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• DEXTROMETHORPHAN

Indication: Adjunct to smoking cessation in combination with motivational support.

Cautions: Elderly; hepatic impairment (Appendix 2, avoid in severe hepatic cirrhosis), renal impairment (Appendix 3); predisposition to seizures; measure blood pressure before and during treatment (monitor weekly if used with nicotine products);

Interaction: Appendix 1 (bupropion).

Contra-Indication: History of seizures, of eating disorders and of bipolar disorders, pregnancy (Appendix 5).

Side-Effect: Dry mouth, gastro-intestinal dstubaces, insomnia, tremor, impaired concentration, headache, dizziness, depression, agitation, anxiety, rash, pruritus, sweating, hypersensitivity reactions (may resemble serum sickness), fever, taste disturbances; less commonly chest pain, asthenia, tachycardia, hypertension, flushing, anorexia, tinntus, visual disturbances; rarely postural hypotension, hallucinations, depersonalization, seizures, stevens-johnson syndrome, jaundice, hepatitis, blood-glucose disturbances, exacerbation of psoriasis.

DOSE: Start 1-2 weeks before target stop date, initially 150 mg daily for 6 days then 150 mg twice daily (max. single dose 150 mg, max. daily dose 300 mg); max. period of treatment 7-9 weeks; discontinue if abstinence not achieved at 7 weeks; consider 150 mg daily throughout treatment in patients with risk factors for seizures; ELDERLY max.150 mg daily; CHILD and ADOLESCENT under 18 years not recommended.