Dextromethorphan Availability as an Over-the-Counter Medication
Yes, dextromethorphan is widely available as an over-the-counter (OTC) cough suppressant in many formulations. 1, 2, 3
Evidence Supporting OTC Status
Dextromethorphan is a non-sedating opiate derivative that serves as a component in numerous over-the-counter cough remedies. It has been shown to effectively suppress acute cough in clinical studies 1. According to the FDA-approved labeling, dextromethorphan is available in various OTC formulations, including extended-release oral suspensions 3.
The Thorax journal guidelines specifically identify dextromethorphan as:
- A non-sedating opiate that is a component of many over-the-counter cough remedies
- Having better efficacy than placebo in suppressing acute cough
- The first-line medication of choice for dry cough due to its efficacy and better safety profile compared to codeine-based preparations 1, 2
Common Formulations
Dextromethorphan is available in several OTC formulations:
- Oral syrups and suspensions
- Extended-release formulations (providing 12-hour cough relief)
- Combined preparations with other ingredients such as antihistamines or decongestants 2, 3
A typical example is dextromethorphan polistirex extended-release oral suspension, which contains the equivalent of 30 mg dextromethorphan hydrobromide per 5 mL 3.
Dosing Considerations
Standard dosing for dextromethorphan varies by age:
- Children 2-5 years: 7.5 mg
- Children 6-11 years: 15 mg
- Adolescents and adults 12+ years: 30 mg 4
The recommended therapeutic dose is often 10-15 mg three to four times daily for adults 2. However, research suggests that the generally recommended OTC dosage may be subtherapeutic, with maximum cough reflex suppression occurring at higher doses of around 60 mg 1.
Safety Profile and Cautions
While dextromethorphan has a generally favorable safety profile at therapeutic doses 5, there are important considerations:
- Abuse potential: Dextromethorphan can be abused at high doses (over 1500 mg/day), potentially inducing psychosis and other serious adverse effects 6
- Drug interactions: Particular safety concerns arise when monoamine oxidase inhibitors (MAOIs) and dextromethorphan are used together 5
- Combined preparations: Care must be taken with combined preparations that contain other ingredients such as paracetamol/acetaminophen 1
Comparison to Other Antitussives
Dextromethorphan has overtaken codeine as the most widely used cough suppressant due to its:
- Better availability (OTC status)
- Comparable efficacy to codeine at equivalent doses
- Superior safety profile, particularly regarding side effects and overdose risk 7
The Thorax guidelines specifically note that codeine or pholcodine have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile and are not recommended 1.
Regulatory Considerations
While dextromethorphan remains available OTC nationally, some states have begun to limit the quantity sold or restrict sales to individuals over 18 years of age due to abuse concerns. However, there is currently no federal ban or restriction on dextromethorphan 6.