputum characteristics.
• Assess hydration status. Increase patient's fluid input to help moisten secretions.
Patient teaching
• Advise patient to avoid irritants, such as smoking, dust, and fumes. Suggest use of humidifier to filter air pollutants.
• Inform patient that treatment aims to decrease coughing frequency and intensity without completely eliminating protective cough reflex.
• Instruct patient to contact health care provider if cough lasts more than 7 days.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.