Dextromethorphan or DXM is a drug found in some common cold and cough medicines like:
- Vicks® DayQuil™ and NyQuil™
- Robitussin®
- TYLENOL® Cold + Cough
- Alka-Seltzer Plus®
- SUDAFED®
Dextromethorphan doesn’t cure colds or flus, but it can provide relief by binding to the part of the brain that controls the lungs and their coughing reflex. This temporary relieves some bothersome cold and flu symptoms. Taken in large doses, dextromethorphan side effects can mimic those of some illegal drugs, which is why it’s sometimes used recreationally to achieve a DXM high.
DXM Abuse
In medicine, dextromethorphan got the reputation as the lesser of the evils compared to codeine, which was the typical ingredient in flu, cold, and cough medications before DXM came along. Codeine is a mild opioid and can be very addictive. DXM was first approved by the U.S. Food and Drug Administration (FDA) in 1958. Reports of DXM abuse began soon after. By 1975, dextromethorphan abuse was reported as a serious problem. Data suggests that dextromethorphan abuse peaked among teens and young adults around 2006, with 34,755 single-substance exposures. Since then, restrictions have been put in place to reduce the risk of young people abusing DXM. Even so, abuse of dextromethorphan is still prevalent in the U.S. because DXM medications are available over the counter, while any medication with codeine requires a prescription.
It’s difficult to determine how many people abuse DXM. There’s no way to know who’s buying DXM medications to abuse it and who’s purchasing it for cold and flu relief. DXM is in the same family as several dissociative anesthetics, like ketamine and PCP. That means DXM can cause hallucinations and sensory changes at high doses, along with other psychedelic effects. These are the types of effects associated with dextromethorphan that people who abuse it are seeking.
Why Is DXM Abused?
Some people seeking psychedelic, hallucinatory, or dissociative effects, take DXM drugs because they are easy to find and inexpensive.
DXM is sold over the counter without a prescription as:
- Chewable tablets
- Dissolving syrups
- Liquid solutions
- Gel capsules
- Extended-release capsules
- Lozenges
It lasts between 4 and 12 hours, depending on how much of the substance is in the medication.
Normal doses of DXM medications depend on your condition and doctor recommendations. For an average adult, DXM dosage is typically between 15 mg and 30 mg three or four times a day as needed for a cough. By comparison, people who abuse dextromethorphan take between 250 mg and 1500 mg in one dose. People who are addicted to DXM have been known to consume as many as 3 or 4 bottles of cough syrup per day.
Dextromethorphan Side Effects
When DXM became a popular substance of abuse in the mid-2000s, few local or state governments banned it. The federal government only released label requirements that made usage and safe doses clear. Some states passed age limits on who could buy medications containing DXM, while other states imposed limits on how many DXM-containing medications you could buy at once.
When taken as recommended, DXM drugs may cause some mild side effects:
- Dizziness or drowsiness
- Lightheadedness
- Nervousness
- Restlessness
- Nausea
- Vomiting
- Gastrointestinal issues
When you take dextromethorphan in large quantities it can come with uncomfortable, dangerous, and serious side effects like:
- Trouble breathing
- Blackouts
- Vision issues
- Constipation or diarrhea
- Vomiting
- Hallucinations
- Rashes
- Drowsiness
- Agitation
- Nervousness
Studies show people who abuse DXM may also have problems with short and long-term memory, attention, and confusing thoughts after taking this medication in high doses. The dangers of dextromethorphan abuse increase when you take it with prescription drugs, alcohol, marijuana, or illegal drugs.
What Are DXM Plateaus?
People who abuse dextromethorphan report dose-dependent plateaus. This means they take different amounts of the drug to achieve the desired “high.” Large doses can cause dextromethorphan side effects, like emotional dissociation, hallucinations, or euphoria.
There are four major DXM plateaus reported in dextromethorphan abuse:
Plateau 1: 100 mg to 200 mg of DXM can lead to euphoria and restlessness.
Plateau 2: 200 mg to 500 mg of DXM can bring about exaggerated auditory or visual sensations, psychedelic effects, feeling dizzy or imbalanced, and closed-eye hallucinations.
Plateau 3: 500 mg to 1,000 mg can cause visual and auditory hallucinations or disturbances, altered consciousness, delayed reaction times, mania, panic and paranoia, and partial dissociation from reality.
Plateau 4: Over 1000 mg, DXM effects can lead to psychotic symptoms, complete dissociation, and impaired balance and physical coordination.
Long-Term Effects of DXM
When you frequently abuse DXM, it can lead to symptoms like:
- Insomnia
- Mood swings
- Depression
- Anxiety
- Muscle pain and weakness
- Weakened bones
Long-term, high-dose DXM abuse may lead to toxic psychosis, which is when you lose touch with reality and may have hallucinations and act erratically.
Physical dependence on any drug can cause withdrawal symptoms if you try to quit cold-turkey. That’s why it’s important to quit substances with the help of medical professionals who can ease withdrawal symptoms.
Withdrawal symptoms of dextromethorphan include:
- Anxiety
- Restlessness
- Insomnia
- Diarrhea
- Vomiting
- Gastrointestinal distress
- Bone and muscle aches
Signs of Overdose
Overdosing on dextromethorphan is a real risk among those who abuse the drug, especially if they mix and match over-the-counter drugs. Dextromethorphan overdose symptoms include:
- Nausea, vomiting, and gastrointestinal distress
- Drowsiness and trouble staying awake
- Dizziness and unsteadiness
- Changes in vision, like blurry sight
- Difficulty breathing or suppressed or irregular breathing
- Stopped breathing
- Muscle twinges
- High body temperature
- Very high or very low blood pressure
- Rapid heartbeat
- Hallucinations
- Seizures
Overdosing on drugs like dextromethorphan is serious and can lead to death. Call 911 immediately if you suspect someone is overdosing on DXM.
Self-Assessment: Am I Addicted?
You Can Recover from DXM Abuse
The Drug Enforcement Administration (DEA) lists dextromethorphan as a “drug of concern.” That means even though it’s not a controlled substance, there are risks associated with abuse. While it’s generally thought to be psychologically addictive, some case studies also suggest it’s possible to develop a physical dependence on DXM.
Any substance that you continue abusing despite negative effects qualifies as an addiction. It’s important to address the underlying issues causing you to misuse drugs in order to get better. Some people benefit from medical detox from DXM, especially if they’re abusing other substances. Drug and alcohol detox can be painful and dangerous. Medical professionals can help ease withdrawal symptoms and keep you safe and as comfortable as possible.
Detox is the first step in recovery. Addiction treatment is the second one. Co-occurring mental health issues, trauma, and relationship problems are some of the struggles that lead to substance abuse. An inpatient or outpatient treatment program provides a blend of therapies that will help you address these issues and learn healthy coping skills. With the help of behavioral health professionals and peers in recovery, you can find your way to a better life.
If you or a loved one are struggling with addiction, we can help. Call Footprints to Recovery for a free, confidential phone consultation.
- https://www.researchgate.net/publication/256461074_Design_of_Taste_Masked_Dextromethorphan_Through_Incorporation_Into_Shellac-Based_Matrix
- https://www.consumerreports.org/drug-safety/dangers-of-teens-abusing-cough-meds-with-dextromethorphan/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918034/
- https://www.dea.gov/sites/default/files/2020-06/DXM-2020.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925345/
- https://www.jabfm.org/content/19/3/320.full
- https://www.drugs.com/monograph/dexamethasone-systemic.html#cautions
- https://medlineplus.gov/ency/article/002628.htm
- https://www.mayoclinic.org/drugs-supplements/dextromethorphan-oral-route/side-effects/drg-20068661
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