Examples of Dextromethorphan-Containing Medications
Dextromethorphan is available as both immediate-release and extended-release formulations, with common brand names including Delsym® (extended-release) and numerous generic over-the-counter cough suppressants in liquid, tablet, and combination products. 1
Available Formulations
Extended-Release Products
- Delsym® is a widely available extended-release oral suspension containing dextromethorphan polistirex, providing 12-hour cough relief 1
- The extended-release formulation is dosed every 12 hours rather than every 4-6 hours like immediate-release products 1
- Available in orange-flavored liquid with a dosing cup included 1
Immediate-Release Products
- Generic dextromethorphan is available in multiple immediate-release formulations including syrups, liquids, lozenges, and tablets 1
- Many over-the-counter cough and cold medications contain dextromethorphan as the active cough suppressant ingredient 2, 3
- Combination products often include dextromethorphan with other ingredients such as acetaminophen, antihistamines, or decongestants 4
Standard Dosing by Age
Adults and Children ≥12 Years
- Extended-release: 10 mL every 12 hours, not exceeding 20 mL in 24 hours 1
- Immediate-release: 10-15 mg three to four times daily, with maximum daily dose of 120 mg 4
- For maximum cough suppression, single doses of 60 mg can be used 4, 5
Children 6 to <12 Years
- Extended-release: 5 mL every 12 hours, not exceeding 10 mL in 24 hours 1
Children 4 to <6 Years
- Extended-release: 2.5 mL every 12 hours, not exceeding 5 mL in 24 hours 1
Children <4 Years
- Do not use dextromethorphan in children under 4 years of age 1
Important Safety Considerations
Product Selection Warnings
- Always check combination products carefully to avoid excessive amounts of other ingredients like acetaminophen when using higher doses of dextromethorphan 4, 5
- Some preparations contain sodium metabisulfite, which may cause allergic-type reactions in susceptible individuals 1
- Standard over-the-counter dosing is often subtherapeutic; maximum cough reflex suppression occurs at 60 mg 4, 5
Clinical Context
- Dextromethorphan is the preferred pharmacological agent for dry cough due to its superior safety profile compared to codeine-based alternatives 4, 5
- It is a non-sedating opiate that acts centrally to suppress the cough reflex 4
- At therapeutic doses, dextromethorphan is safe and effective, but at much higher doses it produces dissociative effects similar to phencyclidine and ketamine 3