Embedded Files
Pharmacologic Category
Dosing: Adult
Also refer to specific product labeling.
Cough (antitussive/expectorant): Oral:
General dosing guidelines: Guaifenesin 200 to 400 mg and dextromethorphan 10 to 20 mg every 4 hours (maximum dose: Guaifenesin 2,400 mg and dextromethorphan 120 mg per day)
Mucinex DM: 1 to 2 tablet every 12 hours (maximum: 4 tablets/24 hours)
Mucinex DM Maximum Strength: 1 tablet every 12 hours (maximum: 2 tablets/24 hours)
Mucinex Children’s Cough Mini-Melts: 2 to 4 packets every 4 hours (maximum: 6 doses/24 hours)
Scot-Tussin Senior SF DMEXP: 10 mL (guaifenesin 400 mg/dextromethorphan 30 mg) every 6 hours (maximum: 4 doses/24 hours)
Dosing: Geriatric
Refer to adult dosing.
Dosing: Renal Impairment: Adult
There are no dosage adjustments provided in the manufacturer's labeling.
Dosing: Hepatic Impairment: Adult
There are no dosage adjustments provided in the manufacturer's labeling.
Dosing: Pediatric
Note: Multiple concentrations of oral liquid formulations (liquid, solution, and syrup) exist; close attention must be paid to the concentration when ordering or administering. Refer to product-specific labeling for approved pediatric ages. Safety and efficacy for the use of cough and cold products in infants and young children is limited; the AAP warns against the use of these products for respiratory illnesses in infants and young children; the FDA does not recommend OTC use in infants and children <2 years of age due to the risk of serious and life-threatening adverse effects (including death) and recommends to use with caution in pediatric patients ≥2 years of age (AAP 2018; FDA 2017).
Cough (antitussive/expectorant): Oral: Note: For all immediate release products (eg, capsules, granules, liquid formulations); do not exceed 6 doses in 24 hours.
General dosing: Immediate release products:
Children 4 to <6 years: Dextromethorphan 2.5 to 5 mg with Guaifenesin 50 to 100 mg every 4 hours as needed
Children 6 to <12 years: Dextromethorphan 5 to 10 mg with Guaifenesin 100 to 200 mg every 4 hours as needed
Children ≥12 years and Adolescents: Dextromethorphan 10 to 20 mg with Guaifenesin 200 to 400 mg every 4 hours as needed
Product-specific dosing:
Capsules, liquid filled: Dextromethorphan 10 mg and Guaifenesin 200 mg per capsule: Children ≥ 12 years and Adolescents: 1 to 2 capsules every 4 hours as needed
Granules: Dextromethorphan 5 mg and Guaifenesin 100 mg per packet:
Children 4 to <6 years: 1 packet every 4 hours as needed
Children 6 to 11 years: 1 to 2 packets every 4 hours as needed
Liquid/Solution/Syrup: Note: Multiple concentrations available; close attention must be paid. Refer to product specific labeling for approved pediatric ages.
Dextromethorphan 5 mg and Guaifenesin 100 mg per 5 mL:
Children 4 to <6 years: 2.5 to 5 mL every 4 hours as needed
Children 6 to <12 years: 5 to 10 mL every 4 hours as needed
Children ≥12 years and Adolescents: 10 to 20 mL every 4 hours as needed
Dextromethorphan 10 mg and Guaifenesin 100 mg per 5 mL:
Children 2 to <6 years: 2.5 mL every 4 hours as needed
Children 6 to <12 years: 5 mL every 4 hours as needed
Children ≥12 years and Adolescents: 10 mL every 4 hours as needed
Dextromethorphan 10 mg and Guaifenesin 200 mg per 5 mL: Children ≥12 years and Adolescents: 10 mL every 4 hours as needed
Dextromethorphan 10 mg and Guaifenesin 200 mg per 15 mL:
Children 6 to <12 years: 15 mL every 4 hours as needed
Children ≥12 years and Adolescents: 30 mL every 4 hours as needed.
Dextromethorphan 20 mg and Guaifenesin 400 mg per 5 mL: Children ≥ 12 years and Adolescents: 5 mL every 4 hours as needed
Tablet, extended release:
Dextromethorphan 30 mg and Guaifenesin 600 mg per tablet: Children ≥12 years and Adolescents: 1 to 2 tablets every 12 hours as needed; do not exceed 4 tablets in 24 hours
Dextromethorphan 60 mg and Guaifenesin 1,200 mg per tablet: Children ≥12 years and Adolescents: 1 tablet every 12 hours as needed; do not exceed 2 tablets in 24 hours
Tablet, immediate release: Dextromethorphan 20 mg and Guaifenesin 400 mg per tablet:
Children 6 to <12 years: 1/2tablet every 4 hours as needed
Children ≥12 years and Adolescents: 1 tablet every 4 hours as needed
Dosing: Renal Impairment: Pediatric
There are no dosage adjustments provided in the manufacturer's labeling. See individual agents.
Dosing: Hepatic Impairment: Pediatric
There are no dosage adjustments provided in the manufacturer's labeling. See individual agents.
Use: Labeled Indications
Cough (antitussive/expectorant): Temporary control of cough due to minor throat and bronchial irritation associated with the common cold or inhaled irritants; help loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive; temporary relief of coughing intensity and cough impulse to help fall asleep.
Administration: Oral
Administer with water. Do not crush or chew ER or long acting formulations. Do not chew granules. Only use dosing cup provided with liquid formulations.
Bariatric surgery: Tablet, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Switch to IR tablet, capsule, or oral solution.
Administration: Pediatric
Oral: Administer without regard to meals, with a large quantity of fluid to ensure proper effect; do not crush, chew, or break extended release tablets.
Dietary Considerations
Some products may contain phenylalanine and/or sodium.
Storage/Stability
Store at room temperature.
Medication Patient Education with HCAHPS Considerations
What is this drug used for?
• It is used to thin mucus so it can be taken from the body by coughing.
• 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
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 <2 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.
• Phenylalanine: Some products may contain phenylalanine.
Other warnings/precautions:
• Cough: Appropriate use: Underlying cause of cough should be determined prior to prescribing.
• Self-medication (OTC use): When used for self medication (OTC), notify health care provider if symptoms do not improve within 7 days, or are accompanied by fever, rash, or persistent headache.
Geriatric Considerations
See individual agents.
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). Multiple concentrations of oral liquid formulations (drops, elixir, and liquid) exist; close attention must be paid to the concentration when ordering or administering.
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
Refer to individual monographs.
Breast-Feeding Considerations
Refer to individual monographs.
Lexicomp Pregnancy & Lactation, In-Depth
Briggs' Drugs in Pregnancy & Lactation
Adverse Reactions
See individual agents.
Allergy and Idiosyncratic Reactions
Toxicology
Metabolism/Transport Effects
Refer to individual components.
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
See individual agents.
Genes of Interest
Advanced Practitioners Physical Assessment/Monitoring
See individual agents.
Nursing Physical Assessment/Monitoring
See individual agents.
Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product.
Caplet, oral:
Fenesin DM IR: Guaifenesin 400 mg and dextromethorphan hydrobromide 15 mg [DSC]
Fenesin DM IR: Guaifenesin 400 mg and dextromethorphan hydrobromide 20 mg
Refenesen DM: Guaifenesin 400 mg and dextromethorphan hydrobromide 20 mg
Capsule, oral:
Coricidin HBP Chest Congestion and Cough: Guaifenesin 200 mg and dextromethorphan hydrobromide 10 mg
Robitussin Cough + Chest Congestion DM: Guaifenesin 200 mg and dextromethorphan hydrobromide 10 mg
Granules, oral:
Mucinex Kid’s Cough Mini-Melts: Guaifenesin 100 mg and dextromethorphan hydrobromide 5 mg per packet (12s) [contains magnesium 6 mg/pack, phenylalanine 2 mg/packet, sodium 3 mg/packet; orange crème flavor]
Liquid, oral:
Delsym Cough + Chest Congestion DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 5 mg per 5 mL (180 mL [DSC]) [contains edetate disodium, proylene glycol, sodium benzoate; cherry flavor]
Diabetic Tussin DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [dye free, ethanol free, sugar free; contains phenylalanine 8.4 mg/5 mL]
Diabetic Tussin DM Maximum Strength: Guaifenesin 200 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [dye free, ethanol free, sugar free; contains phenylalanine 8.4 mg/5 mL]
Double Tussin DM: Guaifenesin 300 mg and dextromethorphan hydrobromide 20 mg per 5 mL (120 mL, 480 mL) [dye free, ethanol free, sugar free]
Iophen DM-NR: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (480 mL [DSC]) [contains propylene glycol, sodium benzoate; raspberry flavor]
Kolephrin GG/DM: Guaifenesin 150 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [ethanol free; cherry flavor]
Maxi-Tuss GMX: Guaifenesin 200 mg and dextromethorphan hydrobromide 10 mg per 5 mL (473 mL) [ sugar free; contains propylene glycol; cherry flavor)
Mucinex Fast-Max DM Max: Guaifenesin 400 mg and dextromethorphan hydrobromide 20 mg per 20 mL (180 mL) [contains propylene glycol, potassium 6 mg/20 mL, sodium 13 mg/20 mL]
Mucinex Kid’s Cough: Guaifenesin 100 mg and dextromethorphan hydrobromide 5 mg per 5 mL (120 mL) [contains propylene glycol, sodium 3 mg/5 mL; cherry flavor]
Robafen DM Peak Cold Cough/Congestion: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (118 mL) [contains menthol, methylparaben, polyethylene glycol, sodium benzoate]
Robitussin Cough + Chest Congestion DM: Guaifenesin 50 mg and dextromethorphan hydrobromide 5 mg per 5 mL (118 mL, 237 mL); Guaifenesin 100 mg and dextromethorphan hydrobromide 5 mg per 5 mL (118 mL, 237 mL) [contains menthol, propylene glycol, sodium benzoate]
Robitussin Peak Cold Cough + Chest Congestion DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL ( 120 mL, 240 mL) [contains menthol, propylene glycol, sodium 3.5 mg/5 mL, sodium benzoate]
Safe Tussin DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 15 mg per 5 mL (120 mL) [contains benzoic acid, phenylalanine 4.2 mg/5 mL, and propylene glycol; orange and mint flavors]
Scot-Tussin Senior: Guaifenesin 200 mg and dextromethorphan hydrobromide 15 mg per 5 mL (120 mL) [ethanol free, sodium free, sugar free]
Vicks 44E: Guaifenesin 200 mg and dextromethorphan hydrobromide 20 mg per 15 mL (120 mL, 235 mL) [contains ethanol, sodium 31 mg/15 mL, sodium benzoate]
Vicks DayQuil Mucus Control DM: Guaifenesin 200 mg and dextromethorphan hydrobromide 10 mg per 15 mL (295 mL) [contains propylene glycol, sodium 25 mg/15 mL, sodium benzoate; citrus blend flavor]
Vicks Pediatric Formula 44E: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 15 mL (120 mL) [ethanol free; contains sodium 30 mg/15 mL, sodium benzoate; cherry flavor]
Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (480 mL)
Syrup, oral:
Cheracol D: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL, 180 mL) [contains benzoic acid, ethanol 4.75%]
Cheracol Plus: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [contains benzoic acid, ethanol 4.75%]
Diabetic Siltussin-DM DAS-Na: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (118 mL) [ethanol free, sugar free; contains benzoic acid, phenylalanine 3 mg/5 mL, propylene glycol; strawberry flavor]
Diabetic Siltussin-DM DAS-Na Maximum Strength: Guaifenesin 200 mg and dextromethorphan hydrobromide 10 mg per 5 mL (118 mL) [ethanol free, sugar free; contains benzoic acid, phenylalanine 3 mg/5 mL, propylene glycol; strawberry flavor]
Guaicon DMS: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (10 mL) [ethanol free, sugar free]
Q-Tussin DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (118 mL, 237 mL, 473 mL) [ethanol free, contains sodium benzoate; cherry flavor]
Robafen DM Cough Clear: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (5 mL, 10 mL) [contains sodium benzoate, propylene glycol, menthol]
Silexin: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (45 mL) [ethanol free, sugar free)]
Siltussin DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL, 240 mL, 480 mL) [strawberry flavor]
Siltussin DM DAS: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [dye free, ethanol free, sugar free; strawberry flavor]
Triaminic Cough & Cold: Guaifenesin 100 mg and dextromethorphan hydrobromide 5 mg per 5 mL (118 mL) [contains propylene glycol, sodium benzoate; cherry flavor]
Zyncof: Guaifenesin 400 mg and dextromethorphan hydrobromide 20 mg per 5 mL (120 mL, 480 mL) [dye free, ethanol free, sugar free; contains propylene glycol; grape flavor]
Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (5 mL, 10 mL, 120 mL, 480 mL)
Tablet, oral:
GoodSense Mucus Relief DM: Guaifenesin 400 mg and dextromethorphan hydrobromide 20 mg [dye free, gluten free]
Silexin: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg
Generic: Guaifenesin 400 mg and dextromethorphan hydrobromide 20 mg; guaifenesin 1000 mg and dextromethorphan hydrobromide 60 mg; guaifenesin 1200 mg and dextromethorphan hydrobromide 60 mg
Tablet, extended release, oral:
Mucinex DM: Guaifenesin 600 mg and dextromethorphan hydrobromide 30 mg
Mucinex DM Maximum Strength: Guaifenesin 1200 mg and dextromethorphan hydrobromide 60 mg
Generic: Guaifenesin 1200 mg and dextromethorphan hydrobromide 60 mg
Anatomic Therapeutic Chemical (ATC) Classification
- N07XX59
Generic Available (US)
Yes: Excludes extended release tablet
Pricing: US
Capsules (Robitussin Cough+Chest Cong DM Oral)
10-200 mg (per each): $0.31
Liquid (Delsym Cgh/Chest Cong DM Child Oral)
5-100 mg/5 mL (per mL): $0.08
Liquid (Dextromethorphan-guaiFENesin Oral)
10-100 mg/5 mL (per mL): $0.43
Liquid (Diabetic Tussin DM Oral)
100-10 mg/5 mL (per mL): $0.04
Liquid (Diabetic Tussin For Children Oral)
10-100 mg/5 mL (per mL): $0.04
Liquid (Diabetic Tussin Max St Oral)
10-200 mg/5 mL (per mL): $0.04
Liquid (Double-Tussin DM Oral)
20-300 mg/5 mL (per mL): $0.03
Liquid (Giltuss Cough & Chest Children Oral)
10-100 mg/5 mL (per mL): $0.06
Liquid (Giltuss Cough & Chest Oral)
20-200 mg/10 mL (per mL): $0.06
Liquid (Giltuss Diabetic Cough & Cold Oral)
10-100 mg/5 mL (per mL): $0.06
Liquid (Mucinex Cough Childrens Oral)
5-100 mg/5 mL (per mL): $0.08
Liquid (Mucinex Fast-Max DM Max Oral)
20-400 mg/20 mL (per mL): $0.07
Liquid (Pecgen DMX Oral)
10-187 mg/5 mL (per mL): $0.02
Liquid (Robafen DM Cgh/Chest Congest Oral)
10-100 mg/5 mL (per mL): $0.02
Liquid (Robafen DM Cough Oral)
10-100 mg/5 mL (per mL): $0.01
Liquid (Robafen DM Peak Cold Cgh/Cong Oral)
10-100 mg/5 mL (per mL): $0.02
Liquid (Robitussin Cough+Chest Cong DM Oral)
20-200 mg/20 mL (per mL): $0.05
20-400 mg/20 mL (per mL): $0.06
Liquid (Safe Tussin DM Oral)
100-10 mg/5 mL (per mL): $0.04
Liquid (Trispec DMX Oral)
10-187 mg/5 mL (per mL): $0.11
15-125 mg/5 mL (per mL): $0.11
Liquid (Trispec DMX Pediatric Oral)
10-187 mg/5 mL (per mL): $0.22
Pack (Mucinex Cough For Kids Oral)
5-100 mg (per each): $0.75
Syrup (Dextromethorphan-guaiFENesin Oral)
10-100 mg/5 mL (per mL): $0.02
Syrup (G-Zyncof Oral)
20-400 mg/5 mL (per mL): $0.02
Syrup (Zyncof Oral)
20-400 mg/5 mL (per mL): $0.11
Tablet, 12-hour (DM-guaiFENesin ER Oral)
60-1200 mg (per each): $0.74
Tablet, 12-hour (Mucinex DM Maximum Strength Oral)
60-1200 mg (per each): $1.09
Tablet, 12-hour (Mucinex DM Oral)
30-600 mg (per each): $0.57
Tablets (Dextromethorphan-guaiFENesin Oral)
20-400 mg (per each): $0.06
Tablets (Fenesin DM IR Oral)
20-400 mg (per each): $0.13
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
Guaifenesin is thought to act as an expectorant by irritating the gastric mucosa and stimulating respiratory tract secretions, thereby increasing respiratory fluid volumes and decreasing phlegm viscosity
Dextromethorphan is a chemical relative of morphine lacking opioid properties except in overdose; controls cough by depressing the medullary cough center
Pharmacodynamics/Kinetics
See individual agents.
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
Related Information
Index Terms
Dextromethorphan and Guaifenesin; Guaifenesin/Dextromethorphan
References
Abduljalil K, Frank D, Gaedigk A, et al. Assessment of activity levels for CYP2D6*1, CYP2D6*2, and CYP2D6*41 genes by population pharmacokinetics of dextromethorphan. Clin Pharmacol Ther. 2010;88(5):643-651. doi: 10.1038/clpt.2010.137[PubMed 20881950]
Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319.[PubMed 11487763]
American Academy of Pediatrics (AAP). Cough and cold medicines should not be prescribed, recommended or used for respiratory illnesses in young children. Updated June 12, 2018. Available at http://www.choosingwisely.org/clinician-lists/american-academy-pediatrics-cough-and-cold-medicines-for-children-under-four/
American Academy of Pediatrics Committee on Drugs. "Inactive" ingredients in pharmaceutical products: update (subject review). Pediatrics. 1997;99(2):268-278.[PubMed 9024461]
Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm[PubMed 6810084]
Centers for Disease Control and Prevention (CDC). Infant deaths associated with cough and cold medications--two states, 2005. MMWR Morb Mortal Wkly Rep. 2007;56(1):1-4.[PubMed 17218934]
Cheracol D Cough Formula 4 oz syrup (guaifenesin and dextromethorphan) [prescribing information]. South El Monte CA: Lee Pharmaceuticals; December 2013.
Children's Delsym DM (guaifenesin and dextromethorphan) [prescribing information]. Parsippany, NJ: Reckitt Benckiser; 2013.
Children's Mucinex Mini-Melts Cough (dextromethorphan hydrobromide and guaifenesin) [prescribing information]. Parsippany, NJ: Reckitt Benckiser; November 2014.
Coricidin HBP Chest Congestion & Cough (dextromethorphan hydrobromide and guaifenesin) [prescribing information]. Whitehouse Station, NJ: MSD Consumer Care, Inc.; February 2014.
Delsym (guaifenesin and dextromethorphan) [prescribing information]. Parsippany, NJ: Reckitt Benckiser; 2013.
Delsym Cough Plus Chest Congestion DM (dextromethorphan hydrobromide and guaifenesin) [prescribing information]. Parsippany, NJ: Reckitt Benckiser; November 2014.
Diabetic Maximum Strength Siltussin DM DAS-NA (guaifenesin and dextromethorphan) [prescribing information]. Carmel, NY: Silarx Pharmaceuticals, Inc; June 2014.
Diabetic Siltussin DM DAS-NA (guaifenesin and dextromethorphan) [prescribing information]. Carmel, NY: Silarx Pharmaceuticals, Inc; June 2014.
Diabetic Tussin DM Maximum Strength (guaifenesin and dextromethorphan) [prescribing information]. Amittyville, NY: Health Care Products; September 2012.
Food and Drug Administration (FDA). Most young children with a cough or cold don't need medicines. July 18, 2017. Available at https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm422465.htm. Last accessed November 2, 2018.
Food and Drug Administration (FDA). Use caution when giving cough and cold products to kids. Updated February 8, 2018. Available at https://www.fda.gov/drugs/resourcesforyou/specialfeatures/ucm263948.htm. Last accessed November 2, 2018.
Iophen DM-NR Liquid (guaifenesin and dextromethorphan) [prescribing information]. Huntsaville, AL: Qualitest Pharmaceuticals; October 2009.
Iophen DM-NR solution (guaifenesin and dextromethorphan) [prescribing information]. Huntsaville, AL: Qualitest Pharmaceuticals; March 2015.
Jurica J, Bartecek R, Zourkova A, et al. Serum dextromethorphan/dextrorphan metabolic ratio for CYP2D6 phenotyping in clinical practice. J Clin Pharm Ther. 2012;37(4):486-490. doi:10.1111/j.1365-2710.2012.01333.x[PubMed 22548589]
Maxi-Tuss G (dextromethorphan and guaifenesin) [prescribing information]. Brooksville, FL: MCR American Pharmaceuticals, Inc; May 2020.
Mucinex (guaifenesin and dextromethorphan) [prescribing information]. Parsippany, NJ: Reckitt Benckiser; May 2009.
Mucinex DM (dextromethorphan hydrobromide and guaifenesin) [prescribing information]. Parsippany, NJ: Reckitt Benckiser Health (US); received April 2019.
Mucinex DM Maximum Strength (dextromethorphan hydrobromide and guaifenesin) [prescribing information]. Parsippany, NJ: RB Health (US); received September 2019.
Mucinex Fast Max DM Max (dextromethorphan hydrobromide and guaifenesin) [prescribing information]. Parsippany, NJ: RB Health (US); January 2020.
Mucinex Mini-Melts (guaifenesin and dextromethorphan) [prescribing information]. Parsippany, NJ: Reckitt Benckiser; September 2009.
Mucus Relief DM immeduate release (guaifenesin and dextromethorphan) [prescribing information]. Deer Park, NY: Allegiant Health; December 2014.
Q Tussin DM syrup (guaifenesin and dextromethorphan) [prescribing information]. Huntsaville, AL: Qualitest Pharmaceuticals; January 2013.
Robitussin (guaifenesin and dextromethorphan) [prescribing information]. Madison, NJ: Pfizer; received June 2017.
Sager JE, Lutz JD, Foti RS, et al. Fluoxetine- and norfluoxetine-mediated complex drug-drug interactions: in vitro to in vivo correlation of effects on CYP2D6, CYP2C19, and CYP3A4. Clin Pharmacol Ther. 2014;95(6):653-662. doi: 10.1038/clpt.2014.50[PubMed 24569517]
Shehab N, Lewis CL, Streetman DD, Donn SM. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256-259.[PubMed 19188870]
Triaminic Cough & Congestion (guaifenesin and dextromethorphan) [prescribing information]. Novartis Consumer Health, Inc; 2014.
Zhou SF. Polymorphism of human cytochrome P450 2D6 and its clinical significance: part II. Clin Pharmacokinet. 2009;48(12):761-804. doi:10.2165/11318070[PubMed 19902987]
Zyncof syrup (guaifenesin and dextromethorphan) [prescribing information]. San Juan, PR: Kramer Novis; December 2012.
Brand Names: International
Bre-A-Col (MX); Broncholar (QA); Bronchotec (EG); Bronpect-D (HK); Cheracol D (MX); Debequin C (MX); Dequin (MX); Dexometorfano-Guaifenesina (MX); Diacol (MT); Dimacol (MX); Exiadol (MX); Megal (MX); Robitussin DM (MX); Tukol D (MX); Tussin DM (HK); Tussolvina (EC); Vicksolytic (EG); Xarope 44E (BR)
Last Updated 9/23/20
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