Dextromethorphan

Pharmacologic Category

Antitussive; N-Methyl-D-Aspartate (NMDA) Receptor Antagonist

Dosing: Adult

Cough suppressant: Oral: 10 to 20 mg every 4 hours or 20 to 30 mg every 6 to 8 hours; extended release: 60 mg twice daily; maximum: 120 mg/24 hours

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

There are no dosage adjustment provided in manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustment provided in manufacturer's labeling.

Dosing: Pediatric

Note: Safety and efficacy for the use of cough and cold products in infants and young children limited; the AAP warns against the use of these products for respiratory illnesses in infants and young children (AAP 2018; FDA 2017).

Cough suppressant: Oral:

Oral syrup (immediate release):

Children 2 to <6 years: 5 mg every 4 hours as needed; do not exceed 6 doses in 24 hours.

Children 6 to <12 years: 10 mg every 4 hours as needed; do not exceed 6 doses in 24 hours.

Children ≥12 years and Adolescents: 20 mg every 4 hours as needed; do not exceed 6 doses in 24 hours.

Long-acting liquid: Children ≥12 years and Adolescents: 30 mg every 6 to 8 hours as needed; do not exceed 4 doses in 24 hours.

Oral capsule: Children ≥12 years and Adolescents: 30 mg every 6 to 8 hours as needed; do not exceed 4 doses in 24 hours.

Extended-release suspension (dextromethorphan polistirex):

Children 4 to <6 years: 15 mg every 12 hours as needed; do not exceed 30 mg in 24 hours.

Children 6 to <12 years: 30 mg every 12 hours as needed; do not exceed 60 mg in 24 hours.

Children ≥12 years and Adolescents: 60 mg every 12 hours as needed; do not exceed 120 mg in 24 hours.

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling.

Use: Labeled Indications

Cough (suppressant): Temporary control of cough due to minor throat and bronchial irritation associated with the common cold or inhaled irritants; temporary relief of cough impulse to improve sleep (extended release formulations)

* See Uses in AHFS Essentials for additional information.

Administration: Oral

Shake extended release suspension well before use. Only use dosing cup provided to measure liquid doses.

Administration: Pediatric

Oral: Administer liquid/suspension products with an accurate measuring device; do not use a household teaspoon (overdosage may occur).

Suspension: Shake well prior to administration.

Dietary Considerations

Some products may contain sodium.

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to relieve coughing.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Medication Safety Issues

​Sound-alike/look-alike issues:

Contraindications

Concurrent administration with or within 2 weeks of discontinuing an MAO inhibitor

Warnings/Precautions

Concurrent drug therapy issues:

• Serotonin syndrome: Symptoms of agitation, confusion, hallucinations, hyper-reflexia, myoclonus, shivering, and tachycardia may occur with concomitant proserotonergic drugs (ie, SSRIs/SNRIs or triptans); especially with higher dextromethorphan doses.

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).

• Debilitated patients: Use with caution in patients who are sedated, debilitated or confined to a supine position.

• Pediatric: Use with caution in atopic children. Not for OTC use in children <4 years of age.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

• Tartrazine: Some products may contain tartrazine.

Other warnings/precautions:

• Abuse/misuse: Healthcare providers should be alert to problems of abuse or misuse. Abuse can cause death, brain damage, seizure, loss of consciousness, and irregular heartbeat.

• Self-medication (OTC use): When used for self medication (OTC) notify healthcare provider if symptoms do not improve within 7 days, or are accompanied by fever, rash or persistent headache. Do not use for persistent or chronic cough (as with smoking, asthma, chronic bronchitis, emphysema) or if cough is accompanied by excessive phlegm unless directed to do so by healthcare provider.

* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

No specific information for use in elderly.

Warnings: Additional Pediatric Considerations

Safety and efficacy for the use of cough and cold products in pediatric patients <4 years of age is limited; the AAP warns against the use of these products for respiratory illnesses in young children. Serious adverse effects including death have been reported. Many of these products contain multiple active ingredients, increasing the risk of accidental overdose when used with other products. The FDA does not recommend OTC uses for these products in pediatric patients <2 years of age and recommends to use with caution in pediatric patients ≥2 years of age. Health care providers are reminded to ask caregivers about the use of OTC cough and cold products in order to avoid exposure to multiple medications containing the same ingredient (AAP 2018; CDC 2007; FDA 2017; FDA 2018).

Anecdotal reports of abuse of dextromethorphan-containing cough/cold products have increased, especially among teenagers.

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).

Pregnancy Considerations

Dextromethorphan is metabolized in the liver via CYP2D6 and CYP3A enzymes. The activity of both enzymes is increased in the mother during pregnancy (Tracy 2005; Wadelius 1997). In the fetus, CYP2D6 activity is low in the fetal liver and CYP3A4 activity is present by ~17 weeks' gestation (Jacqz-Aigrain 1992).

When an antitussive is needed during pregnancy, dextromethorphan at standard OTC doses is generally considered acceptable. Some sources recommend use be reserved for significant maternal need; products containing alcohol should be avoided (Chasnoff 1981; Conover 2003; Koren 1998; Ward 2005).

Breast-Feeding Considerations

Information related to the presence of dextromethorphan in breast milk has not been located. Data are not available to make recommendations for use in breastfeeding women (WHO 2002). Products containing alcohol should be avoided.

Lexicomp Pregnancy & Lactation, In-Depth

• Dextromethorphan

Briggs' Drugs in Pregnancy & Lactation

• Dextromethorphan

Adverse Reactions

Frequency not defined.

Central nervous system: Dizziness, drowsiness, nervousness, restlessness

Gastrointestinal: Gastrointestinal distress, nausea, stomach pain, vomiting

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• Aniline Dye Allergy

Metabolism/Transport Effects

Substrate of CYP2B6 (minor), CYP2C19 (minor), CYP2C9 (minor), CYP2D6 (major), CYP2E1 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions Open Interactions

Ajmaline: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Cobicistat: 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. Exceptions: DULoxetine. 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

Lumefantrine: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

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, CNS depressant effects may be increased. Management: Avoid products containing alcohol in patients treated with methotrimeprazine. Risk X: Avoid combination

Monoamine Oxidase Inhibitors: May enhance the serotonergic effect of Dextromethorphan. This may cause serotonin syndrome. 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

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. If combined, monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes). 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. Exceptions: FLUoxetine; Isocarboxazid; Linezolid; Methylene Blue; Moclobemide; PARoxetine; Phenelzine; Tranylcypromine. Risk C: Monitor therapy

Test Interactions

False-positive phencyclidine, opioids and heroin urine drug screen

Genes of Interest

• Cytochrome P450 2D6

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral, as hydrobromide:

Robafen Cough: 15 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]

Robitussin Lingering CoughGels: 15 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, polyethylene glycol, propylene glycol]

Gel, Oral, as hydrobromide:

ElixSure Cough: 7.5 mg/5 mL (120 mL) [alcohol free; contains carbomer 934p, propylene glycol, propylparaben; cherry bubblegum flavor]

Liquid, Oral, as hydrobromide:

Buckleys Cough: 12.5 mg/5 mL (118 mL) [alcohol free, sugar free; contains butylparaben, menthol, propylparaben, saccharin sodium]

Little Colds Cough Formula: 7.5 mg/mL (30 mL) [alcohol free, dye free, saccharin free; contains sodium benzoate; grape flavor]

PediaCare Childrens Long-Act: 7.5 mg/5 mL (118 mL) [contains brilliant blue fcf (fd&c blue #1), saccharin sodium, sodium benzoate]

Robitussin Lingering LA Cough: 15 mg/5 mL (118 mL [DSC]) [contains alcohol, usp, fd&c red #40, menthol, saccharin sodium, sodium benzoate]

Scot-Tussin Diabetes CF: 10 mg/5 mL (480 mL [DSC], 3780 mL [DSC]) [alcohol free, dye free, fructose free, sodium free, sorbitol free, sugar free]

Triaminic Long Acting Cough: 7.5 mg/5 mL (118 mL) [alcohol free, dye free, pseudoephedrine free; contains benzoic acid, propylene glycol]

Lozenge, Mouth/Throat, as hydrobromide:

Hold: 5 mg (10 ea)

Hold: 5 mg (10 ea) [cherry flavor]

Strip, Oral, as hydrobromide:

Triaminic Long Acting Cough: 7.5 mg (14 ea, 16 ea) [contains alcohol, usp, fd&c red #40; cherry flavor]

Triaminic Long Acting Cough: 7.5 mg (14 ea) [contains alcohol, usp, fd&c red #40, isopropyl alcohol]

Suspension Extended Release, Oral:

Cough DM: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL) [alcohol free; contains fd&c yellow #10 aluminum lake, methylparaben, polysorbate 80, propylparaben, sodium metabisulfite; orange flavor]

Delsym: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL [DSC], 148 mL [DSC]) [alcohol free; contains brilliant blue fcf (fd&c blue #1), disodium edta, methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben]

Delsym: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free; contains brilliant blue fcf (fd&c blue #1), disodium edta, methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben; grape flavor]

Delsym: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL [DSC], 148 mL [DSC]) [alcohol free; contains edetate disodium, fd&c yellow #6 (sunset yellow), methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben]

Delsym: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free; contains edetate disodium, fd&c yellow #6 (sunset yellow), methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben; orange flavor]

Delsym Cough Childrens: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free; contains brilliant blue fcf (fd&c blue #1), edetate disodium, methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben, soybean oil; grape flavor]

Delsym Cough Childrens: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free; contains edetate disodium, fd&c yellow #6 (sunset yellow), methylparaben, polyethylene glycol, polysorbate 80, propylene glycol, propylparaben, soybean oil; orange flavor]

GoodSense Cough DM: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (148 mL) [alcohol free, gluten free; contains fd&c yellow #10 aluminum lake, methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

GoodSense Cough DM Childrens: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL, 148 mL) [alcohol free, gluten free; contains fd&c yellow #10 aluminum lake, methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

Robitussin 12 Hour Cough: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL) [alcohol free; contains brilliant blue fcf (fd&c blue #1), methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

Robitussin 12 Hour Cough: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL) [alcohol free; contains fd&c yellow #10 (quinoline yellow), methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

Robitussin 12 Hour Cough Child: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL) [alcohol free; contains brilliant blue fcf (fd&c blue #1), methylparaben, polysorbate 80, propylparaben, sodium metabisulfite]

Generic: Dextromethorphan polistirex [equivalent to dextromethorphan hydrobromide 30 mg/5 mL] (89 mL)

Syrup, Oral, as hydrobromide:

Creomulsion Adult: 20 mg/15 mL (118 mL [DSC])

Creomulsion for Children: 5 mg/5 mL (118 mL [DSC]) [cherry flavor]

Robitussin Childrens Cough LA: 7.5 mg/5 mL (118 mL) [alcohol free; contains fd&c red #40, propylene glycol, saccharin sodium, sodium benzoate; fruit punch flavor]

Silphen DM Cough: 10 mg/5 mL (118 mL) [contains alcohol, usp; strawberry flavor]

Triaminic Long Acting Cough: 7.5 mg/5 mL (118 mL [DSC]) [alcohol free, dye free; contains benzoic acid, edetate disodium, propylene glycol]

Anatomic Therapeutic Chemical (ATC) Classification

• R05DA09

Generic Available (US)

May be product dependent

Pricing: US

Capsules (Robitussin Lingering CoughGels Oral)

15 mg (per each): $0.26

Gel (ElixSure Cough Oral)

7.5 mg/5 mL (per mL): $0.04

Liquid (Buckleys Cough Oral)

12.5 mg/5 mL (per mL): $0.04

Liquid (Little Colds Cough Formula Oral)

7.5 mg/mL (per mL): $0.13

Liquid (PediaCare Childrens Long-Act Oral)

7.5 mg/5 mL (per mL): $0.05

Liquid (Triaminic Long Acting Cough Oral)

7.5 mg/5 mL (per mL): $0.04

Lozenge (Hold Mouth/Throat)

5 mg (per each): $0.24

Strip (Triaminic Long Acting Cough Oral)

7.5 mg (per each): $0.35

Suspension Extended Release (Delsym Cough Childrens Oral)

30 mg/5 mL (per mL): $0.11

Suspension Extended Release (Delsym Oral)

30 mg/5 mL (per mL): $0.11

Suspension Extended Release (Dextromethorphan Polistirex ER Oral)

30 mg/5 mL (per mL): $0.09

Suspension Extended Release (Robitussin 12 Hour Cough Child Oral)

30 mg/5 mL (per mL): $0.10

Suspension Extended Release (Robitussin 12 Hour Cough Oral)

30 mg/5 mL (per mL): $0.10

Syrup (Robitussin Childrens Cough LA Oral)

7.5 mg/5 mL (per mL): $0.05

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

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

Pharmacodynamics/Kinetics

Onset of action: Antitussive: 15 to 30 minutes.

Metabolism: Hepatic via demethylation via CYP2D6 to dextrorphan (active); CYP3A4 and CYP3A5 form smaller amounts of 3-hydroxy and 3-methoxy derivatives.

Half-life elimination:

Dextromethorphan:

Pediatric patients: Excluding poor metabolizers (Guenin 2014).

Children 2 to 5 years: 4.09 ± 1.44 hours.

Children 6 to 11 years: 4.8 ± 1.59 hours.

Children ≥12 years and Adolescents: 6.41 ± 1.639 hours.

Adults: Extensive metabolizers: 2 to 4 hours; poor metabolizers: 24 hours.

Time to peak:

Children 2 to 5 years: 1.44 ± 0.563 hours (Guenin 2014).

Children 6 to 11 years: 2.12 ± 0.801 hours (Guenin 2014).

Children ≥12 years and Adolescents: 2.04 ± 0.865 hours (Guenin 2014).

Adults: Mean range: 2.1 to 2.6 hours (Silvasti 1987).

Peak concentration:

Pediatric patients: Excluding poor metabolizers (Guenin 2014).

Children 2 to 5 years (following doses of 7.5 to 11.25 mg): 1.47 ± 1.597 ng/mL.

Children 6 to 11 years (following doses of 15 to 24.75 mg): 1.26 ± 1.211 ng/mL.

Children ≥12 years and Adolescents (following doses of 30 mg): 4.9 ± 4.215 ng/mL.

Adults (following doses of 60 mg): Mean range: 5.2 to 5.8 ng/mL (Silvasti 1987).

Excretion: Primarily in urine as metabolites.

Pharmacodynamics/Kinetics: Additional Considerations

Metabolism: Pharmacokinetic parameters are affected by the genetic predisposition of CYP2D6 activity (Guenin 2014).

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

References

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Brand Names: International

Acodin (PL); Acough (HK); Actifed New (BE); Adult Dry Cough (GB); Alex (IN); Altec (VN); Antus (TH); Arilcodiltosse (IT); Aritos (ES); Astomari (JP); Athos (MX); Atos (PE); Atuxane (FR); Balsedrina (MX); Bechilar (IT); Bei Ke Er (CN); Benylin Dry Coughs Syrup (MT); Benylin Non-Drowsy Dry Cough (IE); Biocadextro (FR); Bioquidan (MX); Bisoltussin (BE, BR, HR, ID, PT, VN); Bisolvon Dry (AU); Bisolvon Tosse Sed (IT); Brocolan (MX); Brofex (BD); Bronchenolo Tosse (IT); Bronchetab (IT); Bronchosedal (BE, LU); Bronchydex (FR); Broncogrip (PY); Brudex (MX); Cinfatos (ES); Codiphan (EG); Coldflu (BD); Contrasal (QA, SA); Cortuss (TH); Couldetos (ES); Curatos (PE); Daro Retard (NL); Dekesi (CN); Depan-F (TH); Dexatussin (PL); Dexcophan (HK, SG); Dexir (BE); Dexof (PH); Dexofan (DK, LV, SA); Dexsol (BD); Dextonil (VE); Dextro Toss (UY); Dextrocough (TH); Dextrokuf (BH, ET, QA, SA); Dextrome (HK); Dextrophan (MY); Dextrotos (AR); Diacol (LB, MT, PT); DM (IN); Drikof (BD); Eascof-DM (ET); Ergix Toux Seche (FR); Exedexe (AE, BH, QA, SA); Exophan (BD); Fluditec Dry Cough (LV); Formitrol (IT); Formulatus (ES); Garde (MX); Hihustan (JP); Humisec (RO); Hustenstiller-ratiopharm (DE); Icolid (TH); Jiang Ke (CN); Kafosed (BH, QA, SA); Ke Le Er (CN); KeDi (CN); Kofban (IN); Kofrid (IN); Lafedar (AR); Laitos (ES); Larentel (PT); Lastuss LA (LK); Lexatussin (PE); Lexcof (IN); Libolar (VE); MedDex (CZ); Meddex (HU); Metodex (BD); Metorfan (EC, IT); Metorfan Forte (EC); Mugotussol (SK); Mytusan DM (PH); Nodex (FR); Numark Adult Dry Cough Linctus (MT); PCD Dry Cough (ZW); Promedin (VE); Pusiran (CN, HK, MY, SG, TH); Quimofan (MX); Resilar (FI); Riaphan (SA); Robitussin (PL); Robitussin Antitussicum (SK); Robitussin Dry Cough (GB, IE, MT); Robitussin Dry Cough Forte (AU); Robitussin Junior (CZ, HU, RO, SK); Rodilar (VN); Rofedex (RO); Rometor (FI); Romilar (ES, ID, MX, TH); Romin (QA, SA); Setustop (PT); Shu De (CN); Silomat DMP (DE); Sisaal (JP); Stopex (CZ, SK); Strepsils Dry Cough (AU, PH); Sumentol (PY); Teratos Miel Adultos (CO); Tilodrin (VE); Tip (ES); Tomephen (BD); Tositec (PY); Tossoral (IT); Touxium Antitussivum (BE, LU); Trimedal Tosse (BR); Tusifan (HR); Tusminal (CL); Tuspulmin (PE); Tussal Antitussicom (PL); Tussastopp (AT); Tussidane (FR); Tussidex (PL, SG); Tussidex Forte (HK); Tussidril (ES); Tussidrill (CZ, PL); Tussilar (EG); Tussils (MY, SG); Tussin (RO); Tussin Forte (RO); Tussipect (ET, NL); Tussis Om (PE); Tussopront (HU); Tussoral (PT); Tussycalm (IT); Tuxium (FR); Vicks MedDex (PL); Vicks Tosse Pastiglie (IT); Vicks Tosse Sedativo (IT); Vicks Vaposyrup Antitussif (BE); Wick Formel 44 Husten-Pastillen S (AT); Wick Formel 44 Hustenstiller (AT)

Last Updated 10/14/20