Monitor for dextromethorphan-related side effects, such as drowsiness, nausea or vomiting, sweating, restlessness, or tremor. If dextromethorphan- related side effects occur, a dose reduction or discontinuation of dextromethorphan may be necessary. The AUC for dextrorphan, the active metabolite of dextromethorphan, increased approximately 1.
Acetaminophen; Codeine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose adjustment. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Alfentanil: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering alfentanil with dextromethorphan.
Amiodarone: Moderate Use of dextromethorphan with amiodarone may result in increased and prolonged dextromethorphan exposure. Due to the extremely long half-life of amiodarone, a drug interaction is possible for days to weeks after discontinuation of amiodarone. Amlodipine; Celecoxib: Moderate Use of dextromethorphan with celecoxib may result in increased dextromethorphan exposure.
Artemether; Lumefantrine: Moderate Use of dextromethorphan with lumefantrine may result in increased dextromethorphan exposure. Aspirin, ASA; Butalbital; Caffeine; Codeine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan.
Aspirin, ASA; Carisoprodol; Codeine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan. Atazanavir; Cobicistat: Moderate Use of dextromethorphan with cobicistat may result in increased dextromethorphan exposure. Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Major Because of the potential risk and severity of serotonin syndrome, coadministration of dextromethorphan and IV methylene blue should be avoided if possible.
Methylene blue has been demonstrated to be a potent monoamine oxidase inhibitor MAOI and may cause potentially fatal serotonin toxicity serotonin syndrome when combined with serotonin reuptake inhibitors SRIs. Dextromethorphan increases central serotonin effects. Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Major Because of the potential risk and severity of serotonin syndrome, coadministration of dextromethorphan and IV methylene blue should be avoided if possible.
Buprenorphine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering buprenorphine with dextromethorphan. Buprenorphine; Naloxone: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering buprenorphine with dextromethorphan.
Butalbital; Acetaminophen; Caffeine; Codeine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan. Celecoxib: Moderate Use of dextromethorphan with celecoxib may result in increased dextromethorphan exposure. Chlorpheniramine; Codeine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan. Cinacalcet: Moderate Use of dextromethorphan with cinacalcet may result in increased dextromethorphan exposure.
Citalopram: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with citalopram. Clobazam: Moderate Use of dextromethorphan with clobazam may result in increased dextromethorphan exposure. A dosage reduction of dextromethorphan may be necessary for some patients. Cobicistat: Moderate Use of dextromethorphan with cobicistat may result in increased dextromethorphan exposure.
Codeine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan. Codeine; Guaifenesin: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan.
Codeine; Guaifenesin; Pseudoephedrine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan.
Codeine; Phenylephrine; Promethazine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan. Codeine; Promethazine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering codeine with dextromethorphan.
Dacomitinib: Moderate Use of dextromethorphan with dacomitinib results in increased dextromethorphan exposure. The Cmax and AUC of dextromethorphan were increased by approximately fold when coadminstered with a single dose of dacomitinib. Darifenacin: Minor Use of dextromethorphan with darifenacin may result in increased dextromethorphan exposure. Darunavir; Cobicistat: Moderate Use of dextromethorphan with cobicistat may result in increased dextromethorphan exposure.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Use of dextromethorphan with cobicistat may result in increased dextromethorphan exposure. Delavirdine: Moderate Use of dextromethorphan with delavirdine may result in increased dextromethorphan exposure. Desvenlafaxine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with desvenlafaxine.
It may be prudent to avoid coadministration of dextromethorphan with memantine. If coadministration cannot be avoided, monitor for increased adverse effects such as agitation, dizziness and other CNS events. Dronedarone: Moderate Use of dextromethorphan with dronedarone may result in increased dextromethorphan exposure. Duloxetine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with duloxetine.
Eliglustat: Moderate Use of dextromethorphan with eliglustat may result in increased dextromethorphan exposure. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Use of dextromethorphan with cobicistat may result in increased dextromethorphan exposure. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Use of dextromethorphan with cobicistat may result in increased dextromethorphan exposure.
Escitalopram: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with escitalopram. Fedratinib: Moderate Use of dextromethorphan with fedratinib may result in increased dextromethorphan exposure. Fenfluramine: Moderate Use fenfluramine and dextromethorphan with caution due to an increased risk of serotonin syndrome. Monitor patients for the emergence of serotonin syndrome.
Fentanyl: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering fentanyl with dextromethorphan. Fluoxetine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with fluoxetine. In addition, fluoxetine may inhibit CYP2D6-mediated metabolism of dextromethorphan, increasing systemic dextromethorphan exposure. Increased dextromethorphan concentrations may result in adverse effects consistent with the serotonin syndrome.
Fluvoxamine: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with fluvoxamine. Givosiran: Moderate If possible, avoid concomitant use of dextromethorphan with givosiran due to the risk of increased dextromethorphan-related adverse reactions.
If use is necessary, consider decreasing the dextromethorphan dose. Dextromethorphan is a sensitive CYP2D6 substrate. Givosiran may moderately reduce hepatic CYP2D6 enzyme activity because of its pharmacological effects on the hepatic heme biosynthesis pathway. Grapefruit juice: Minor Intake of grapefruit juice or seville orange juice increased dextromethorphan bioavailability in one study. Patients with increased concentrations of dextromethorphan may experience drowsiness or serotonergic side effects dizziness, nervousness or restlessness, nausea, vomiting, stomach upset not usually noted with prescribed or nonprescription product doses.
Grapefruit juice and seville orange juice contain compounds that can inhibit P-glycoprotein in the intestinal wall, and dextromethorphan absorption may be affected by P-glycoprotein activity.
Dextromethorphan is largely metabolized by CYP2D6, so this particular interaction with grapefruit juice may be more relevant in patients who are poor CYP2D6 metabolizers. Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: Major Because of the potential risk and severity of serotonin syndrome, coadministration of dextromethorphan and IV methylene blue should be avoided if possible.
Imatinib: Moderate Use of dextromethorphan with imatinib may result in increased dextromethorphan exposure. Isocarboxazid: Contraindicated Dextromethorphan products are contraindicated in patients taking a monoamine oxidase inhibitor MAOI or in patients who have taken an MAOI within the last 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome.
A washout period of at least 14 days should elapse between the start of dextromethorphan after discontinuation of an MAOI. Patients should read nonprescription product labels carefully.
Before initiating an MAOI after using other serotonergic agents, a sufficient amount of time must be allowed for clearance of the serotoninergic agent and its active metabolites. Lasmiditan: Moderate Serotonin syndrome may occur during coadministration of lasmiditan and dextromethorphan. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome, particularly after a dose increase or the addition of other serotonergic medications to an existing regimen.
Discontinue all serotonergic agents if serotonin syndrome occurs and implement appropriate medical management. Levomilnacipran: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with levomilnacipran.
Dextromethorphan has serotonergic activity. Linezolid: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering linezolid with dextromethorphan. Linezolid is an antibiotic that is also a reversible, non-selective MAO inhibitor and has potential to interact with serotonergic agents.
However, the potential for interaction has been studied. Subjects were administered dextromethorphan two mg doses given 4 hours apart with or without linezolid. No serotonin syndrome effects confusion, delirium, restlessness, tremors, blushing, diaphoresis, hyperpyrexia have been observed in normal subjects receiving linezolid and dextromethorphan.
Lorcaserin: Moderate Because of the potential risk and severity of serotonin syndrome, caution should be observed when administering dextromethorphan with lorcaserin. Try our raspberry-flavored daytime formula to control and relieve frequent coughs, plus thin and loosen mucus to send that cold packing. All rights reserved. Trade marks are owned by or licensed to the GSK group of companies.
The content of this site is intended for US audiences only. OK Cancel. Get Coupon. Where to Buy. Sign Up. Dolansky G, Rieder M. What is the evidence for the safety and efficacy of over-the-counter cough and cold preparations for children younger than six years of age? Paediatr Child Health. Bem JL, Peck R. Dextromethorphan An Overview of Safety Issues. Drug Safety. Your Privacy Rights.
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