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Guaifenesin and Dextromethorphan


Pronunciation

 (gwye FEN e sin & deks troe meth OR fan)


U.S. Brand Names

 Altarussin DM [OTC]; Amibid DM; Aquatab® DM [DSC]; Benylin® Expectorant [OTC]; Cheracol® D [OTC]; Cheracol® Plus [OTC]; Diabetic Tussin® DM [OTC]; Diabetic Tussin® DM Maximum Strength [OTC]; Duratuss® DM; Gani-Tuss DM NR; Genatuss DM® [OTC]; Guaifenex® DM; Guiatuss-DM® [OTC]; Humibid® CS [OTC]; Humibid® DM [DSC]; Hydro-TussinTM DM; Kolephrin® GG/DM [OTC]; Mucinex® DM [OTC]; Respa-DM®; Robafen DM [OTC]; Robitussin® DM [OTC]; Robitussin® DM Infant [OTC]; Robitussin® Sugar Free Cough [OTC]; Safe Tussin® 30 [OTC]; Scot-Tussin® Senior [OTC]; Silexin® [OTC]; Siltussin DM [OTC]; Siltussin DM DAS [OTC]; Touro® DM; Tussi-Organidin® DM NR [DSC]; Vicks® 44E [OTC]; Vicks® Pediatric Formula 44E [OTC]; Z-Cof LA™


Synonyms

 Dextromethorphan and Guaifenesin


Generic Available

 Yes


Canadian Brand Names

 Balminil DM E; Benylin® DM-E; Koffex DM-Expectorant; Robitussin® DM


Use

 Temporary control of cough due to minor throat and bronchial irritation


Pregnancy Risk Factor

 C


Pregnancy Implications

 Reproduction studies have not been conducted with this combination. Refer to individual agents.


Lactation

 Excretion in breast milk unknown/use caution


Contraindications

 Hypersensitivity to guaifenesin, dextromethorphan, or any component of the formulation; use with or within 14 days of MAO inhibitor therapy


Warnings/Precautions

 Should not be used for persistent or chronic cough such as that occurring with smoking, asthma, chronic bronchitis, or emphysema or for cough associated with excessive phlegm. Use caution in patients who are sedated, debilitated or confined to a supine position; use with caution in atopic children. When used for self-medication (OTC), contact healthcare provider if needed for >7 days or for a cough with a fever, rash, or persistent headache.


Adverse Reactions

 See individual agents.


Drug Interactions

 Dextromethorphan: Substrate of CYP2B6 (minor), 2C8/9 (minor), 2C19 (minor), 2D6 (major), 2E1 (minor), 3A4 (minor); Inhibits CYP2D6 (weak)

Also see individual agents.


Stability

 Store at room temperature.


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 narcotic properties except in overdose; controls cough by depressing the medullary cough center


Pharmacodynamics/Kinetics

 See individual agents.


Dosage

 Oral:

Children 2-6 years:

General dosing guidelines: Guaifenesin 50-100 mg and dextromethorphan 2.5-5 mg every 4 hours (maximum dose: Guaifenesin 600 mg and dextromethorphan 30 mg per day)

Product-specific labeling:

Benylin®: 5 mL every 4 hour (maximum: 6 doses/24 hours)

Guaifenex® DM, Touro™ DM: 1 /2 tablet every 12 hours (maximum: 1 tablet/24 hour)

Robitussin® DM, Robitussin® DM Infant, Robitussin® Sugar Free Cough: 2.5 mL every 4 hours (maximum: 6 doses/24 hours)

Vicks® Pediatric Formula 44E: 7.5 mL every 4 hours (maximum: 6 doses/24 hours)

Children: 6-12 years:

General dosing guidelines: Guaifenesin 100-200 mg and dextromethorphan 5-10 mg every 4 hours (maximum dose: Guaifenesin 1200 mg and dextromethorphan 60 mg per day)

Product-specific labeling:

Benylin®: 10 mL every 4 hours (maximum: 6 doses/24 hours)

Guaifenex® DM, Touro™ DM: 1 tablet every 12 hours (maximum: 2 tablets/24 hours)

Humibid® CS: 1 /2 tablet every 4 hours (maximum: 6 doses/24 hours)

Robitussin® DM, Robitussin® Sugar Free Cough: 5 mL every 4 hours (maximum: 6 doses/24 hours)

Vicks® 44E: 7.5 mL every 4 hours (maximum: 6 doses/24 hours)

Vicks® Pediatric Formula 44E: 15 mL every 4 hours (maximum: 6 doses/24 hours)

Z-Cof LA™: 1 /2 tablet very 12 hours

Children 12 years and Adults:

General dosing guidelines: Guaifenesin 200-400 mg and dextromethorphan 10-20 mg every 4 hours (maximum dose: Guaifenesin 2400 mg and dextromethorphan 120 mg per day)

Product-specific labeling:

Benylin®: 20 mL every 4 hours (maximum: 6 doses/24 hours)

Guaifenex® DM, Mucinex® DM, Touro™ DM: 1-2 tablets every 12 hours (maximum: 4 tablets/24 hours)

Humibid® CD: 1 tablet every 4 hours (maximum: 6 tablets/24 hours)

Robitussin® DM, Robitussin® Sugar Free Cough: 10 mL every 4 hours (maximum: 6 doses/24 hours)

Vicks® 44E: 15 mL every 4 hours (maximum: 6 doses/24 hours)

Vicks® Pediatric Formula 44E: 30 mL every 4 hours (maximum: 6 doses/24 hours)

Z-Cof LA™: 1 tablet every 12 hours


Administration

 Take with water. Do crush or chew extended release or long acting formulations.


Dietary Considerations

 Diabetic Tussin® DM and Diabetic Tussin® DM Maximum Strength contain phenylalanine 8.4 mg/5 mL. Vicks® 44E contains sodium 31 mg/15 mL; Vicks® Pediatric Formula 44E contains sodium 30 mg/15 mL.


Patient Education

 Also see Guaifenesin.

Based on Dextromethorphan component: Do not exceed recommended dosage; take with a large glass of water; if cough lasts more than 1 week or is accompanied by a rash, fever, or headache, notify physician.

Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.


Nursing Implications

 Administer with a large quantity of fluid. The "NR" in Tussi-Organidin® DM NR means "Newly Reformulated."


Dental Health: Effects on Dental Treatment

 No significant effects or complications reported


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 May cause drowsiness


Mental Health: Effects on Psychiatric Treatment

 Concurrent use with psychotropics may produce additive sedation


Dosage Forms

 [DSC] = Discontinued product

Liquid: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (480 mL)

Diabetic Tussin® DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [alcohol free, sugar free, dye 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) [alcohol free, sugar free, dye free; contains phenylalanine 8.4 mg/5 mL]

Duratuss® DM: Guaifenesin 200 mg and dextromethorphan hydrobromide 20 mg per 5 mL (480 mL) [contains alcohol 5%, sodium benzoate; fruit flavor]

Gani-Tuss DM NR: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (480 mL) [raspberry flavor]

Hydro-Tussin™ DM: Guaifenesin 200 mg and dextromethorphan hydrobromide 20 mg per 5 mL (480 mL) [alcohol free, sugar free]

Kolephrin® GG/DM: Guaifenesin 150 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [alcohol free; cherry flavor]

Safe Tussin®: Guaifenesin 100 mg and dextromethorphan hydrobromide 15 mg per 5 mL (120 mL) [alcohol free, sodium free, sugar free, dye free; mint flavor]

Scot-Tussin® Senior: Guaifenesin 200 mg and dextromethorphan hydrobromide 15 mg per 5 mL (120 mL) [alcohol free, sodium free, sugar free]

Tussi-Organidin® DM NR: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL, 480 mL) [contains sodium benzoate; raspberry flavor] [DSC]

Vicks® 44E: Guaifenesin 200 mg and dextromethorphan hydrobromide 20 mg per 15 mL (120 mL, 235 mL) [contains sodium 31 mg/15 mL, alcohol, sodium benzoate]

Vicks® Pediatric Formula 44E: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 15 mL (120 mL) [alcohol free; contains sodium 30 mg/15 mL, sodium benzoate; cherry flavor]

Liquid, oral drops (Robitussin® DM Infant): Guaifenesin 100 mg and dextromethorphan hydrobromide 5 mg per 2.5 mL (30 mL) [alcohol free; contains sodium benzoate; fruit punch flavor]

Syrup: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL, 480 mL)

Altarussin DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL, 240 mL, 480 mL, 3840 mL)

Benylin® Expectorant: Guaifenesin 100 mg and dextromethorphan hydrobromide 5 mg per 5 mL (120 mL) [alcohol free, sugar free; contains sodium benzoate; raspberry flavor]

Cheracol® D: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL, 180 mL) [contains alcohol, benzoic acid]

Cheracol® Plus: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL)

Genatuss DM®: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [cherry flavor]

Guiatuss® DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL, 480 mL, 3840 mL) [alcohol free; fruit-mint flavor]

Robafen DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL)

Robitussin®-DM: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (5 mL, 120 mL, 360 mL, 480 mL) [alcohol free; contains sodium benzoate]

Robitussin® Sugar Free Cough: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [alcohol free, sugar free; contains sodium benzoate]

Silexin®: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 5 mL (45 mL, 480 mL) [alcohol 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) [alcohol free, dye free, sugar free; strawberry flavor]

Tablet:

Humibid® CS: Guaifenesin 400 mg and dextromethorphan hydrobromide 20 mg

Silexin®: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg

Tablet, extended release: Guaifenesin 500 mg and dextromethorphan hydrobromide 30 mg; Guaifenesin 600 mg and dextromethorphan hydrobromide 30 mg; Guaifenesin 1000 mg and dextromethorphan hydrobromide 60 mg

Amibid DM, Guaifenex® DM, Humibid® DM [DSC], Mucinex® DM, Respa-DM®: Guaifenesin 600 mg and dextromethorphan hydrobromide 30 mg

Aquatab® DM: Guaifenesin 1200 mg and dextromethorphan hydrobromide 60 mg [DSC]

Touro® DM: Guaifenesin 575 mg and dextromethorphan hydrobromide 30 mg

Tablet, long acting [scored] (Z-Cof LA): Guaifenesin 650 mg and dextromethorphan hydrobromide 30 mg


International Brand Names

 Balminil DM E (CA); Benylin® DM-E (CA); Koffex DM-Expectorant (CA); Robitussin® DM (CA)


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