Delsym

Del·sym (dlsm)

A trademark for the drug dextromethorphan.

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dextromethorphan hydrobromide

Adult Dry Cough (UK), Balminil DM (CA), Broncho-Grippol-DM (CA), Calmylin #1 (CA), Creo-Terpin, Creomulsion, Delsym, DexAlone, Dry Cough Syrup (UK), ElixiSure Cough, Hold DM, Koffex-DM (CA), Neo-DM (CA), PediaCare Infants Long-Acting Cough, Robitussin for Dry Coughs (UK), Robitussin CoughGels, Robitussin Maximum Strength Cough Suppressant, Robitussin Pediatric Cough, Sedatuss (CA), 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 2 to 6: 2.5 to 5 mg P.O. q 4 hours, or 7.5 mg q 6 to 8 hours, or 15 mg of extended-release form P.O. q 12 hours (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.

Route	Onset	Peak	Duration
P.O.	15-30 min	Unknown	3-6 hr
P.O. (extended)	Unknown	Unknown	9-12 hr

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.