Common Dextromethorphan Brands
Delsym® (dextromethorphan polistirex extended-release oral suspension) is a widely available over-the-counter brand containing dextromethorphan for cough suppression. 1
Available Formulations
- Delsym® is marketed as a 12-hour extended-release formulation containing dextromethorphan polistirex equivalent to 30 mg dextromethorphan hydrobromide per 5 mL 1
- The product is available as an orange-flavored liquid suspension that is alcohol-free 1
- Robitussin DM is another common brand that combines dextromethorphan with guaifenesin (an expectorant) 2
Clinical Context for Use
- Dextromethorphan is a non-sedating opiate component found in many over-the-counter cough remedies and has been shown to suppress acute cough in meta-analysis 2
- For optimal cough suppression in adults with acute viral cough, the recommended dose is 30-60 mg, with maximum cough reflex suppression occurring at 60 mg 2, 3
- Standard over-the-counter dosing is often subtherapeutic, so higher doses within the safe range may be needed for adequate relief 2, 3
Important Safety Considerations
- Caution is required when using higher doses of dextromethorphan because some combination preparations contain additional ingredients like acetaminophen (paracetamol) that could lead to toxicity at higher doses 2, 3
- Delsym® contains sodium metabisulfite, which may cause allergic-type reactions in susceptible individuals 1
- The maximum daily dose should not exceed 120 mg 3
Practical Prescribing Approach
- For simple acute viral cough in adults without significant medical history, recommend starting with simple home remedies like honey and lemon before pharmacological treatment 2, 3
- If pharmacological treatment is needed, dextromethorphan 30-60 mg provides effective cough suppression with a superior safety profile compared to codeine-based alternatives 2, 3
- Dextromethorphan is preferred over codeine or pholcodine, which have no greater efficacy but significantly more adverse effects including drowsiness, nausea, constipation, and physical dependence 2, 3