Based on data from a comprehensive surveillance program of OTC cough/cold medicine, no deaths were reported in children aged <12 years after ingestion of  single-ingredient dextromethorphan product. The findings were published in the journal Clinical Toxicology. 

Dextromethorphan, the most common over-the-counter (OTC) antitussive, is indicated for nonproductive cough. A team of researchers aimed to characterize adverse events linked to dextromethorphan in children from a surveillance program of OTC cough and cold treatment exposures. 

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The review included oral exposures to dextromethorphan with at least one adverse event from multiple U.S. sources, including the National Poison Data System, FDA Adverse Event Reporting System, manufacturer safety reports, news/media, and medical literature between 2008–2014. The relationship between exposure and adverse events was established, as well as estimated ingested dose, intent of exposure, and contributing factors to exposure.

A total of 1,716 cases included at least one adverse event considered potentially related to dextromethorphan, of which 1,417 were single-drug exposures. About half of these cases (55%) involved dextromethorphan-only products. Of the dextromethorphan-only cases, 78% followed an overdose and 3% followed a therapeutic dose ingestion. Unsupervised ingestion was seen in 69% of cases of which 60% happened in children aged <4 years old.

Overall, no fatalities or pathologic dysrhythmias occurred. The most common adverse events were central nervous system (CNS) symptoms (n=420) and autonomic symptoms (n=224). The study authors added adverse events were mostly associated with overdose. 

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