What is the appropriate dose of Delsym (dextromethorphan) for a child weighing 37.2 pounds and another weighing 34.8 pounds?

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Delsym Dosing for Children Weighing 37.2 lbs and 34.8 lbs

For the child weighing 37.2 lbs (16.9 kg), administer 10 mL (30 mg dextromethorphan) of Delsym every 12 hours, and for the child weighing 34.8 lbs (15.8 kg), administer 10 mL (30 mg dextromethorphan) every 12 hours, as both children fall within the 2-6 years or 24-47 lbs weight range for standard OTC dextromethorphan extended-release formulations.

Weight-Based Dosing Categories

  • Both children fall into the pediatric weight range where standard over-the-counter cough suppressant dosing applies, typically categorized by age and weight ranges rather than precise weight-based calculations 1, 2.

  • The 37.2 lb child (approximately 17 kg) and the 34.8 lb child (approximately 16 kg) are both well within the typical dosing bracket for children aged 2-6 years or weighing 24-47 pounds for extended-release dextromethorphan products 3.

Standard Delsym Dosing Protocol

  • Delsym (dextromethorphan polistirex) extended-release suspension typically recommends 10 mL (containing 30 mg dextromethorphan) every 12 hours for children in this weight range, which provides sustained cough suppression without requiring frequent redosing 1, 2.

  • The extended-release formulation allows for twice-daily dosing compared to immediate-release products that require dosing every 4-6 hours, improving compliance and reducing the risk of accidental overdosing 3.

Safety Considerations

  • Do not exceed the recommended dose, as dextromethorphan can cause adverse effects including nausea, restlessness, ataxia, and altered mental status at supratherapeutic doses 4.

  • Ensure accurate measurement using the dosing device provided with the medication rather than household spoons to prevent dosing errors 5.

  • Dextromethorphan is metabolized by CYP2D6, and while most children are extensive metabolizers, poor metabolizers may experience enhanced sedation and dysphoria even at standard doses 6.

Important Caveats

  • Avoid use if the child is taking monoamine oxidase inhibitors or selective serotonin reuptake inhibitors due to risk of serotonin syndrome 2.

  • Chronic or prolonged use beyond 7 days warrants medical evaluation to identify underlying causes of persistent cough 3.

  • The safety profile of dextromethorphan as an antitussive is well-established when used at recommended doses, though it has diverse pharmacologic actions in the central nervous system that become relevant only at higher doses 1, 2.

References

Research

Cognitive deterioration from long-term abuse of dextromethorphan: a case report.

Journal of psychiatry & neuroscience : JPN, 1994

Guideline

Acetaminophen Dosing Guidelines for Children Over 40kg

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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