Dextromethorphan is a substance with cough-suppressing capabilities that is found in some cough syrups and cold medicines. Sometimes dextromethorphan is used as an adulterant in illegal drugs, particularly with methylenedioxymethamphetamine (MDMA/ecstasy).

Dextromethorphan is available to be taken orally in lozenges, tablets, capsules, and cough syrups. Medications that include this drug should not be taken by individuals who are also taking monoamine oxide inhibitors (MAOIs) or antidepressants that are selective serotonin reuptake inhibitors (SSRIs). The combination could induce serotonin syndrome, which is characterized by cardiac arrhythmia, hypertension, and fever. It should also be noted that dextromethorphan increases the action of antihistamines, antipsychotics, and alcohol, and the combination should be avoided whenever possible.

At normal recommended doses, dextromethorphan does not affect the central nervous system, and few people experience any adverse effects, although some may experience a slight drowsiness or nausea. With the higher doses of drugs used "recreationally" by abusers, however, dextromethorphan is a central nervous system depressant, and it may induce euphoria, heightened mood, and increased perceptual awareness.

Abusive dosages may also cause visual and auditory hallucinations, altered time perception, confusion, and decreased sexual performance. In the worst case, dextromethorphan abuse may cause brain damage and even death.

Some pharmacies will not sell drugs with dextromethorphan to minors because they are concerned about possible abuse.

Often dextromethorphan is sold with cold remedies that include other substances that can be dangerous when large dosages are ingested but are safe at the indicated dosage. For example, if the preparation includes both dextromethorphan and guaifenesin, this combination at high dosages can cause extreme nausea and vomiting. In addition, a high dosage of the combination of dextromethorphan and chlorpheniramine can cause seizures and loss of consciousness.

 With regular use of abusively high levels of dextromethorphan, the individual may develop a mild psychological dependence to the drug. If the usage abruptly ceases, the individual may experience depression and insomnia.

References:

National Highway Traffic Safety Administration. Drugs and Human Performance Fact Sheets. Washington, D.C.: National Highway Traffic Safety Administration, 2004.

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