(deks troe meth OR fan & MEN thole)
Cough suppressant/sore throat: Temporary relief of sore throat, sore mouth, minor throat irritation, and cough due to minor throat and bronchial irritation as may occur with the common cold.
OTC labeling: When used for self-medication, do not use if you are taking a MAO inhibitor or within 2 weeks after stopping a MAO inhibitor; do not use in children <6 years of age
Cough suppressant/sore throat: Oral: A total of 2 lozenges (dextromethorphan 5 mg/menthol 5 mg per lozenge) dissolved in mouth, 1 immediately after the other. May repeat every 4 hours; maximum: 12 lozenges (dextromethorphan 60 mg/menthol 60 mg) daily
Refer to adult dosing.
Cough suppressant/sore throat: Oral:
Children <6 years: Not for OTC use.
Children 6 to <12 years: One lozenge (dextromethorphan 5 mg/menthol 5 mg per lozenge) dissolved in mouth. May repeat every 4 hours; maximum: 6 lozenges (dextromethorphan 30 mg/menthol 30 mg) daily
Children ≥12 years and Adolescents: Refer to adult dosing.
Allow lozenge to dissolve slowly in the mouth.
Store between 20 ‚ °C to 25 ‚ °C (68 ‚ °F to 77 ‚ °F).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Lozenge, Mouth/Throat:
Delsym Cough Relief: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea) [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow); honey-lemon flavor]
Delsym Cough Relief: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea) [sugar free; contains fd&c red #40; cherry flavor]
Delsym Cough+ Soothing Action: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea) [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow); honey-lemon flavor]
Delsym Cough+ Soothing Action: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea) [sugar free; contains fd&c red #40; cherry flavor]
Robitussin Medi-Soothers: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (4 ea, 16 ea) [honey-lemon flavor]
Abiraterone Acetate: May increase the serum concentration of CYP2D6 Substrates. Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity. Consider therapy modification
Ajmaline: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy
Analgesics (Opioid): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy
Antiemetics (5HT3 Antagonists): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy
Antipsychotic Agents: Serotonin Modulators may enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy
Asunaprevir: May increase the serum concentration of CYP2D6 Substrates. Consider therapy modification
Cobicistat: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy
CYP2D6 Inhibitors (Moderate): May decrease the metabolism of CYP2D6 Substrates. Monitor therapy
CYP2D6 Inhibitors (Strong): May decrease the metabolism of CYP2D6 Substrates. Consider therapy modification
Dapoxetine: May enhance the adverse/toxic effect of Serotonin Modulators. Avoid combination
Darunavir: May increase the serum concentration of CYP2D6 Substrates. Monitor therapy
MAO Inhibitors: May enhance the serotonergic effect of Dextromethorphan. This may cause serotonin syndrome. Avoid combination
Memantine: NMDA Receptor Antagonists may enhance the adverse/toxic effect of Memantine. Monitor therapy
Metaxalone: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy
Methylene Blue: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Avoid combination
Metoclopramide: Serotonin Modulators may enhance the adverse/toxic effect of Metoclopramide. This may be manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome. Monitor therapy
Panobinostat: May increase the serum concentration of CYP2D6 Substrates. Management: Avoid concurrent use of sensitive CYP2D6 substrates when possible, particularly those substrates with a narrow therapeutic index. Consider therapy modification
Parecoxib: May increase the serum concentration of Dextromethorphan. Monitor therapy
Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates. Monitor therapy
Perhexiline: CYP2D6 Substrates may increase the serum concentration of Perhexiline. Perhexiline may increase the serum concentration of CYP2D6 Substrates. Monitor therapy
QuiNIDine: May increase the serum concentration of Dextromethorphan. Management: Avoid concurrent use of these agents when possible, unless the increased psychoactive effects of dextromethorphan are desired. Since codeine activation is also inhibited by quinidine, codeine is unlikely to be suitable as an alternative antitussive. Consider therapy modification
Selective Serotonin Reuptake Inhibitors: May enhance the serotonergic effect of Dextromethorphan. Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dextromethorphan. Management: Avoid the concurrent use of dextromethorphan and SSRIs, particularly fluoxetine and paroxetine, when possible. The risk for this interaction may persist for several weeks following discontinuation of fluoxetine or paroxetine. Exceptions: FluvoxaMINE. Consider therapy modification
Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid. Monitor therapy
TraMADol: Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy
See Dextromethorphan monograph.
Concurrent drug therapy issues:
- Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Other warnings/precautions:
- Self-medication (OTC use): When used for self-medication (OTC) contact health care provider prior to use if you have a persistent or chronic cough associated with asthma, emphysema or smoking, or if you have cough with excess phlegm; notify healthcare provider if symptoms do not improve within 7 days, irritation, pain or redness persist/worsen, swelling develops, or cough is accompanied by fever, rash or persistent headache.
Dextromethorphan: Decreases the sensitivity of cough receptors and interrupts cough impulse transmission by depressing the medullary cough center through sigma receptor stimulation; structurally related to codeine
Menthol: Local anesthetic and counterirritant to relieve minor sore throat irritation
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.