Skip to Content

Dextromethorphan and Menthol

Medically reviewed by Drugs.com. Last updated on Jun 16, 2020.

Pronunciation

(deks troe meth OR fan & MEN thole)

Dosage Forms

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

Lozenge, Mouth/Throat:

Delsym Cough Relief: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea [DSC]) [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow)]

Delsym Cough Relief: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea [DSC]) [sugar free; contains fd&c red #40]

Delsym Cough+ Soothing Action: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea [DSC]) [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow)]

Delsym Cough+ Soothing Action: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea [DSC]) [sugar free; contains fd&c red #40]

Brand Names: U.S.

  • Delsym Cough Relief [OTC] [DSC]
  • Delsym Cough+ Soothing Action [OTC] [DSC]

Pharmacologic Category

  • Antitussive
  • Local Anesthetic

Pharmacology

Dextromethorphan: 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

Menthol: Local anesthetic and counterirritant to relieve minor sore throat irritation

Use: Labeled Indications

Cough suppressant/sore throat: Temporary relief of sore throat, sore mouth, minor throat irritation, and cough due to minor throat and bronchial irritation as may occur with the common cold.

Contraindications

OTC labeling: When used for self-medication, do not use if you are taking a MAO inhibitor or within 2 weeks after stopping a MAO inhibitor; do not use in children <6 years of age

Dosing: Adult

Cough suppressant/sore throat: Oral: A total of 2 lozenges (dextromethorphan 5 mg/menthol 5 mg per lozenge) dissolved in mouth, 1 immediately after the other. May repeat every 4 hours; maximum: 12 lozenges (dextromethorphan 60 mg/menthol 60 mg) daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Cough suppressant/sore throat: Oral:

Children <6 years: Not for OTC use.

Children 6 to <12 years: One lozenge (dextromethorphan 5 mg/menthol 5 mg per lozenge) dissolved in mouth. May repeat every 4 hours; maximum: 6 lozenges (dextromethorphan 30 mg/menthol 30 mg) daily

Children ≥12 years and Adolescents: Refer to adult dosing.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Administration

Allow lozenge to dissolve slowly in the mouth.

Storage

Store between 20°C to 25°C (68°F to 77°F).

Drug Interactions

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

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

CYP2D6 Inhibitors (Moderate): May increase the serum concentration of Dextromethorphan. Exceptions: DULoxetine. Monitor therapy

CYP2D6 Inhibitors (Strong): May increase the serum concentration of Dextromethorphan. Monitor therapy

Disulfiram: May enhance the adverse/toxic effect of Products Containing Ethanol. Management: Do not use disulfiram with dosage forms that contain ethanol. Avoid combination

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

Memantine: NMDA Receptor Antagonists may enhance the adverse/toxic effect of Memantine. 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. Avoid combination

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

Parecoxib: May increase the serum concentration of Dextromethorphan. 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). 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). 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. Monitor therapy

Adverse Reactions

See Dextromethorphan monograph.

Warnings/Precautions

Other warnings/precautions:

• Self-medication (OTC use): When used for self-medication (OTC) contact health care provider prior to use if you have a persistent or chronic cough associated with asthma, emphysema or smoking, or if you have cough with excess phlegm; notify healthcare provider if symptoms do not improve within 7 days, irritation, pain or redness persist/worsen, swelling develops, or cough is accompanied by fever, rash or persistent headache.

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).

Pregnancy Considerations

Refer to individual monographs.

Patient Education

What is this drug used for?

• It is used to relieve coughing.

• It is used to treat a sore throat, sore mouth, or mouth irritation.

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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.