KAFOSED SYRUP 100ML

Indications

Approved Uses

Symptomatic (temporary) relief of non-productive (dry) cough due to minor throat/bronchial irritation (e.g., common cold).

Off-Label Uses

Pseudobulbar affect only in combination with quinidine (dextromethorphan/quinidine); dextromethorphan alone is not a standard off-label therapy for neuropathic pain.

Dosage & Administration

Dosing by Condition

Dry cough (immediate-release dextromethorphan): Adults/≥12 years: 10-20 mg every 4 hours or 30 mg every 6-8 hours (max 120 mg/day). Children 6-11 years: 5-10 mg every 4 hours or 15 mg every 6-8 hours (max 60 mg/day).

Initial Dose

10-20 mg (3.3-6.7 ml) every 4 hours in adults

Maintenance Dose

15-30mg every 4-8 hours as needed

Maximum Dose

Not specified for this exact formulation; general adult max for dextromethorphan syrup is typically 120 mg/day (e.g., 20 mg every 4-6 hours, not exceeding 120 mg/24h).

Children's Dosage

Children 6-11 years: 5-10 mg every 4 hours or 15 mg every 6-8 hours (max 60 mg/day). Not recommended under 6 years.

Dose Adjustment Notes

Use caution in hepatic impairment (especially severe); no specific renal adjustment is typically required; avoid/monitor with strong CYP2D6 inhibitors or in CYP2D6 poor metabolizers due to increased exposure.

How to Take

Shake well before use; measure the dose with an oral syringe/medicine cup (not a household spoon); take by mouth and may be taken with or without food.

Side Effects

Common Side Effects

Drowsiness, dizziness, nausea, vomiting, stomach pain, constipation, nervousness.

Side Effect Frequency

Common (≥1% to <10%): drowsiness/somnolence, dizziness, nausea, vomiting, gastrointestinal discomfort (e.g., abdominal pain). Less common/rare: constipation, confusion/hallucinations (especially with overdose), serotonin syndrome with serotonergic drugs, and respiratory depression mainly in overdose or with CNS depressants.

Safety & Warnings

Contraindications

Concomitant use with MAOIs (or within 14 days of stopping an MAOI) and known hypersensitivity to dextromethorphan.

Warnings & Precautions

Do not use with MAOIs or within 14 days; caution with other serotonergic drugs (serotonin syndrome); risk of misuse/abuse at high doses; avoid for chronic cough due to smoking/asthma/emphysema or for productive cough unless evaluated; use caution in hepatic impairment and with CYP2D6 inhibitors/poor metabolizers; avoid combining with CNS depressants (alcohol/sedatives).

Age Restriction

Not recommended for children under 4 years (avoid OTC cough/cold use; if prescribed, only under clinician direction).

Driving Warning

May Cause Drowsiness

Drug Interactions

Drug Interactions

MAOIs (contraindicated); other serotonergic drugs including SSRIs/SNRIs/TCAs, linezolid, methylene blue (serotonin syndrome risk); strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine, bupropion) increase dextromethorphan exposure; CNS depressants (alcohol, benzodiazepines, opioids) increase sedation/respiratory depression risk.

Interaction Severity

MAJOR/Contraindicated: MAOIs (and within 14 days) due to serotonin syndrome risk. MODERATE: other serotonergic drugs (e.g., SSRIs/SNRIs, linezolid, triptans) and strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) increasing serotonin toxicity/adverse effects; CNS depressants/alcohol may increase sedation.

Alcohol Interaction

Avoid

Special Populations

Children

Children 6-11 years: 5-10 mg every 4 hours or 15 mg every 6-8 hours (max 60 mg/day). Not recommended under 6 years.

Elderly

Start at lower end of dosing range; monitor for increased CNS effects including dizziness and sedation

Kidney Impairment

No routine adjustment in mild-moderate renal impairment; use with caution in severe renal impairment.

Liver Impairment

Use with caution in hepatic impairment; consider dose reduction/extended dosing interval in moderate-severe impairment and monitor for CNS toxicity.

Storage & Patient Advice

Missed Dose

If used on a schedule: take when remembered unless close to the next dose; skip the missed dose if near the next dose; do not double. (If used as needed, take only when needed within max daily dose.)

Stopping the Medicine

At therapeutic doses for short-term cough, it can generally be stopped when symptoms resolve; tapering is not usually required. If used in high doses, for prolonged periods, or if misuse/dependence is suspected, do not stop abruptly-seek medical advice and consider gradual dose reduction.

Overdose

Symptoms: nausea/vomiting, dizziness, drowsiness, ataxia, agitation, hallucinations/dissociation, tachycardia/hypertension, seizures, respiratory depression/coma; may cause serotonin syndrome (especially with serotonergic coingestants). Management: urgent medical care, activated charcoal if early, supportive care/airway management, benzodiazepines for seizures/agitation, and naloxone may be tried for significant CNS/respiratory depression.

Patient Counseling

Use for temporary relief of dry cough; shake well and measure with a proper device; do not exceed recommended doses (adults max 120 mg/day); may cause drowsiness/dizziness-avoid alcohol and use caution driving; do not use with MAOIs or within 14 days of stopping; seek medical advice if cough lasts >7 days or is accompanied by fever/rash/persistent headache, or if breathing difficulty occurs; keep out of reach of children.

Monitoring Requirements

No routine monitoring required; monitor for signs of serotonin syndrome if used with serotonergic agents

Pharmacology

Mechanism of Action

Suppresses the cough reflex via central action on the medullary cough center; pharmacologically acts as a sigma-1 receptor agonist and NMDA receptor antagonist (among other actions).

Duration of Effect

Approximately 3-6 hours (immediate-release).

Half-Life

Variable: typically ~2-4 hours in extensive metabolizers; markedly prolonged in CYP2D6 poor metabolizers (commonly ~20-30 hours, with reports up to ~45 hours).

Bioavailability

Low and highly variable due to extensive first-pass metabolism (commonly cited around ~10-20% in extensive metabolizers; higher in CYP2D6 poor metabolizers).

Metabolism

Hepatic metabolism primarily via CYP2D6 (O-demethylation) to active dextrorphan; secondary pathways include CYP3A4 (N-demethylation) and subsequent conjugation.

Excretion

Renal, primarily as metabolites

Product Information

Available Dosage Forms

Syrup (this product).

Composition per Dose

Each 5ml: Dextromethorphan hydrobromide 15mg (equivalent to 3mg/ml)

Generic Availability

Yes

Symptom Target

Cough

Sedating

Yes

Reviewed by Al Mujtama Pharmacy Medical Review Team. Last reviewed 31-07-2026