The concurrent quantification of this 4 factors mixed tablet using HPLC resulted in the establish of a quantifying procedure with high precision (0,87- 1,91%) good accuracy (get backing to 98,8%- 99,5%). Lineal degree was investigated in a large range of concentration and could be applied on diverse mixed tablet samples containing 2-4 active substances of various formulations. The technique gave sombrous advantages, simple, quick, saving the solvant
Dextromethorphan ; Chlorpheniramine ; Phenylpropanolamine

An HPLC method for simultaneous determination of Dextromethorphan hydrobromide, Clorpheniramine maleate, Guaiphenesin, and Phenylpropanolamine hydrochloride in tablets, capsules or in syrups is introduced. The chromatographic conditions are as follows: Column: Lichrosorb Si 60(250X 4 mm; 5mm); Mobile phase: Water: 0.001 M Ammonium Perchlorate methanolic solution pH6.7:20:80; Flow rate: 0.8 ml/min; UV- Detector at 254 nm. Experimental results showed that the method is accurate (er = 0.69 - 3.19%; recoveries: 98.7-101.9%).
Pharmaceutical Preparations ; Dextromethorphan ; Chlorpheniramine ; Analgesics, Non-Narcotic ; Analgesics

Antitussive Agents ; poisoning ; Child, Preschool ; Dextromethorphan ; poisoning ; Humans ; Male

Lung cancer is the leading cause of cancer death worldwide. It may present as airway obstruction in a patient with endobronchial masses. Endobronchial brachytherapy (EBBT) has been shown to provide palliative therapy. It is the insertion of a radioactive material near the mass to reduce tumor size, thereby improving airway obstruction. This is the first case of EBBT done in our institution during the COVID-19 pandemic. A 53-year-old male, 60 kg, ASA Physical Status 2 for hypertension, smoker, malignancy, and previous pulmonary tuberculosis patient, presented with a cough and dyspnea. An endobronchial mass almost obstructing the right mainstem bronchus was seen on a computed tomography (CT) scan. He was diagnosed with squamous cell carcinoma of the lung and underwent radiotherapy and erlotinib chemotherapy. On repeat CT scan, there was no noted decrease in the size of the mass. EBBT was suggested, and a multi-disciplinary team was formed for the planned procedure. Pulmonology, radiation oncology, and anesthesiology teams were identified, and thorough planning was done prior to the actual procedure. Three fractions of EBBT were done under sedation using midazolam, fentanyl, and dexmedetomidine infusion. Lidocaine spray and transtracheal block were also performed as adjuncts prior to sedation. The procedure went as planned, and points for improvement were discussed for subsequent fractions. Due to persistent cough and discomfort from the catheter, additional ipratropium nebulization for minimization of secretions, and oral dextromethorphan for cough suppression were incorporated. After each fraction, the patient was monitored post-procedure for any side effects both from the radiotherapy and anesthetic technique. Qualitative reduction in mass size was noted in subsequent fractions. The patient was able to complete 3 fractions and was advised to follow-up after a month. EBBT is an emerging palliative and treatment modality for lung cancer, especially for intraluminal masses. Anesthetic considerations will depend on each case’s characteristics such as airway anatomy, patient comfort and capacity, and procedural requirements. Conscious sedation with topical anesthesia is an adequate and appropriate anesthetic option, especially in cases where severe airway obstruction may compromise ventilation if airway reflexes are blunted. A multidisciplinary approach with different services and stakeholders is important for the proper planning, execution, and management of such patients.
Lung Neoplasms ; Conscious Sedation ; Dexmedetomidine ; Midazolam ; Fentanyl ; Lidocaine ; Dextromethorphan

This study focused on the role of cytochrome P450 2D6 (CYP2D6) genotypes to predict phenotypes in the metabolism of dextromethorphan. CYP2D6 genotypes and metabolic ratios (MRs) of dextromethorphan were determined in 201 Koreans. Unsupervised clustering algorithms, hierarchical and k-means clustering analysis, and color visualizations of CYP2D6 activity were performed on a subset of 130 subjects. A total of 23 different genotypes were identified, five of which were observed in one subject. Phenotype classifications were based on the means, medians, and standard deviations of the log MR values for each genotype. Color visualization was used to display the mean and median of each genotype as different color intensities. Cutoff values were determined using receiver operating characteristic curves from the k-means analysis, and the data were validated in the remaining subset of 71 subjects. Using the two highest silhouette values, the selected numbers of clusters were three (the best) and four. The findings from the two clustering algorithms were similar to those of other studies, classifying *5/*5 as a lowest activity group and genotypes containing duplicated alleles (i.e., CYP2D6*1/*2N) as a highest activity group. The validation of the k-means clustering results with data from the 71 subjects revealed relatively high concordance rates: 92.8% and 73.9% in three and four clusters, respectively. Additionally, color visualization allowed for rapid interpretation of results. Although the clustering approach to predict CYP2D6 phenotype from CYP2D6 genotype is not fully complete, it provides general information about the genotype to phenotype relationship, including rare genotypes with only one subject.
Alleles ; Classification ; Cluster Analysis* ; Cytochrome P-450 CYP2D6* ; Dextromethorphan ; Genotype ; Metabolism ; Phenotype* ; ROC Curve

Backgound: The effect of dextromethorphan, an N-methyl d-aspartate (NMDA) antagonist, on the analgesic consumption and pain scoring after abdominal gynecologic surgery was studied. Methods: In this double-blind study, 60 patients were randomized into 2 groups. The study group was given oral dextromethorphan 25 mg 8 hours before the scheduled operation and one hour before the operation. Patients in the control group were given placebo capsules at the same intervals. Both groups of patients were given diclofenac sodium 75 mg i.m. prior to transfer to the post anesthesia care unit, and every twelve hours thereafter for a total of three doses. The study group was given dextromethorphan eight hours after the last dose prior to operation and every eight hours thereafter for the next 24 hours. The control group received placebo capsules at the same intervals. Visual analog pain scores were recorded preoperatively and at 4,8,12 and 24 hours postoperatively with the patient supine and coughing. Results: The mean VAS scores for the two groups, during rest and coughing, at 4 hours of observation, showed no significant difference. However, at 8 hours until 24 hours of observation, a significant difference was noted. Results of this study show that administration of dextromethorphan 25 mg orally preoperatively and postoperatively provides an adjuvant analgesic effect, as evidenced by lesser opioid requirements and lower resting and coughing VAS pain scores postoperatively. Conclusion: These results imply that the development of central hyperalgesia in the spinal cord induced by nociceptive stimulation of surgery was either blocked or modulated by dextromethorphan acting on NMDA receptors. The nonsedating property and lack of adverse side effects of dextromethorphan make it a promising alternative analgesic to other commonly used drugs.
Human ; Female ; Aged ; Middle Aged ; Adult ; HYPERALGESIA ; DEXTROMETHORPHAN ; GYNECOLOGIC SURGICAL PROCEDURES ; PAIN, POSTOPERATIVE

In the present study, we investigated whether ambroxol, S-carboxymethyl-L-cysteine, dextromethorphan and noscapine affect mucin release from airway goblet cells. Confluent primary hamster tracheal surface epithelial cells were metabolically radiolabeled and chased for 30 min in the presence of varying concentrations of the above agents to assess the effects on 3H-mucin release. Noscapine stimulated mucin release during 30 min of treatment period in a dose-dependent manner. However, ambroxol, S-carboxymethyl-L-cysteine and dextromethorphan showed no significant effect on mucin release during 30 min of treatment period. We conclude that noscapine can affect mucin release by acting on airway mucin-secreting cells.
Ambroxol* ; Animals ; Carbocysteine* ; Cricetinae ; Dextromethorphan* ; Epithelial Cells ; Goblet Cells* ; Mucins* ; Noscapine*

Nuedexta (dextromethorphan and quinidine) is an Food and Drug Administration approved medication for pseudobulbar affect. Interestingly, this drug was recently reported to improve speech, swallowing, and the ability to handle oral secretions along with emotional lability in amyotrophic lateral sclerosis (ALS) patients with bulbar symptoms. We report a Korean ALS patient whose bulbar function improved after administering Nuedexta for 6 months, extending therapeutic choice of approach in treating ALS patients.
Amyotrophic Lateral Sclerosis ; Deglutition ; Dextromethorphan ; Humans ; Quinidine ; United States Food and Drug Administration

The authors report a case of dexfromethorphan induced mood disorder with the review of literafures. The patient is a 19-year old female who had been taking dextromethorphan hydrobromide (trade name : romilar) for 14 month s to enjoy its pleasurable effects and to reduce anxiely. Acute intoxication symptoms of dextromethorphan hydrobromide were silly smiles, a euphoric feeling of floating and an optimistic mood. Tolerance developed and she had been taking 70 tablets (1050mg) ot maximum per day. Withdrawal symptoms were anxiely and its related symptoms and a craving for the drug. While taking 50 tagblets per day about 12 days prior to admission, she had developed leated and irritable mood. grandicstily and auditory hallucinations. These symptoms continued despite discontinuation of the drug after admission. the degree of elated and irritable patient's mood was prominent. flight of ideas was not so severe. However, there was prominent grandiosity and auditory hallucinations. She was treated with haloperidol and lithium and then showed gradual remission in 3weeks. If would necessary to explore any drug abuse history in psychiatric patients who are in their teens.
Adolescent ; Dextromethorphan* ; Female ; Hallucinations ; Haloperidol ; Humans ; Irritable Mood ; Lithium ; Mood Disorders* ; Substance Withdrawal Syndrome ; Substance-Related Disorders ; Tablets ; Young Adult

BACKGROUND AND OBJECTIVES: Peripheral tissue or nerve injury often leads to post-injury pain hypersensitivity caused by peripheral and central sensitization. Central sensitization which plays a significant role is triggered by nociceptive afferent inputs and mainly results from N-methyl-D-aspartic acid (NMDA) receptor activation. If the afferent impulses are prevented from gaining access to the CNS or if NMDA receptor is blocked by antagonist, central sensitization will not develop and then less pain will result. Previous studies demonstrated that preoperative infiltration of local anesthetics or oral NMDA receptor antagonist could alleviate postoperative pain. We investigated the effects of peritonsillar infiltration with bupivacaine and oral dextromethorphan on post-tonsillectomy pain. MATERIALS AND METHODS: Forty consecutive patients were randomly allocated to one of four groups. Group I was bupivacaine-treated group, and group II was dextromethorphan-treated group. Group III was both bupivacaine and dextromethorphan-treated group, and group IV was control group. Pain scores were assessed using self-rating numeric rating scale ( NRS) at rest and on swallowing during the postoperative day 0, 1, 2, and 7. Doses of supplementary diclofenac administered postoperatively were also recorded. RESULTS: Group I, II, and III showed significantly lower NRS pain scores compared with control group at rest and on swallowing throughout the postoperative 7 days. Diclofenac doses were not statistically different among the four groups. CONCLUSION: Preoperative peritonsillar infiltration with bupivacaine and/or medication with dextromethorphan contributed to decrease the intensity of postoperative pain after tonsillectomy.
Anesthetics, Local ; Bupivacaine* ; Central Nervous System Sensitization ; Deglutition ; Dextromethorphan* ; Diclofenac ; Humans ; Hypersensitivity ; N-Methylaspartate ; Pain, Postoperative ; Tonsillectomy