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Dextromethorphan is a cough suppressant and NMDA receptor antagonist that compounding pharmacies prepare by prescription in several dosage forms.
Dextromethorphan is a nonopioid morphinan cough suppressant that acts on brainstem pathways that control coughing. It is also a sigma-1 receptor agonist and an uncompetitive NMDA receptor antagonist. It is sold without a prescription in cough products such as Delsym extended-release suspension, which temporarily relieves cough from minor throat and bronchial irritation. Prescription combinations include Nuedexta (with quinidine), FDA-approved for pseudobulbar affect, and Auvelity (with bupropion), approved for major depressive disorder in adults and for agitation associated with dementia due to Alzheimer's disease. A prescriber might order dextromethorphan compounded for a strength, dosage form or allergen-free vehicle that is not manufactured. Compounded preparations are not FDA-approved and require a prescription.
Nonprescription labels say not to use dextromethorphan with an MAO inhibitor or for 2 weeks after stopping one, and to stop and ask a doctor if cough lasts more than 7 days or comes with fever, rash or lasting headache. MedlinePlus says not to give these products to children under 4 and warns that large amounts can cause serious side effects or death. Nuedexta is contraindicated with quinidine, quinine or mefloquine, a history of reactions to them such as low platelets or hepatitis, MAO inhibitor use, QT prolongation, heart failure and certain heart blocks; its warnings include serotonin syndrome and dizziness. Auvelity carries a boxed warning for suicidal thoughts and behaviors in children and young adults. LactMed says cough-syrup amounts in milk are very low, while Auvelity's maker advises avoiding breastfeeding during treatment and for 5 days afterward. Talk to your prescriber or pharmacist about side effects.
Dextromethorphan is a dextrorotatory morphinan structurally related to levorphanol with minimal mu-opioid activity; its main active metabolite, dextrorphan, is formed by CYP2D6 (StatPearls). In CYP2D6 extensive metabolizers, first-pass metabolism keeps oral bioavailability low and the median elimination half-life is about 2 to 3 hours; poor metabolizers have markedly higher exposure and a half-life of roughly 15 to 20 hours. Quinidine in Nuedexta inhibits CYP2D6 to raise and prolong dextromethorphan levels; with Auvelity, the mean dextromethorphan half-life was about 22 hours. Labeled uses: nonprescription cough relief; pseudobulbar affect (Nuedexta); major depressive disorder and agitation associated with Alzheimer's dementia (Auvelity). StatPearls describes investigational uses, including stroke, traumatic brain injury and seizures; these are not FDA-approved indications. Dosing is per prescriber. Avoid MAO inhibitors and allow 14 days between them, use caution with other serotonergic drugs, and review CYP2D6 substrates and QT risk when quinidine is part of the regimen. Monitor for sedation, dizziness and misuse.
Compounded at Bayview
Patient guides for the preparations we make most often. Each one is compounded to order and requires a prescription.
We do not have a patient page for this ingredient yet. That does not mean we cannot make it. Bayview compounds this ingredient to a prescriber's order, and our full compounding formulary lists every preparation we make. Viewing the formulary requires a prescriber account.
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Every preparation in our formulary that contains this ingredient. Strength, base and dose form are set by the prescription.
Other salt forms of this molecule, and ingredients commonly compounded alongside it.
This page describes an active pharmaceutical ingredient, not a finished drug product. Bayview Pharmacy compounds preparations containing it only on a prescriber's order for an individual patient.
Compounded preparations are not FDA-approved, and the FDA has not evaluated them for safety, effectiveness, or manufacturing quality. Nothing on this page is a claim that any preparation is effective for any condition.
A valid prescription is required. Availability depends on Bayview's licensure in your state. This page is general information, not medical advice. Discuss your situation with a licensed healthcare provider.
Our pharmacists work with prescribers to build preparations around a patient's dose, form and tolerances. Ask us what is possible with this ingredient.
