II. Efficacy

  1. As effective as Codeine for cough suppression
  2. But no more effective than Placebo in children
    1. Paul (2004) Pediatrics 114:e85-90 [PubMed]

III. Preparations

  1. Common component in Cold Preparations for cough suppression (e.g. Robitussin, Coricidin)

IV. Dosing

  1. Dextromethorphan (DM): 0.5 mg/kg up to 30 mg PO tid-qid
  2. Robitussin DM (15 mg/tsp)
    1. Adult: 2 tsp (10 ml) q4h
    2. Age 6 to 12 years: 1 tsp (5 ml) q4h
    3. Age 2 to 6 years: 1/2 tsp (2.5 ml) q4h

V. Adverse effects

  1. Abuse potential (esp. in teens)
    1. See Dextromethorphan Toxicity
    2. Bryner (2006) Arch Pediatr Adolesc Med 160:1217-22 [PubMed]
  2. Other (rare)
    1. Lethargy, stupor or coma
    2. Hyperexcitability
    3. Abnormal limb movements

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Cost: Medications

dextromethorphan (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
DEXTROMETHORPHAN ER 30 MG/5 ML Generic OTC $0.06 per ml
delsym (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
DELSYM 30 MG/5 ML SUSPENSION Generic OTC $0.06 per ml
DELSYM COUGH+CHEST CNGST DM LQ OTC $0.05 per ml
DELSYM COUGH+COLD NIGHTTIME LQ OTC $0.05 per ml
DELSYM COUGH-COLD DAYTIME LIQ OTC $0.06 per ml

Ontology: Delsym (C0011218)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D003915
English delsym, Delsym

Ontology: Dextromethorphan (C0011816)

Definition (NCI) A synthetic, methylated dextrorotary analogue of levorphanol, a substance related to codeine and a non-opioid derivate of morphine. Dextromethorphan exhibits antitussive activity and is devoid of analgesic or addictive property. This agent crosses the blood-brain-barrier and activates sigma opioid receptors on the cough center in the central nervous system, thereby suppressing the cough reflex.
Definition (CSP) d-isomer of the codeine analog of levorphanol; dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center; this compound is an NMDA receptor antagonist (n-methyl-d-aspartate receptors) and acts as a noncompetitive channel blocker; it is one of the widely used antitussives, and is also used to study the involvement of glutamate receptors in neurotoxicity.
Definition (MSH) Methyl analog of DEXTRORPHAN that shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is an NMDA receptor antagonist (RECEPTORS, N-METHYL-D-ASPARTATE) and acts as a non-competitive channel blocker. It is one of the widely used ANTITUSSIVES, and is also used to study the involvement of glutamate receptors in neurotoxicity.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D003915
SnomedCT 2016004, 387114001
LNC LP16105-6, MTHU004183
English d-Methorphan, Morphinan, 3-methoxy-17-methyl-, (9alpha,13alpha,14alpha)-, METHORPHAN D, DXM, dextromethorphan (medication), Dextromethorphan [Chemical/Ingredient], DEXTROMETHORPHAN, d methorphan, d-methorphan, dextromethorphan, Dextromethmorphan, Dextromethorphan (product), Dextromethorphan (substance), Dextromethorphan
Swedish Dextrometorfan
Czech dextromethorfan
Finnish Dekstrometorfaani
Russian DEKSTROMETORFAN, D-METORFAN, ДЕКСТРОМЕТОРФАН, Д-МЕТОРФАН
Japanese D-メトルファン, デキストロメトルファン, 臭化水素デキストロメトルファン
Italian d-Metorfano, Destrometorfano
German METHORPHAN D, D-Methorphan, Dextromethorphan
Spanish dextrometorfano (sustancia), dextrometorfán (sustancia), dextrometmorfano, dextrometorfán, dextrometorfano (producto), dextrometorfano, Dextrometorfano, d-Metorfano
Polish Dekstrometorfan
French Dextrométhorphane
Portuguese Dextrometorfano, d-Metorfano