Name /bks_53161_deglins_md_disk/dextromethorphan 02/25/2014 09:31AM Plate # 0-Composite pg 1 # 1 TIME/ACTION PROFILE (cough suppression) 1 dextromethorphan (dex-troe-meth-or-fan) Balminil DM, Benylin DM, Bronchophan Forte DM, Buckley’s DM, Cough Syrup DM, Creo-Terpin, Creomulsion Adult Formula, Creomulsion for Children, Delsym, Delsym DM, DM Children’s Cough Syrup, DM Cough Syrup, Dry Cough Syrup, Father John’s, Hold DM, Koffex DM, Neocitran Thin Strips Cough, Pediacare Children’s Long Acting Cough, Robafin Cough, Robitussin Children’s Cough Long-Acting, Robitussin Cough Long-Acting, Robitussin CoughGels Long-Acting, Robitussin Lingering Cold Long-Acting CoughGels, Scot-Tussin Diabetes, Sedatuss DM, Sucrets Cough Control, Sucrets DM, Triaminic DM, Triaminic Long Acting Cough, Triaminic Thin Strips Children’s Long Acting Cough, Triaminic Children’s Cough Long Acting, Vicks 44 Cough Relief, Vicks Custom Care Dry Cough, Vicks DayQuil Cough, Vicks Nature Fusion Cough Classification Therapeutic: allergy, cold, and cough remedies, antitussives Pregnancy Category C ROUTE ONSET PO 15–30 min PO-ER unknown †Up to 8 hr for gelcaps PEAK unknown unknown DURATION 3–6 hr† 9–12 hr Contraindications/Precautions Contraindicated in: Hypersensitivity; Patients taking MAO inhibitors or SSRIs; Should not be used for chronic productive coughs; Some products contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Cough that lasts more than 1 wk or is accompanied by fever, rash, or headache— health care professional should be consulted; History of drug abuse or drug-seeking behavior (capsules have been abused resulting in deaths); Diabetes (some products contain sucrose); OB: Pregnancy (has been used safely); Lactation: Lactation; Pedi: Children ⬍4 yr (OTC cough and cold products containing this medication should be avoided). Adverse Reactions/Side Effects CNS: high dose— dizziness, sedation. GI: nausea. Interactions Drug-Drug: Use with MAO inhibitors may result in serotonin syndrome (nausea, Symptomatic relief of coughs caused by minor viral upper respiratory tract infections or inhaled irritants. Most effective for chronic nonproductive cough. A common ingredient in nonprescription cough and cold preparations. confusion, changes in BP); concurrent use should be avoided.qCNS depression with antihistamines, alcohol, antidepressants, sedative/hypnotics, or opioids. Amiodarone, fluoxetine, or quinidine mayqblood levels and adverse reactions from dextromethorphan. Action Route/Dosage Indications Suppresses the cough reflex by a direct effect on the cough center in the medulla. Related to opioids structurally but has no analgesic properties. Therapeutic Effects: Relief of irritating nonproductive cough. Pharmacokinetics Absorption: Rapidly absorbed from the GI tract. Extended-release product is slowly absorbed. Distribution: Unknown. Probably crosses the placenta and enters breast milk. Metabolism and Excretion: Metabolized to dextrorphan, an active metabolite. Dextromethorphan and dextrorphan are renally excreted. Half-life: Unknown. ⫽ Canadian drug name. ⫽ Genetic Implication. PO (Adults and Children ⬎12 yr): 10– 20 mg q 4 hr or 30 mg q 6– 8 hr or 60 mg of extended-release preparation bid (not to exceed 120 mg/day). PO (Children 6– 12 yr): 5– 10 mg q 4 hr or 15 mg q 6– 8 hr or 30 mg of extendedrelease preparation q 12 hr (not to exceed 60 mg/day). PO (Children 4– 6 yr): 2.5– 5 mg q 4 hr or 7.5 mg q 6– 8 hr or 15 mg of extendedrelease preparation q 12 hr (not to exceed 30 mg/day). NURSING IMPLICATIONS Assessment ● Assess frequency and nature of cough, lung sounds, and amount and type of spu- tum produced. Unless contraindicated, maintain fluid intake of 1500– 2000 mL to decrease viscosity of bronchial secretions. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued. PDF Page #1 Name /bks_53161_deglins_md_disk/dextromethorphan 02/25/2014 09:31AM Plate # 0-Composite pg 2 # 2 2 PDF Page #2 Potential Nursing Diagnoses Ineffective airway clearance (Indications) Implementation ● Dextromethorphan 15– 30 mg is equivalent in cough suppression to codeine 8– 15 mg. ● PO: Do not give fluids immediately after administering to prevent dilution of vehi- cle. Shake oral suspension well before administration. Patient/Family Teaching ● Instruct patient to cough effectively: Sit upright and take several deep breaths be- fore 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. Evaluation/Desired Outcomes ● Decrease in frequency and intensity of cough without eliminating patient’s cough reflex. Why was this drug prescribed for your patient? 䉷 2015 F.A. Davis Company