Version May 2024
Cough suppressant/sore throat: Oral: A total of 2 lozenges (dextromethorphan 5 mg/menthol 5 mg per lozenge) dissolved in mouth, 1 immediately after the other. May repeat every 4 hours; maximum: 12 lozenges (dextromethorphan 60 mg/menthol 60 mg) daily.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Refer to adult dosing.
Cough suppressant/sore throat: Oral:
Children <6 years: Not for OTC use.
Children 6 to <12 years: One lozenge (dextromethorphan 5 mg/menthol 5 mg per lozenge) dissolved in mouth. May repeat every 4 hours; maximum: 6 lozenges (dextromethorphan 30 mg/menthol 30 mg) daily.
Children ≥12 years and Adolescents: Refer to adult dosing.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
See Dextromethorphan monograph.
OTC labeling: When used for self-medication, do not use if you are taking a MAO inhibitor or within 2 weeks after stopping a MAO inhibitor; do not use in children <6 years of age
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Other warnings/precautions:
• Self-medication (OTC use): When used for self-medication (OTC) contact health care provider prior to use if you have a persistent or chronic cough associated with asthma, emphysema or smoking, or if you have cough with excess phlegm; notify healthcare provider if symptoms do not improve within 7 days, irritation, pain or redness persist/worsen, swelling develops, or cough is accompanied by fever, rash or persistent headache.
Special populations:
• CYP2D6 poor metabolizers: Dextromethorphan is metabolized by hepatic CYP2D6. Poor metabolizers of CYP2D6 may have exaggerated or prolonged effects of dextromethorphan. Increased risk may be seen with concomitant use of potent CYP2D6 inhibitors; use with caution (Abduljalil 2010; Jurica 2012; Sager 2014; Zhou 2009).
May be product dependent
Lozenge (Delsym Cough Relief Mouth/Throat)
5-5 mg (16): $6.36
Lozenge (Delsym Cough+ Soothing Action Mouth/Throat)
5-5 mg (16): $6.36
Lozenge (Robitussin Medi-Soothers Mouth/Throat)
5-5 mg (4): $0.90
Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of the brand and/or generic product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or adjudicate any prices for reimbursement or purchasing functions. Pricing data is updated monthly.
Allow lozenge to dissolve slowly in the mouth.
Oral: Allow lozenge to dissolve slowly in the mouth.
Cough suppressant/sore throat: Temporary relief of sore throat, sore mouth, minor throat irritation, and cough due to minor throat and bronchial irritation as may occur with the common cold.
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Ajmaline: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
Artemether and Lumefantrine: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
CYP2D6 Inhibitors (Moderate): May increase the serum concentration of Dextromethorphan. Risk C: Monitor therapy
CYP2D6 Inhibitors (Strong): May increase the serum concentration of Dextromethorphan. Risk C: Monitor therapy
Disulfiram: May enhance the adverse/toxic effect of Products Containing Ethanol. Management: Do not use disulfiram with dosage forms that contain ethanol. Risk X: Avoid combination
Memantine: NMDA Receptor Antagonists may enhance the adverse/toxic effect of Memantine. Risk C: Monitor therapy
Methotrimeprazine: Products Containing Ethanol may enhance the adverse/toxic effect of Methotrimeprazine. Specifically, a disulfiram-like reaction may occur and CNS depressant effects may be increased. Management: Avoid products containing alcohol in patients treated with methotrimeprazine. Risk X: Avoid combination
Monoamine Oxidase Inhibitors: Dextromethorphan may enhance the serotonergic effect of Monoamine Oxidase Inhibitors. This may cause serotonin syndrome. Risk X: Avoid combination
Ornidazole: May enhance the adverse/toxic effect of Products Containing Ethanol. Specifically, a disulfiram-like reaction may occur. Risk X: Avoid combination
Parecoxib: May increase the serum concentration of Dextromethorphan. Risk C: Monitor therapy
Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
Secnidazole: Products Containing Ethanol may enhance the adverse/toxic effect of Secnidazole. Risk X: Avoid combination
Selective Serotonin Reuptake Inhibitors (Strong CYP2D6 Inhibitors): Dextromethorphan may enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors (Strong CYP2D6 Inhibitors). This could result in serotonin syndrome. Selective Serotonin Reuptake Inhibitors (Strong CYP2D6 Inhibitors) may increase the serum concentration of Dextromethorphan. Management: Consider alternatives to this drug combination. The dose of dextromethorphan/bupropion product should not exceed 1 tablet once daily. Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity. Risk D: Consider therapy modification
Serotonergic Agents (High Risk): Dextromethorphan may enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor therapy
Warfarin: Menthol may decrease the serum concentration of Warfarin. Risk C: Monitor therapy
Refer to individual monographs.
Refer to individual monographs.
Dextromethorphan: Decreases the sensitivity of cough receptors and interrupts cough impulse transmission by depressing the medullary cough center through sigma receptor stimulation; structurally related to codeine
Menthol: Local anesthetic and counterirritant to relieve minor sore throat irritation
See Dextromethorphan monograph.
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