Dextromethorphan

Balminil DM (dextromethorphan) is approved by the FDA as a prescription medicine used to treat cough in adults and children over the age of 6. Balminil DM belongs to a class of medications called antitussives, which are used to control coughing.

Dextromethorphan works by blocking the cough reflex and by controlling the cough associated with the common cold or the flu. It is available as tablets, capsules, oral gel capsules, oral and extended-release liquid, oral syrup, lozenges and oral strips.

Dextromethorphan is also available under different brand names including Benylin DM, Bronchophan, Buckleys DM, Calmylin #1, Delsym, Koffex DM, Novahistex DM, Robitussin Lingering Cold Long-Acting Cough, Robitussin Lingering Cold Long-Acting CoughGels, Children's Robitussin Cough Long-Acting, Sucrets 8 Hour Cough Relief DM Cough Formula.

Dextromethorphan and dextromethorphan hydrobromide is often combined with other medications such as guaifenesin and phenylephrine hydrochloride to manage the severity of cough and other symptoms associated with the common cold or flu.

• Liquid and Syrup: Dose medicine 10-20 mg orally every four hours, or dose 30 mg orally once every 6 to 8 hours
• Gel Capsules: Dose medicine 30 mg by mouth every 6 to 8 hours, not to exceed 120 mg in a 24-hour period of time
• Extended-Release Oral Suspension: Dose medicine 60 mg by mouth every 12 hours; not to exceed 120 mg in 24 hours
• Lozenges: Dose medicine 5-15 mg by mouth every 1 to 4 hours; not to exceed 120 mg in 24 hours
• Strips: Dose medicine 30 mg by mouth every 6 to 8 hours; not to exceed 120 in 24 hours

• The abuse potential of this medicine is much lower than codeine
• About 15-30 mg dextromethorphan is equal to 8-15 mg codeine as an antitussive drug

Common side effects associated with using Balminil DM are:

• nausea,
• vomiting,
• constipation,
• drowsiness,
• dizziness,
• sedation,
• confusion, and
• nervousness.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Severe Interactions of Dextromethorphan Cough
  • Taking certain MAO inhibitors with this medication may cause severe and possibly fatal drug interactions. Avoid taking isocarboxazid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, or tranylcypromine during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor or health care provider when to start or stop taking this medication.
• Serious Interactions of Dextromethorphan Cough
  • Panobinostat may increase the amount of your medicine in your body by slowing down how quickly your liver can process it. You may experience increased side effects from your medicine or other symptoms.
• Moderate Interactions of Dextromethorphan Cough
  • Fluoxetine/paroxetine should be avoided. These medicines may cause some risk when taken together with dextromethorphan. Contact your healthcare professional (e.g. doctor or pharmacist) for more information. Your antidepressant may cause your body to process dextromethorphan more slowly. In addition, both medicines can increase the level of serotonin in your body.

You could have worsening of usual side effects such as dizziness, headache, or nausea. Symptoms of high serotonin levels may include changes in body temperature, blood pressure, muscle movements and mood, leading to a medical condition called Serotonin Syndrome. Serotonin Syndrome may be very serious or rarely life-threatening.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: other medications for cough (e.g., hydrocodone, over-the-counter cough or cold products).

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Warnings

• Balminil DM should not be used in patients who are currently taking MAO inhibitors (MAOI). MAOI refers to a class of drugs used to treat depression, psychiatric, or emotional conditions, or Parkinson's disease. Baliminil DM should not be used with these medications, or for 2 weeks after stopping the MAOI drugs. Examples of MAO inhibitors include asagiline (Azilect), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), and. tranylcypromine (Parnate). This drug should be used with caution in patients younger than 6 years of age. This medication is not intended for children under 4 years of age.
• This medication contains dextromethorphan. Do not take Balminil DM if you are allergic to dextromethorphan or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

• Serotonin syndrome can result if this medication is taken with MAO inhibitors.

• Dextromethorphan (also called DXM), is safe and effective as a cough suppressant and expectorant when used at recommended doses (typically 15 to 30 milligrams). This drug can lead to serious side effects when abused. For example, the use of dextromethorphan at high doses (from 200 to 1,500 milligrams) can produce dissociative effects similar to PCP and ketamine and increase the risk of the serious central nervous system and cardiovascular effects such as respiratory distress, seizures, and increased heart rate from the antihistamines found in cough medicines.

• Dissociative drugs can produce visual and auditory distortions and a sense of floating and dissociation (feeling detached from reality) in users. The use of dissociative drugs can also cause anxiety, memory loss, and impaired motor function, including body tremors and numbness. These effects, which depend on the amount of the drug taken, are also unpredictable—typically beginning within minutes of ingestion and lasting for several hours, although some users report feeling the drug's effects for days.

• While the long-term use of most dissociative drugs has not been investigated systematically, research shows that repeated use can lead to tolerance and the development of a substance use disorder that includes a withdrawal syndrome (including craving for the drug, headaches, and sweating) when drug use is stopped. Other effects of long-term use include persistent speech difficulties, memory loss, depression, suicidal thoughts, anxiety, and social withdrawal that may persist for a year or more after chronic use stops.

• Phenylketonuria: Contains aspartame
• Hallucinations, confusion, agitation, overactive reflexes, shivering, sleepiness, and increased heart rate may occur
• Caution in children younger than 6 years
• Not for use in children under the age of 4 years
• Use caution in patients who are sedated, debilitated or confined to a supine position

• Breastfeeding mothers should use caution when taking Balminil DM. It is not known if dextromethorphan or other ingredients found in this drug are excreted into breast milk. Pregnant and breastfeeding women should only use this drug if the benefits outweigh the risks. If you are pregnant, consult your health care provider or pharmacist before taking this medication.
• Animal studies show risk and human studies not available or neither animal nor human studies done.