Delsym


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Related to Delsym: dextromethorphan, Robitussin, Mucinex

dextromethorphan hydrobromide

Adult Dry Cough (UK), Balminil DM (CA), Broncho-Grippol-DM (CA), Calmylin #1 (CA), Creo-Terpin, Creomulsion, Delsym, DexAlone, Hold DM, Koffex-DM (CA), Neo-DM (CA), Robitussin Children's Cough Long-Acting, Robitussin for Dry Coughs (UK), Robitussin Maximum Strength Cough Suppressant, Scot-Tussin Diabetes, Sedatuss (CA), Triaminic Children's Long-Acting Cough, Trocal, Vicks DayQuil Cough, Vicks Vaposyrup for Dry Cough (UK), Vicks 44 Cough Relief

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.

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.

dextromethorphan

(dex-troe-meth-or-fan) ,

Balminil DM

(trade name),

Benylin DM

(trade name),

Bronchophan Forte DM

(trade name),

Buckley's DM

(trade name),

Cough Syrup DM

(trade name),

Creo-Terpin

(trade name),

Creomulsion Adult Formula

(trade name),

Creomulsion for Children

(trade name),

Delsym

(trade name),

Delsym DM

(trade name),

DM Children's Cough Syrup

(trade name),

DM Cough Syrup

(trade name),

Dry Cough Syrup

(trade name),

Father John's

(trade name),

Hold DM

(trade name),

Koffex DM

(trade name),

Neocitran Thin Strips Cough

(trade name),

Pediacare Children's Long-Acting Cough

(trade name),

Robafin Cough

(trade name),

Robitussin Children's Cough Long-Acting

(trade name),

Robitussin Cough Long-Acting

(trade name),

Robitussin CoughGels Long-Acting

(trade name),

Robitussin Lingering Cold Long-Acting CoughGels

(trade name),

Scot-Tussin Diabetes

(trade name),

Sedatuss DM

(trade name),

Sucrets Cough Control

(trade name),

Sucrets DM

(trade name),

Triaminic DM

(trade name),

Triaminic Long-Acting Cough

(trade name),

Triaminic Thin Strips Children's Long-Acting Cough

(trade name),

Triaminic Children's Cough Long-Acting

(trade name),

Vicks 44 Cough Relief

(trade name),

Vicks Custom Care Dry Cough

(trade name),

Vicks DayQuil Cough

(trade name),

Vicks Nature Fusion Cough

(trade name)

Classification

Therapeutic: allergy cold cough remedies
Pregnancy Category: C

Indications

Symptomatic relief of coughs caused by minor viral upper respiratory tract infections or inhaled irritants.Most effective for chronic nonproductive cough.A common ingredient in nonprescription cough and cold preparations.

Action

Suppresses the cough reflex by a direct effect on the cough center in the medulla. Related to opioids structurally but has no analgesic properties.

Therapeutic effects

Relief of irritating nonproductive cough.

Pharmacokinetics

Absorption: Rapidly absorbed from the GI tract. Extended-release product is slowly absorbed.
Distribution: Unknown. Probably crosses the placenta and enters breast milk.
Metabolism and Excretion: Metabolized to dextrorphan, an active metabolite. Dextromethorphan and dextrorphan are renally excreted.
Half-life: Unknown.

Time/action profile (cough suppression)

ROUTEONSETPEAKDURATION
PO15–30 minunknown3–6 hr†
PO-ERunknownunknown9–12 hr
†Up to 8 hr for gelcaps

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Patients taking MAO inhibitors or SSRIs;Should not be used for chronic productive coughs;Some products contain alcohol and should be avoided in patients with known intolerance.
Use Cautiously in: Cough that lasts more than 1 wk or is accompanied by fever, rash, or headache—health care professional should be consulted;History of drug abuse or drug-seeking behavior (capsules have been abused resulting in deaths);Diabetes (some products contain sucrose); Obstetric: Pregnancy (has been used safely); Lactation: Lactation; Pediatric: Children <4 yr (OTC cough and cold products containing this medication should be avoided).

Adverse Reactions/Side Effects

Central nervous system

  • high dose—dizziness, sedation

Gastrointestinal

  • nausea

Interactions

Drug-Drug interaction

Use with MAO inhibitors may result in serotonin syndrome (nausea, confusion, changes in BP); concurrent use should be avoided.↑ CNS depression with antihistamines, alcohol, antidepressants, sedative/hypnotics, or opioids.Amiodarone, fluoxetine, or quinidine may ↑ blood levels and adverse reactions from dextromethorphan.

Route/Dosage

Oral (Adults and Children >12 yr) 10–20 mg q 4 hr or 30 mg q 6–8 hr or 60 mg of extended-release preparation bid (not to exceed 120 mg/day).
Oral (Children 6–12 yr) 5–10 mg q 4 hr or 15 mg q 6–8 hr or 30 mg of extended-release preparation q 12 hr (not to exceed 60 mg/day).
Oral (Children 4–6 yr) 2.5–5 mg q 4 hr or 7.5 mg q 6–8 hr or 15 mg of extended-release preparation q 12 hr (not to exceed 30 mg/day).

Availability (generic available)

Gelcaps: 30 mgOTC
Lozengescherry: 2.5 mgOTC, 5 mgOTC
Liquidcherry, grape: 3.5 mg/5 mLOTC, 5 mg/5 mL, 7.5 mg/5 mLOTC, 15 mg/5 mLOTC, 30 mg/5 mLOTC
Syrupcherry, cherry bubblegum: 7.5 mg/5 mLOTC, 15 mg/15 mLOTC, 10 mg/5 mLOTC
Extended-release suspensionorange: 30 mg/5 mLOTC
DropsGrape: 7.5 mg/0.8 mLOTC, 7.5 mg/1 mLOTC
Orally-disintegrating stripscherry, grape: 7.5 mgOTC, 15 mgOTC
In combination with: antihistamines, decongestants, and expectorants in cough and cold preparationsOTC, quinidine sulfate (Nuedextra). See combination drugs.

Nursing implications

Nursing assessment

  • Assess frequency and nature of cough, lung sounds, and amount and type of sputum produced. Unless contraindicated, maintain fluid intake of 1500–2000 mL to decrease viscosity of bronchial secretions.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)

Implementation

  • Dextromethorphan 15–30 mg is equivalent in cough suppression to codeine 8–15 mg.
  • Oral: Do not give fluids immediately after administering to prevent dilution of vehicle. Shake oral suspension well before administration.

Patient/Family Teaching

  • Instruct patient to cough effectively: Sit upright and take several deep breaths before attempting to cough.
  • Advise patient to minimize cough by avoiding irritants, such as cigarette smoke, fumes, and dust. Humidification of environmental air, frequent sips of water, and sugarless hard candy may also decrease the frequency of dry, irritating cough.
  • Caution patient to avoid taking more than the recommended dose or taking alcohol or other CNS depressants concurrently with this medication; fatalities have occurred. Caution parents to avoid OTC cough and cold products while breast feeding or to children <4 yrs.
  • May occasionally cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
  • Advise patient that any cough lasting over 1 wk or accompanied by fever, chest pain, persistent headache, or skin rash warrants medical attention.

Evaluation/Desired Outcomes

  • Decrease in frequency and intensity of cough without eliminating patient’s cough reflex.

Delsym

(dĕl′sĭm′)
A trademark for an over-the-counter preparation containing a form of the drug dextromethorphan.
References in periodicals archive ?
The resin chosen was AMBERLITE IRP69, a resin similar to that used in Delsym and Tussionex.
Delsym is a cough medicine that doctors and pharmacists have recommended for years in the United States.
Table 54: United States' Leading Cough Syrup Brands (2005): Sales through Drugstores in Units for Robitussin OM, Robitussin, Delsym, Vicks NyQuil Cough, Vicks Formula 44, Vicks Formula 44e, Diabetic Tussin, Robitussin Pediatric, Robitussin Honey Cough, Zicam Cough Mist 135
Delsym is currently sold in two adult and two children's lines.
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The remainder of our non-CNS sales, including Delsym sales of (pound)3.
In addition to bringing Cepacol, Clearasil, Delsym, Rid-X, Veet and Mucinex to the platform, RB will also take advantage of extended publishing rights for some brands to integrate videos within their owned brand websites and syndicate the assets to YouTube and Facebook.
Delsym, the OTC extended-release paediatric cough product and our second largest respiratory product, achieved sales of (pound)7 million which was in line with 1997, in what was a weak "cough and cold" season.
The new product will fill the gap between Tussionex (hydrocodone) our potent anti-tussive prescription product for severe coughs and Delsym (dextromethorphan) our extended release over-the-counter product for mild to moderate cough suppression.
The new product is equivalent to Delsym extended-release oral liquid suspension containing dextromethorphan polistirex and will be marketed under major U.