Smuth (Dextromethorphan) Syrup Pediatric Dosing
For children 4 to under 6 years of age, administer 2.5 mL every 12 hours, not to exceed 5 mL in 24 hours; for children 6 to under 12 years, give 5 mL every 12 hours, not to exceed 10 mL in 24 hours; and dextromethorphan is contraindicated in children under 4 years of age. 1
Age-Based Dosing Guidelines
The FDA-approved dosing for dextromethorphan syrup follows strict age-based parameters 1:
- Children under 4 years: Do not use 1
- Children 4 to under 6 years: 2.5 mL every 12 hours (maximum 5 mL per 24 hours) 1
- Children 6 to under 12 years: 5 mL every 12 hours (maximum 10 mL per 24 hours) 1
- Children 12 years and older: 10 mL every 12 hours (maximum 20 mL per 24 hours) 1
Administration Instructions
Always shake the bottle well before use and measure only with the dosing cup provided with the product. 1 The dosing cup should not be used with other products to prevent dosing errors. 1
Critical Safety Considerations
The absolute contraindication in children under 4 years of age must be strictly observed, as this age group has increased risk of adverse effects and lacks established safety data. 1 This restriction exists despite the general principle that pediatric dosing should be individualized based on developmental physiology and pharmacokinetic parameters. 2
Common Pitfalls to Avoid
- Never extrapolate adult doses to children by simple weight-based reduction, as children are not small adults and have unique pharmacokinetic differences. 3, 4
- Do not use household spoons for measurement, as this significantly increases the risk of dosing errors. 1
- Avoid exceeding maximum daily doses, as the 12-hour dosing interval and 24-hour maximum limits are established for safety. 1
Formulation Considerations
Syrups are generally considered favorable dosage forms for pediatric patients due to ease of administration, though palatability (including taste, smell, and aftertaste) remains a critical factor in medication acceptance. 5 The pineapple flavoring is designed to improve palatability and patient compliance in the pediatric population. 5