From the Guidelines
Dextromethorphan is not recommended for children due to lack of efficacy and potential for significant morbidity and mortality. The American Academy of Pediatrics has advised against the use of codeine and dextromethorphan for treating any type of cough 1. According to a Cochrane review, there is no significant benefit for therapy with diphenhydramine, and OTC cough medications have little, if any, benefit in the symptomatic control of acute cough in children 1.
When considering the use of dextromethorphan in children, it's essential to weigh the potential risks and benefits. The potential for unintentional ingestion and associated morbidity and mortality, particularly in children under 5 years of age, is a significant concern 1.
In terms of dosing, a study from 2003 suggests that children may be given 10–20 mg/kg (600 mg) once daily or twice weekly 1. However, given the lack of efficacy and potential risks associated with dextromethorphan, it's crucial to prioritize alternative treatments that can effectively manage cough symptoms while minimizing harm.
Key considerations for managing cough in children include:
- Consulting a healthcare provider if cough persists beyond 7 days or is accompanied by fever, rash, or persistent headache
- Avoiding the use of adult formulations in children unless specifically directed by a healthcare provider
- Being aware of the potential for side effects, such as drowsiness or excitability, and monitoring children closely for these adverse effects.
From the FDA Drug Label
Directions take every 4 hours or as directed by a doctor chew thoroughly before swallowing adults and children 12 years of age and over - 2 chewable tablets every 4 hours, not to exceed 12 chewable tablets in any 24-hour period children ages 6 to 12 years - 1 chewable tablet every 4 hours, not to exceed 6 chewable tablets in any 24-hour period children ages 6 and under - do not use The recommended dose of dextromethorphan for children is:
- Children 12 years and older: 2 chewable tablets every 4 hours, not to exceed 12 tablets in 24 hours
- Children 6 to 11 years: 1 chewable tablet every 4 hours, not to exceed 6 tablets in 24 hours
- Children under 6 years: Do not use 2
From the Research
Dextromethorphan Doses for Children
The recommended dose of dextromethorphan for children varies by age and weight. According to the study 3, the administered doses were as follows:
- Ages 2 to 5 years: 7.5 mg
- Ages 6 to 11 years: 15 mg
- Ages 12 to 18 years: 30 mg This resulted in a range of 0.35 to 0.94 mg/kg per dose.
Dose-Response Relationship
The study 3 found that there was no significant difference in the outcome measures when comparing the effects of different doses of dextromethorphan. However, the observations suggested somewhat more symptomatic relief for patients receiving medium-dose dextromethorphan (0.45 to <0.60 mg/kg per dose) or high-dose dextromethorphan (0.60-0.94 mg/kg per dose) compared with low-dose dextromethorphan (0.35 to <0.45 mg/kg per dose).
Adverse Events
Adverse events occurred most often in the high-dose group, according to the study 3. The study 4 found that central nervous system and autonomic symptoms were the most common adverse events associated with dextromethorphan overdose in children.
Key Points to Consider
- The dose of dextromethorphan should be based on the child's age and weight, as recommended by the manufacturer 3.
- The study 3 suggests that a dose of 0.5 mg/kg may be considered in future assessments of the antitussive effect of dextromethorphan in pediatric studies, to balance symptomatic relief with the avoidance of adverse events.
- Dextromethorphan can be abused, particularly by teenagers, and can produce a substance dependence syndrome 5, 6.
- Adverse events, including CNS side effects, can occur with dextromethorphan overdose, and two deaths have been reported with intentional dextromethorphan overdose 7.