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Pharmacologic class: Levorphanol derivative
Therapeutic class: Antitussive (nonnarcotic)
Pregnancy risk category C
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.
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.
• Elderly patients
• Hypersensitivity to drug
• Chronic productive cough
• MAO inhibitor use within past 14 days
Use cautiously in:
• tartrazine sensitivity
• diabetes mellitus (with sucrose-containing drug products)
• pregnant or breastfeeding patients
• children younger than age 2 (safety not established).
• Don't administer lozenges to children younger than age 6.
☞ Don't give within 14 days of MAO inhibitors.
CNS: dizziness and sedation
GI: nausea, vomiting, stomach pain
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
• Monitor cough frequency and type, and assess sputum characteristics.
• Assess hydration status. Increase patient's fluid input to help moisten secretions.
• 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.
Balminil DM(trade name),
Benylin DM(trade name),
Bronchophan Forte DM(trade name),
Buckley's DM(trade name),
Cough Syrup DM(trade name),
Creomulsion Adult Formula(trade name),
Creomulsion for Children(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)
ClassificationTherapeutic: allergy cold cough remedies
Time/action profile (cough suppression)
|PO||15–30 min||unknown||3–6 hr†|
Adverse Reactions/Side Effects
Central nervous system
- high dose—dizziness, sedation
Drug-Drug interactionUse 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.
Availability (generic available)
- 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 DiagnosesIneffective airway clearance (Indications)
- 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.
- 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.
- Decrease in frequency and intensity of cough without eliminating patient’s cough reflex.