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
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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 1020 mg q4h or 30 mg q68h (max: 120 mg/d) or 60 mg of sustained action liquid b.i.d. Child: PO 26 y, 2.55 mg q4h or 7.5 mg q68h (max: 30 mg/d) or 15 mg sustained action liquid b.i.d.; 612 y, 510 mg q4h or 15 mg q68h (max: 60 mg/d) or 30 mg sustained action liquid b.i.d.
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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: 1530 min.
Duration: 36 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 wk10 d needs to be medically diagnosed.