D-cough100 ml

D-cough is indicated for the temporary relief of cough caused by minor throat and bronchial irritation, such as that occurring with the common cold or exposure to inhaled irritants.

Evidence-based classification of use

• Established/OTC-approved use: Symptomatic relief of a dry, nonproductive cough associated with upper respiratory tract infections (common cold) or minor throat/bronchial irritation.
• Not indicated for: Chronic or persistent cough associated with smoking, asthma, chronic bronchitis, or emphysema, or a cough that is accompanied by excessive phlegm (productive cough), unless specifically directed by a physician.
• Combination products: D-cough is frequently formulated together with expectorants (e.g. guaifenesin), antihistamines, or decongestants for multi-symptom cold and flu relief; such combination use should follow the specific combination product's labeling.

D-cough does not treat the underlying cause of cough and is intended only for short-term symptomatic relief.

Each dosage form contains Dextromethorphan Hydrobromide as the active antitussive ingredient. Available formulations may include:

• Oral syrup/solution (commonly 10 mg, 15 mg, or 30 mg per 5 mL)
• Immediate-release tablets or capsules (commonly 15 mg or 30 mg)
• Extended-release oral suspension (commonly 30 mg per 5 mL, dosed every 12 hours)
• Lozenges (commonly 5–15 mg)

Dextromethorphan Hydrobromide is also a common component of multi-ingredient cough-and-cold combination products (e.g. with guaifenesin, an antihistamine, or a decongestant). Exact strength and excipients vary by brand and formulation.

D-cough is a synthetic, non-opioid antitussive (cough suppressant). It is the dextrorotatory isomer of a morphinan-based compound and is chemically related to opioid analgesics, but at recommended therapeutic doses it lacks clinically significant analgesic or opioid-agonist activity and has minimal abuse potential compared to opioid antitussives such as codeine.

D-cough is one of the most widely used over-the-counter (OTC) cough suppressants worldwide and is available as a single-ingredient product or in combination with other cold and cough medications.

Antitussive (Cough Suppressant) — Non-opioid, centrally acting. D-cough belongs to the morphinan class of antitussive agents.

Mechanism of Action

Dextromethorphan Hydrobromide acts centrally on the cough center located in the medulla oblongata, raising the threshold for the cough reflex. Its principal mechanisms include:

• Antagonism of N-methyl-D-aspartate (NMDA) glutamate receptors involved in the central cough reflex pathway.
• Agonist activity at sigma-1 receptors, which is thought to contribute to its antitussive and, at high doses, dissociative effects.
• Low affinity for classical opioid (mu) receptors, explaining its minimal analgesic and respiratory-depressant activity at therapeutic doses.

Pharmacokinetics

Dextromethorphan Hydrobromide is well absorbed after oral administration and undergoes extensive first-pass hepatic metabolism primarily via the CYP2D6 enzyme to its active metabolite, dextrorphan. Onset of antitussive action typically occurs within 15–30 minutes, with a duration of action of approximately 3–6 hours (up to 12 hours for extended-release formulations). It is eliminated mainly via the kidneys as metabolites.

Individuals who are poor CYP2D6 metabolizers (a genetically determined subgroup) may have markedly higher plasma levels of Dextromethorphan Hydrobromide and an increased risk of adverse effects.

D-cough is administered orally.

• Use the measuring device provided with liquid formulations (oral syringe, dosing cup, or dropper) — do not use a household spoon, as this may lead to inaccurate dosing.
• May be taken with or without food.
• Do not exceed the recommended dose or dosing frequency.
• Avoid concurrent use of other products that also contain D-cough or other antitussive/cough-and-cold ingredients, to prevent inadvertent overdose.
• Shake oral suspensions well before use if instructed on the product label.
• If cough persists beyond 7 days, recurs, or is accompanied by fever, rash, or persistent headache, discontinue use and consult a physician.

Clinically significant interactions with D-cough include:

• Monoamine oxidase inhibitors (MAOIs): Concurrent use, or use within 14 days of stopping an MAOI, can precipitate serotonin syndrome (hyperthermia, rigidity, myoclonus, autonomic instability, altered mental status) and is an absolute contraindication.
• Other serotonergic agents (SSRIs, SNRIs, triptans, tricyclic antidepressants, tramadol, linezolid, St. John's Wort): Increased risk of serotonin syndrome when combined with D-cough; use with caution and monitor for symptoms.
• CYP2D6 inhibitors (e.g. quinidine, fluoxetine, paroxetine, bupropion, terbinafine): May significantly increase plasma concentrations of D-cough, raising the risk of dissociative effects, sedation, and serotonin syndrome.
• CNS depressants (alcohol, sedatives, benzodiazepines, opioids): Additive central nervous system depression, sedation, and respiratory depression risk when taken with D-cough.

Side effects associated with D-cough at recommended therapeutic doses are generally mild:

Seek medical attention if severe dizziness, breathing difficulty, irregular heartbeat, or signs of an allergic reaction (rash, swelling, difficulty breathing) occur.

Pregnancy: Data on the use of D-cough in human pregnancy are limited. D-cough should be used during pregnancy only if clearly needed and if the potential benefit justifies the potential risk to the fetus. Consult a physician before use during pregnancy.

Lactation: It is not well established whether D-cough passes into breast milk in clinically significant amounts. Caution is advised, and a physician should be consulted before use by a breastfeeding mother, particularly for prolonged use.

• Serotonin syndrome: Avoid use with MAOIs or other serotonergic drugs — see Contraindications and Interaction.
• Not for chronic or productive cough: Do not use D-cough for a persistent or chronic cough (e.g. due to smoking, asthma, chronic bronchitis, or emphysema) or a cough accompanied by excessive phlegm, unless directed by a physician, as this may indicate a condition requiring different treatment.
• Abuse and misuse potential: At doses well above the recommended therapeutic range, D-cough can produce dissociative, euphoric, and hallucinogenic effects and has recognized potential for misuse, particularly among adolescents. Use only as directed and keep out of reach of children and adolescents.
• CYP2D6 poor metabolizers: Individuals who metabolize D-cough slowly may experience exaggerated effects at standard doses.
• CNS effects: May cause drowsiness or dizziness; use caution when driving or operating machinery until the individual response is known.
• Duration of use: Discontinue and consult a physician if cough persists beyond 7 days, recurs, or is accompanied by fever, rash, or persistent headache — see Duration of Treatment.

Overdose of D-cough can cause dissociative and central nervous system effects including confusion, agitation, slurred speech, ataxia (loss of coordination), nystagmus, blurred vision, hallucinations, tachycardia, hypertension or hypotension, seizures, serotonin syndrome, and, in severe cases, respiratory depression, loss of consciousness, or coma.

If overdose is suspected, seek immediate medical attention or contact a poison control center / emergency services right away. Do not attempt to manage a suspected overdose at home. Bring the product packaging with you if seeking emergency care.

Store at room temperature (below 30°C), away from light and moisture. Keep out of reach of children.

• Hepatic impairment: D-cough undergoes extensive hepatic metabolism; use with caution and consider reduced dosing frequency in patients with significant hepatic impairment, under physician guidance.
• Renal impairment: Limited specific data; use with caution in significant renal impairment, as metabolite elimination may be affected.
• Elderly: No specific dose adjustment is generally required, but elderly patients may be more sensitive to CNS effects such as sedation and dizziness.
• CYP2D6 poor metabolizers: May experience higher-than-expected drug levels and increased risk of adverse effects at standard doses — see Pharmacology.
• Children: See Pediatric Uses for age-specific guidance.

D-cough is intended for short-term, symptomatic use only — typically no more than 7 days. If cough persists beyond 7 days, tends to recur, or is accompanied by fever, rash, or persistent headache, discontinue D-cough and consult a physician, as these may be signs of a condition requiring further medical evaluation.

Antitussives; Morphinan derivatives; NMDA receptor antagonists (non-opioid). Dextromethorphan Hydrobromide is the prototypical agent of this class.

Dextromethorphan Hydrobromide suppresses the cough reflex by acting centrally on the cough center in the medulla oblongata, primarily through antagonism of NMDA glutamate receptors and agonist activity at sigma-1 receptors, thereby raising the threshold required to trigger coughing. Unlike opioid antitussives, Dextromethorphan Hydrobromide has minimal affinity for mu-opioid receptors at therapeutic doses and therefore lacks clinically significant analgesic or respiratory-depressant activity under normal use.

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Use of D-cough in children should follow age-appropriate OTC dosing:

• Children ≥12 years: Adult dosing applies.
• Children 6 to <12 years: 5–10 mg every 4 hours, or 15 mg every 6–8 hours; maximum 60 mg/24 hours.
• Children 4 to <6 years: Use only under the direction and supervision of a physician; typically 2.5–5 mg every 4 hours, or 7.5 mg every 6–8 hours; maximum 30 mg/24 hours.
• Children under 4 years: Safety and efficacy of over-the-counter D-cough have not been established in this age group, and use is not recommended without direct physician supervision, given reports of misuse and serious adverse events in young children.

Caregivers should use only the measuring device supplied with the product and avoid combining multiple cough-and-cold products that may each contain D-cough, to prevent unintentional overdose in children.