Adverse events associated with pediatric exposures to dextromethorphan

Area of Science:

• Pediatric Toxicology
• Pharmacovigilance
• Over-the-Counter Medications

Background:

• Dextromethorphan (DXM) is a widely used over-the-counter (OTC) antitussive.
• Understanding DXM's adverse event profile in young children is crucial for public health.
• Previous data on DXM adverse events in children <12 years old is limited.

Purpose of the Study:

• To characterize adverse events associated with dextromethorphan (DXM) exposure in children under 12 years old.
• To analyze data from a surveillance program focused on OTC cough and cold medication exposures.
• To identify risk factors and patterns of DXM-related adverse events in pediatric populations.

Main Methods:

• Retrospective case series analysis of oral dextromethorphan exposures with reported adverse events.
• Data compiled from multiple US surveillance sources (2008-2014).
• Expert panel reviewed cases to determine causality, dose, intent, and contributing factors.

Main Results:

• 1716 cases reported adverse events potentially related to dextromethorphan (DXM).
• Central nervous system (e.g., ataxia) and autonomic symptoms (e.g., tachycardia) were most common.
• No fatalities or pathological dysrhythmias occurred; 78% of single-product exposures were overdoses, often involving unsupervised self-administration in children under 4.

Conclusions:

• Dextromethorphan (DXM) ingestion in children under 12 did not result in any reported fatalities.
• Adverse events were primarily linked to overdose scenarios, affecting the central nervous and autonomic systems.
• Unsupervised self-administration, particularly in very young children, represents a significant risk factor for DXM-related adverse events.