Dextromethorphan (Robitussin DM)

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Therapeutic Class
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Cough suppressant
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Pharmacologic Class
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– Drug for increasing cough threshold – Non-opioid antitussive
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Other Drugs in this Class
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Benzonatate
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Pregnancy Category
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Pregnancy Category C
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Uses
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– Cough suppression in allergy and cold – Can reduce pain when combined with an opioid
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Action
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Suppress cough through its action on the CNS to raise the cough threshold
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Route
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PO
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Contraindications
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– Treatment of chronic cough due to excessive bronchial secretion such as in asthma, smoking, and emphysema – Pregnancy
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Adverse Effects
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– Dizziness, drowsiness – Nausea, Vomit, Stomach pain – Hallucination – Slurred speech – Euphoria – Ataxia – Hyperexcitability – Stupor – Respiratory Depression – Seizure – Coma – CNS Depression
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Drug Interactions
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– MAOIs – *Hypertensive crisis, hypotension, hypopyrexia, CNS excitation* – Alcohol, opioids, and other CNS depressants – *Increased risk of sedation* – Grape fruit juice – *Increased drug levels*
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Treatment of Overdose
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Naloxone (Narcan) if sedation/respiratory depression occurs
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Nursing Implications
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– Cough syrups should be swalled without water and allowed to coat the throat for soothing effects, followed by increased fluid intake 30 to 60 minutes later – Do not use in children younger than 2 *- Do not chew Benzonatate because it can cause the side effect of numbing of the mouth and pharynx* – Monitor for dizziness and drowsiness – Asess respiratory status – Monitor for adverse effects – Instruct patient to ask for assistance when getting up – Notify HCP if cough persists – Do not drink alcohol – Teach patient to supplement drug therapy with nonpharmacologic measures such as increased fluid intake to liquify and assist to mobilize mucus and moisten respiratory tract – Monitor for dry cough, increasing cough severity, increasing congestion, or dyspnea – Instruct patient to report promptly any change in the severity of the frequency of cough – Assess and instruct patient to report color and consistency of sputum

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