From the Guidelines
Dextromethorphan can be used during pregnancy when the potential benefits outweigh the risks, but it should be used with caution and under the guidance of a healthcare provider, preferably after the first trimester and at standard doses (typically 10-30 mg every 4-6 hours, not exceeding 120 mg in 24 hours) for short durations. The classification of dextromethorphan as FDA Pregnancy Category C, as mentioned in the context of previous studies 1, indicates that animal studies have shown adverse effects on the fetus, but there are no adequate studies in humans. However, more recent guidelines and studies, such as those published in 2020 and 2023 1, provide a framework for assessing the risk and benefits of medications during pregnancy, emphasizing the importance of considering the maternal risk of therapy versus no therapy and the fetal risk of uncontrolled maternal disease with the risk of therapy on the newborn. Non-pharmacological approaches like staying hydrated, using a humidifier, and honey (for women without gestational diabetes) should be tried first. Extended-release formulations and combination products containing additional ingredients like antihistamines, decongestants, or alcohol should be avoided during pregnancy. The safety profile of dextromethorphan is based on its minimal systemic absorption and lack of consistent evidence showing harmful effects on fetal development when used as directed, but the most recent and highest quality study 1 does not specifically address dextromethorphan, thus the recommendation is based on the general principles of medication use in pregnancy and the characteristics of dextromethorphan.
Key Considerations
- Pregnancy Category: Dextromethorphan is classified as FDA Pregnancy Category C, indicating potential risks based on animal studies but lacking adequate human studies.
- Dosage and Duration: Standard doses (10-30 mg every 4-6 hours, not exceeding 120 mg in 24 hours) for short durations are recommended.
- Alternative Approaches: Non-pharmacological methods should be tried first.
- Combination Products: Avoid extended-release formulations and combination products with additional ingredients.
- Healthcare Guidance: Consult a healthcare provider before taking any medication during pregnancy.
From the FDA Drug Label
If pregnant or breast-feeding, ask a health professional before use. The FDA drug label does not answer the question.
From the Research
Dextromethorphan in Pregnancy
- There is limited information available on the safety of dextromethorphan during pregnancy 2.
- Most studies on dextromethorphan have focused on its use in children with upper respiratory infections, rather than pregnant women 3, 4, 5.
- One study compared the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children, but did not address pregnancy specifically 3.
- Another study found that honey may be a preferable treatment for cough and sleep difficulty associated with childhood upper respiratory tract infection, but did not discuss dextromethorphan in the context of pregnancy 5.
- A review of drugs to avoid during pregnancy noted that great caution should be taken when prescribing any medication during pregnancy, but did not specifically mention dextromethorphan 6.
- Overall, there is a lack of research on the use of dextromethorphan during pregnancy, and more studies are needed to fully understand its safety and efficacy in this population.
Potential Risks and Benefits
- The available evidence suggests that dextromethorphan may not be as effective as honey in relieving cough symptoms in children 3, 4, 5.
- There is limited information available on the potential risks and benefits of dextromethorphan during pregnancy, and more research is needed to fully understand its effects 2, 6.
- As with any medication, the decision to use dextromethorphan during pregnancy should be made in consultation with a healthcare provider, taking into account the potential risks and benefits and the availability of alternative treatments.
Research Gaps
- There is a need for more research on the safety and efficacy of dextromethorphan during pregnancy, including studies on its potential effects on the fetus and the mother 2, 6.
- Further studies are also needed to compare the effectiveness of dextromethorphan with other treatments for cough and respiratory infections during pregnancy.