Further research is needed to determine whether doses of dextromethorphan beyond those normally used therapeutically are needed to produce this effect. Serotonin syndrome may result from the combined use of dextromethorphan and serotonergic antidepressants such as selective serotonin reuptake inhibitor (SSRIs) or monoamine oxidase inhibitor (MAOIs). Additionally, disturbances have been reported in sleep, senses, movement, mood, and thinking.Īdverse effects of dextromethorphan in overdose at doses 3 to 10 times the recommended therapeutic dose: Įpisodic acute psychosis can occur when high doses of dextromethorphan are taken for recreational use, and an abundance of psychiatric symptoms can result, including dissociation and other PCP-like symptoms. Since dextromethorphan also acts as a serotonin reuptake inhibitor, users report that regular recreational use over a long period of time can cause withdrawal symptoms similar to those of antidepressant discontinuation syndrome. It is considered less addictive than other common cough suppressants, such as the weak opiate codeine. In many documented cases, dextromethorphan has produced psychological dependence in people who used it recreationally.
Neurotoxic changes, including vacuolation, have been observed in posterior cingulate and retrosplenial cortices of rats administered other NMDA receptor antagonists such as PCP, but not with dextromethorphan. Tests were performed on rats, giving them 50 mg or more every day for as long as a month. Neurotoxicity ĭextromethorphan was once thought to cause Olney's lesions when administered intravenously however, this was later proven inconclusive, due to lack of research on humans. Ī rare side effect is respiratory depression. It was patented in 1949 and approved for medical use in 1953. Dextromethorphan and its major metabolite, dextrorphan, also block the NMDA receptor at high doses, which produces effects similar to other dissociative anesthetics such as ketamine, nitrous oxide, and phencyclidine. It has multiple mechanisms of action, including actions as a nonselective serotonin reuptake inhibitor and a sigma-1 receptor agonist. When exceeding approved dosages, dextromethorphan acts as a dissociative hallucinogen. ĭextromethorphan is also used recreationally. In its pure form, dextromethorphan occurs as a white powder. Dextromethorphan does not have a significant affinity for the mu-opioid receptor activity typical of morphinan compounds and exerts its therapeutic effects through several other receptors. It is in the morphinan class of medications with sedative, dissociative, and stimulant properties (at lower doses). It is sold in syrup, instant release tablet, extended release tablet, spray, and lozenge forms. In 2022, the FDA approved a formulation of it combined with bupropion named Auvelity to serve as a rapid acting antidepressant in patients with major depressive disorder. It affects NMDA, glutamate-1, and sigma-1 receptors in the brain, all of which have been implicated in the pathophysiology of depression. Dextromethorphan ( DXM) is a cough suppressant in over-the-counter cold and cough medicines.
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