Dextromethorphan

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[edit] BRAND NAMES

  • Benylin (Canada, Ireland, Malta, UK, South Africa)
  • Bisoltussin (Indonesia, Netherlands, Portugal)
  • Delsym (United States)
  • Dexir (Belgium, Luxembourg)
  • Dexofan (Denmark, Lithuania, Latvia)
  • Robitussin (Australia, Bulgaria, Canada, Czech Republic, Hungary, Ireland, Israel, Lithuania, Malta, New Zealand, Poland, Romania, United Kingdom)
  • Romilar (Argentina, Belgium, Spain, Kenya, Luxembourg, Indonesia, Oman)

[edit] STRUCTURE

Dextromethorphan.jpg

[edit] MECHANISM OF ACTION

Dextromethorphan is a non-opioid cough suppressant. It is the methylated dextrorotatory analogue of levorphanol, a codeine analogue.

Dextromethorphan acts centrally on the cough center in the medulla and nucleus tractus solaris to increase the cough threshold. It does not have classical analgesic, sedative or respiratory depressant effects at usual antitussive doses. It seems also not to cause constipation, which is a side effect of opioids.

[edit] INDICATIONS

Dextromethorphan temporarily relieves:

  • Cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants
  • The impulse to cough to help get to sleep

Dextromethorphan should not be used for chronic persistent cough accompanying a disease state, or for cough associated with excessive secretions.

[edit] DOSAGE

  • Adults and children 12 years of age and over: 60 mg every 12 hours
  • Children 6 to 12 years of age: 30 mg every 12 hours.

[edit] CONTRAINDICATIONS

Dextromethorphan is contraindicated for use in patients with known hypersensitivity or idiosyncratic reaction to dextromethorphan

[edit] WARNINGS AND PRECAUTIONS

Dextromethorphan should not be used for chronic persistent cough accompanying a disease state, or for cough associated with excessive secretions.

Dextromethorphan should not be given to patients with or at risk of developing respiratory failure, e.g. asthma, chronic obstructive airways disease, and pneumonia. Caution is needed in patients with a history of asthma and it should not be given during an acute attack.

[edit] INTERACTIONS

  • Dextromethorphan should not be taken with either of the following:
    • monoamine oxidase inhibitors (e.g. Moclobemide, Rasagiline, Selegiline) or who have taken MAOIs within the previous 14 days. The use of dextromethorphan with, or within two weeks of taking MAOIs, may increase the risk of serious side effects such as hypertensive crisis, hyperpyrexia and convulsions.
    • selective serotonin reuptake inhibitors (SSRIs): Dextromethorphan when used with SSRI’s (such as fluoxetine)or tricyclic antidepressants (such as clomipramine and imipramine) may result in a “serotonin syndrome” with changes in mental status, hypertension, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering and tremor.
  • Concomitant use of dextromethorphan and other CNS depressants (e.g. alcohol, narcotic analgesics and tranquillizers) may increase the CNS depressant effects of these drugs.

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US), Pregnancy Category A (AU)
  • Pregnancy Category A (Australia)
  • Lactation: It is not known whether dextromethorphan is excreted in breast milk or whether it has a harmful effect on the breastfeeding infant. Therefore it is not recommended for breastfeeding mothers unless the potential benefits to the patient are weighed against the possible risk to the infant.

[edit] SIDE EFFECTS

Side effects with usual doses are uncommon but may include mild drowsiness, fatigue, dystonias, dizziness and gastrointestinal disturbances (nausea or vomiting, stomach discomfort, or constipation).

Side effects that may occur with high doses (overdosage) include excitation, confusion, psychosis, nervousness, irritability, restlessness, “serotonin syndrome”, severe nausea and vomiting, and respiratory depression.

[edit] RELATED LINKS

Dextromethorphan Information

[edit] BIBLIOGRAPHY

[edit] REFERENCES

Antitussives / Cough
Cough suppressants Benzonatate   Butamirate   Codeine   Dextromethorphan   Dihydrocodeine   Dropropizine   Levocloperastine   Levodropropizine   Nepinalone   Oxolamine
Mucolytics Acetylcysteine   Ambroxol (Oral)   Bromhexine   Carbocisteine   Erdosteine   Guaifenesin   Neltenexine