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Dextromethorphan, or DXM, is a cough suppressant found in many over-the-counter (OTC) cough, cold, and allergy preparations. These preparations come in a variety of forms, most commonly gelcaps or syrups. DXM is centrally acting, which means it works directly on the brain to stop coughs. When used according to package directions or as directed by a health care provider, dextromethorphan is a safe medication with few side effects. When taken at doses exceeding medical recommendation, however, DXM has powerful, mind-altering properties and a host of potentially dangerous side effects.

Recreational users describe DXM "trips" in terms of plateaus of experience that vary with dosage. Generally speaking, lower doses (but still higher than therapeutic doses) cause a mildly euphoric and stimulating effect similar to that of ecstasy. At even higher doses, the drug's "stoning" effect increases and hallucinations may occur. The highest plateaus are characterized by elaborate hallucinations and out-of-body experiences similar to those caused by the drug ketamine. During such out-of-body experiences, users perceive a complete disconnection from their body and surroundings, with no awareness of what they are doing (or having done to them).

Although DXM has a long history of recreational use and is easily obtainable, DXM abuse poses a significant health risk. Some unpleasant and potentially dangerous side effects of high doses of DXM include:

• confusion and/or impaired judgment
• blurred vision and/or slurred speech
• rigid muscle tone or involuntary muscle movement
• headache
• nausea
• vomiting
• numb fingers or toes
• dry mouth
• itchy skin
• irregular heartbeat
• high blood pressure
• decreased ability to regulate body temperature, which can lead to heat stroke
• slowed breathing
• loss of consciousness

These effects are all temporary and anecdotal evidence suggests that using DXM once or a few times has no permanent side effects.

However, also important to keep in mind is that many DXM-containing products also contain other drugs, some of which are unhealthy or even dangerous if taken in large amounts. Especially dangerous is the cold preparation Coricidin, which combines DXM and chlorpheniramine maleate. Taken at mind-altering doses, these two drugs can be fatal. For more on this aspect of DXM use, see Cold pill coma (DXM).

Adding more drugs to the mix further complicates matters. Little research exists on the interaction between recreational doses of DXM and other drugs, but negative interactions have been reported to occur with ecstasy, non-drowsy antihistamines, nicotine, some diet drugs such as phentermine, alcohol, and some prescription anti-depressants. One class of antidepressants, called MAOIs (monoamine oxidase inhibitors), is particularly dangerous, and sometimes fatal, when taken with DXM (in any amount, therapeutic or recreational). If you're taking an anti-depressant and aren't sure if it's a MAOI, check with your health care provider before using DXM-containing products for any reason.

As for the effects of long-term DXM use, the jury is still out, but the word so far isn't good. Anecdotal reports and limited clinical evidence suggest that DXM has addictive properties (including cravings and a "come-down" after the high wears off), and that extensive and prolonged abuse may cause learning and memory impairment.

The bottom line is that if you're looking to get your party on, you might want to look elsewhere — the risks of dextromethorphan are nothing to cough at.

You can also read more about dextromethorphan and other drugs on:

Medline Plus: A service of the National Library of Medicine of the NIH

Do It Now Foundation web site

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