DEXTROMETHORPHAN HYDROBROMIDE

DEXTROMETHORPHAN HYDROBROMIDe
(dex-troe-meth-or'fan)
Balminil DM

, Benylin DM, Cremacoat 1, Delsym, DM Cough, Hold, Koffex

, Mediquell, Neo-DM

, Ornex DM

, Pedia Care, Pertussin 8 Hour Cough Formula, Robidex

, Robitussin DM, Romilar CF, Romilar Children's Cough, Sedatuss

, Sucrets Cough Control
Classifications: antitussive;
Therapeutic: antitussive
Prototype: Benzonatate
Pregnancy Category: C

Availability

30 mg capsules; 2.5 mg, 5 mg, 7.5 mg, 15 mg lozenges; 10 mg/15 mL, 3.5 mg/5 mL, 7.5 mg/5 mL, 15 mg/5 mL liquid; 15 mg/15 mL, 10 mg/5 mL syrup

Action

Nonnarcotic derivative of levorphanol. Chemically related to morphine but without central hypnotic or analgesic effect. Controls cough spasms by depressing the cough center in medulla. Antitussive activity comparable to that of codeine but is less likely than codeine to cause constipation, drowsiness, or GI disturbances.

Therapeutic Effect

Temporarily relieves coughing spasm.

Uses

Temporary relief of cough spasms in nonproductive coughs due to colds, pertussis, and influenza.

Contraindications

Children <2 y, infants and neonates; asthma, COPD, productive cough, persistent or chronic cough; severe hepatic function impairment; concurrent MAOI therapy; pregnancy (category C).

Cautious Use

Chronic pulmonary disease; enlarged prostate; patients on MAO INHIBITORS; mild or moderate hepatic impairment; lactation.

Route & Dosage

Cough
Adult: PO 10–20 mg q4h or 30 mg q6–8h (max: 120 mg/d) or 60 mg of sustained action liquid b.i.d.
Child: PO 2–6 y, 2.5–5 mg q4h or 7.5 mg q6–8h (max: 30 mg/d) or 15 mg sustained action liquid b.i.d.; 6–12 y, 5–10 mg q4h or 15 mg q6–8h (max: 60 mg/d) or 30 mg sustained action liquid b.i.d.

Administration

Oral

Do not give lozenges to children <6 y.
Ensure that extended release form of drug is not chewed or crushed. It MUST be swallowed whole.
Note: Although soothing local effect of the syrup may be enhanced if given undiluted, depression of cough center depends only on systemic absorption of drug.

Adverse Effects (≥1%)

CNS: Dizziness, drowsiness, CNS depression with very large doses; excitability, especially in children. GI: GI upset, constipation, abdominal discomfort.

Interactions

Drug: High risk of excitation, hypotension, and hyperpyrexia with mao inhibitors.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 15–30 min. Duration: 3–6 h. Metabolism: In liver. Elimination: In urine.

Nursing Implications

Assessment & Drug Effects

Monitor for dizziness and drowsiness, especially when concurrent therapy with CNS depressant is used.

Patient & Family Education

Avoid irritants such as smoking, dust, fumes, and other air pollutants to lessen unnecessary cough. Humidify ambient air to provide some relief.
Note: Treatment aims to decrease the frequency and intensity of cough without completely eliminating protective cough reflex.
While dextromethorphan is available OTC, any cough persisting longer than 1 wk–10 d needs to be medically diagnosed.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(82)