Proper SIG for Children's Delsym Cough 30 mg/5 mL Oral Suspension, Extended Release
For children's Delsym (dextromethorphan) Cough 30 mg/5 mL oral suspension, extended release, the proper SIG is to shake the bottle well before use, measure only with the dosing cup provided, and administer as follows: for children 6 to under 12 years of age, give 5 mL every 12 hours, not to exceed 10 mL in 24 hours; for children 4 to under 6 years of age, give 2.5 mL every 12 hours, not to exceed 5 mL in 24 hours; and do not use in children under 4 years of age. 1
Age-Based Dosing Guidelines
The FDA-approved dosing for Children's Delsym (dextromethorphan polistirex) extended-release suspension is specifically age-based:
- Adults and children 12 years and older: 10 mL every 12 hours, not to exceed 20 mL in 24 hours
- Children 6 to under 12 years: 5 mL every 12 hours, not to exceed 10 mL in 24 hours
- Children 4 to under 6 years: 2.5 mL every 12 hours, not to exceed 5 mL in 24 hours
- Children under 4 years: Do not use 1
Important Administration Instructions
When writing the prescription, include these critical instructions:
- Shake bottle well before use
- Measure only with dosing cup provided with the medication
- Do not use the dosing cup with other products
- Do not exceed recommended doses
Safety Considerations
Dextromethorphan polistirex is an extended-release formulation with a duration of action approximately 2-3 times longer than standard dextromethorphan hydrobromide formulations 2. This extended-release property requires strict adherence to the 12-hour dosing interval.
Cautions and Warnings
- Overdose risk is significant in young children. A case report documented a life-threatening overdose in a 23-month-old with a blood concentration exceeding 100 ng/mL 2
- The FDA and CDC have reported infant deaths associated with cough and cold medications, highlighting the importance of not using these medications in children under 4 years of age 3
- Efficacy of dextromethorphan for acute cough in children has been questioned in systematic reviews, with some studies showing minimal clinical benefit over placebo 4, 5
Clinical Pearls
- The extended-release formulation (polistirex) allows for twice-daily dosing compared to standard dextromethorphan formulations that typically require dosing every 4-6 hours
- Always emphasize to parents/caregivers the importance of using only the provided measuring device to prevent dosing errors
- Remind parents that cough suppressants should not be used for prolonged periods without medical supervision
- Avoid combining with other cough and cold medications that may contain the same active ingredient to prevent overdose
By following these evidence-based dosing guidelines, you can help ensure safe and appropriate use of Children's Delsym Cough suspension in pediatric patients.