Drug reference
(dex-troe-meth-or′fan) Balminil , Benylin DM , Bronchophan Forte DM , Delsym 12-Hour, ElixSure Cough, Koffex , Robitussin, Robitussin Cough with Honey, Robitussin Long Acting Strength, Scot- Tussin Diabetes CF, Triaminic Long Acting Cough, Vicks Formula 44
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Func. class.: Antitussive, nonopioid
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Chem. class.: Levorphanol derivative
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ACTION: Depresses cough center in medulla by direct effect
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USES: Nonproductive cough caused by colds or inhaled irritants
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CONTRAINDICATIONS: Hyper- sensitivity, MAOIs, SSRIs Precautions: Pregnancy, fever, hepatic disease, asthma/emphysema, chronic cough, child <4 yr, breastfeeding
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SIDE EFFECTS CNS: Dizziness, sedation, confusion, ataxia, fatigue GI: Nausea
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INTERACTIONS • Do not give with MAOIs or within 2 wk of MAOIs; avoid furazolidone, linezolid, procarbazine (MAOI activity) Increase: CNS depression—alcohol, antidepressants, antihistamines, opioids, sedative/hypnotics Increase: adverse reactions—amioda- rone, quiNIDine, serotonin receptor ago- nist, sibutramine, SSRI
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DOSAGE AND ROUTES • Adult/child ≥12 yr: PO 10-20 mg q4hr or 30 mg q6-8hr, max 120 mg/day; SUS REL LIQ 60 mg q12hr, max 120 mg/day • Child 6-11 yr: PO 5-10 mg q4hr; SUS REL LIQ 30 mg bid, LOZ 5-10 mg q1-4hr; max 60 mg/day • Child 4-5 yr: PO 2.5-7.5 mg q4-8hr, max 30 mg/day; SUS REL LIQ 15 mg bid
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Available forms: Liquid, extended release, 15 mg/5 mL, 30 mg/5 mL; gel capsules 5, 15 mg; capsules 15 mg; extended-release suspension: 30 mg/5 mL; lozenges 5 mg; solution 3 mg/mL; 7.5 mg/5 mL, 10 mg/5 mL, 15 mg/5 mL; strips, orally disintegrating 7.5 mg
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Administer: • Extended-release suspension: shake well, use calibrated measuring device • Decreased dose for geriatric patients; metabolism may be slowed
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Assess: • Cough: type, frequency, character, lung sounds, sputum • Increase fluids to liquefy secretions, unless contraindicated • Pregnancy/breastfeeding: no well- controlled studies; use only if benefit outweighs fetal risk; avoid breastfeed- ing
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Evaluate: • Therapeutic response: absence of cough
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid driving, other hazardous ac- tivities until stabilized on medication • To avoid smoking, smoke-filled rooms, perfumes, dust, environmental pollutants, cleaners that increase cough • To avoid alcohol, CNS depressants • To notify prescriber if cough persists over a few days • Not to use if breastfeeding or in child <4 yr HIGH ALERT
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PHARMACOKINETICS PO: Onset 15-30 min, duration 3-6 hr SUS: Duration 12 hr Half-life 11 hr, metabolized by the liver, excreted via kidneys
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• Adult/child ≥12 yr: PO 10-20 mg q4hr or 30 mg q6-8hr, max 120 mg/day; SUS REL LIQ 60 mg q12hr, max 120 mg/day
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• Child 6-11 yr: PO 5-10 mg q4hr; SUS REL LIQ 30 mg bid, LOZ 5-10 mg q1-4hr; max 60 mg/day
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• Child 4-5 yr: PO 2.5-7.5 mg q4-8hr, max 30 mg/day; SUS REL LIQ 15 mg bid
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