Dextromethorphan

Chemical structure of dextromethorphan

Dextromethorphan from xtal 3D balls A

Dextromethorphan (DXM) is a medication commonly used as a cough suppressant in over-the-counter cold and cough medicines. It is available in various forms, including syrup, tablet, spray, and lozenge. DXM belongs to the morphinan class of medications and exhibits sedative, dissociative, and stimulant properties at lower doses. Unlike typical morphinan compounds, dextromethorphan does not have a significant affinity for the mu-opioid receptor activity and exerts its therapeutic effects through several other receptors. In its pure form, dextromethorphan occurs as a white powder.

Uses

Dextromethorphan is primarily used as a cough suppressant to provide temporary relief from nonproductive coughs caused by various respiratory conditions, such as the common cold, bronchitis, and allergies. It is often combined with other medications, such as decongestants, antihistamines, and analgesics, in multi-symptom cold and cough formulations.

Mechanism of Action

DXM's primary mechanism of action involves its activity as an NMDA receptor antagonist, which helps to suppress the cough reflex. It also interacts with other receptors, such as the sigma-1 receptor and the serotonin transporter. These interactions contribute to the drug's sedative, dissociative, and stimulant effects.

Side Effects and Precautions

Common side effects of dextromethorphan include dizziness, drowsiness, nausea, and vomiting. Some individuals may experience more severe side effects, such as allergic reactions, difficulty breathing, or hallucinations. It is important to follow the recommended dosing instructions and avoid consuming excessive amounts of DXM, as high doses can lead to serious side effects, including respiratory depression, seizures, and death.

Individuals who are taking certain medications, such as monoamine oxidase inhibitors (MAOIs), should avoid using dextromethorphan due to the risk of dangerous drug interactions. Pregnant or breastfeeding women and those with liver or kidney disease should consult with their healthcare provider before using DXM-containing products.

Recreational Use and Abuse

Dextromethorphan has been subject to recreational abuse due to its dissociative and hallucinogenic effects at high doses. This has led to the emergence of a subculture of users who consume DXM recreationally, often referred to as "dexing" or "robotripping." The abuse of DXM can have serious health risks, including addiction, long-term cognitive impairment, and even death. To curb recreational use, some countries and jurisdictions have implemented age restrictions or behind-the-counter policies for the sale of DXM-containing products.

See also

• Cough medicine
• Dissociative
• NMDA receptor antagonist
• Recreational drug use

References

Recreational uses

Pharmacodynamics

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