dextromethorphan hydrobromide

dextromethorphan hydrobromide

(dex troe meth or' fan)

Balminil DM (CAN), Benylin Adult, Benylin Pediatric, Creo-Terpin, Delsym, DexAlone, Hold DM, Koffex (CAN), Novahistex DM (CAN), Robitussin Pediatric (CAN), Trocal, Vicks Dry Hacking Cough

Pregnancy Category C

Drug class

Nonopioid antitussive

Therapeutic actions

Lacks analgesic and addictive properties; controls cough spasms by depressing the cough center in the medulla; analog of codeine.

Indication

·        Control of nonproductive cough

Contraindications and cautions

·        Contraindicated with hypersensitivity to any component (check label of products for flavorings, vehicles); sensitivity to bromides; cough that persists for more than 1 wk, tends to recur, is accompanied by excessive secretions, high fever, rash, nausea, vomiting, or persistent headache (dextromethorphan should not be used; patient should consult a physician).

·        Use cautiously with lactation, pregnancy.

Available forms

Gelcaps—30 mg; lozenges—5, 7.5 mg; liquid—7.5 mg/5 mL; 10 mg/15 mL, 15 mg/5 mL, 30 mg/5 mL; syrup—7.5 mg/5 mL, 10 mg/5 mL; sustained-action liquid—30 mg/5 mL

Dosages

ADULTS AND PATIENTS > 12 YR

Lozenges, syrup, and chewy squares

10–30 mg q 4–8 hr PO. Do not exceed 120 mg/24 hr.

Sustained-action liquid

60 mg bid PO up to 120 mg/day.

PEDIATRIC PATIENTS

Lozenges, syrup, and chewy squares

6–12 yr: 5–10 mg q 1–4 hr PO. Do not exceed 60 mg/24 hr.

Sustained-action liquid

30 mg bid PO.

Syrup and chewy squares

2–6 yr: 7.5 mg q 6–8 hr PO. Do not exceed 30 mg/24 hr. Do not give lozenges to this age group.

Sustained-action liquid

15 mg bid PO up to 30 mg/day.

< 2 yr: Use only as directed by a physician.

Pharmacokinetics

Route	Onset	Peak	Duration
Oral	15–30 min	2 hr	3–6 hr

Metabolism: Hepatic; T_1/2: 2–4 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

Adverse effects

·        Respiratory: Respiratory depression (with overdose)

Interactions

Drug-drug

·        Concomitant MAOI use may cause hypotension, fever, nausea, myoclonic jerks and coma; avoid this combination

Nursing considerations

Assessment

·        History: Hypersensitivity to any component; sensitivity to bromides; cough that persists for more than 1 wk or is accompanied by excessive secretions, high fever, rash, nausea, vomiting, or persistent headache; lactation, pregnancy

·        Physical: T; R, adventitious sounds

Interventions

·        Ensure drug is used only as recommended. Coughs may be symptomatic of a serious underlying disorder that should be diagnosed and properly treated; drug may mask symptoms of serious disease.

Teaching points

·        Take this drug exactly as prescribed. Do not take more than or for longer than recommended.

·        Be cautious when using over-the-counter products; they may contain the same ingredients and overdose can occur.

·        Report continued or recurring cough, cough accompanied by fever, rash, persistent headache, nausea, vomiting.

Adverse effects in Italic are most common; those in Bold are life-threatening.