Side effects of delsym

Delsym

Generic Name: dextromethorphan (DEX troe me THOR fan)
Brand Name: Babee Cof, Buckleys Mixture, Creomulsion, DayQuil Cough, Delsym, Robafen Cough Liquidgels, Scot-Tussin Diabetic, Silphen DM

Medically reviewed by Drugs.com on Apr 22, 2019 – Written by Cerner Multum

  • Overview
  • Side Effects
  • Dosage
  • Interactions
  • Pregnancy
  • More

What is Delsym?

Delsym is a cough suppressant that is used to treat cough caused by the common cold or flu.

Delsym will not treat a cough caused by smoking, asthma, or emphysema.

There are many brands and forms of dextromethorphan available. Not all brands are listed on this leaflet.

Delsym may also be used for purposes not listed in this medication guide.

Important Information

Do not use Delsym if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Before taking this medicine

Do not use Delsym if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

You should not use Delsym if you are allergic to it.

Ask a doctor or pharmacist if this medicine is safe to use if you have any medical conditions.

Delsym should not be given to a child younger than 12 years old.

Ask a doctor before using this medicine if you are pregnant or breast-feeding.

This medicine may contain phenylalanine. Check the medication label if you have phenylketonuria (PKU).

How should I take Delsym?

Use exactly as directed on the label, or as prescribed by your doctor. Cold or cough medicine is only for short-term use until your symptoms clear up.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Call your doctor if your symptoms do not improve after 7 days, or if you have a fever, rash, or headaches.

If you need surgery or medical tests, tell your surgeon or doctor ahead of time that you have taken Delsym in the past few days.

Store at room temperature away from moisture, heat, and light. Do not freeze.

What happens if I miss a dose?

Since cough or cold medicine is used when needed, you may not be on a dosing schedule. Skip any missed dose if it’s almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Delsym?

Avoid driving or hazardous activity until you know how Delsym will affect you. Your reactions could be impaired.

Drinking alcohol can increase certain side effects of this medicine.

Ask a doctor or pharmacist before using over-the-counter medicines that may contain ingredients similar to Delsym.

Delsym side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using Delsym and call your doctor at once if you have:

  • severe nervousness, confusion;

  • severe dizziness or drowsiness;

  • blurred vision; or

  • painful or difficult urination.

Common side effects may include:

  • nausea, diarrhea, loss of appetite;

  • dizziness;

  • tingling; or

  • feeling restless.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Delsym?

Avoid using Delsym with other drugs that cause drowsiness or slow your breathing (such as opioid medicine, a muscle relaxer, or medicine for anxiety or seizures). Ask a doctor or pharmacist before using any other medication, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed in this medication guide.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 8.01.

Related questions

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Medical Disclaimer

More about Delsym (dextromethorphan)

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  • Drug class: antitussives
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Consumer resources

  • Delsym
  • Delsym (Advanced Reading)

Other brands: Vicks Dayquil Cough, Creomulsion, Vicks Formula 44, Buckleys Mixture, … +11 more

Professional resources

  • Dextromethorphan Hydrobromide (AHFS Monograph)

Other Formulations

  • Delsym12 Hour Cough Relief
  • Delsym Children’s Night Time Cough & Cold
  • Delsym Adult Night Time Multi-Symptom

Related treatment guides

  • Cough

Delsym Cough-Cold oral

uses

This combination medication is used to temporarily treat symptoms caused by the common cold, flu, allergies, or other breathing illnesses (such as sinusitis, bronchitis). Dextromethorphan is a cough suppressant that affects a certain part of the brain, reducing the urge to cough. Acetaminophen (APAP) is a non-aspirin pain reliever and fever reducer. Antihistamines help relieve watery eyes, itchy eyes/nose/throat, runny nose, and sneezing.This medication is not usually used for ongoing coughs from smoking, asthma, or other long-term breathing problems (such as emphysema), or for coughs with a lot of mucus, unless directed by your doctor.Cough-and-cold products have not been shown to be safe or effective in children younger than 6 years. Therefore, do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Some products (such as long-acting tablets/capsules) are not recommended for use in children younger than 12 years. Ask your doctor or pharmacist for more details about using your product safely.These products do not cure or shorten the length of the common cold and may cause serious side effects. To decrease the risk for serious side effects, carefully follow all dosage directions. Do not use this product to make a child sleepy. Do not give other cough-and-cold medication that might contain the same or similar ingredients

See also Drug Interactions section.

Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).

how to use

See also Warning section.

Read and follow all directions on the package label. Do not give children medicines labeled only for adults. If you have any questions, consult your pharmacist.Take this medication by mouth with or without food, usually every 4 to 6 hours as needed or as directed by your doctor. If stomach upset occurs, it may help to take this medication with food or milk. Drink plenty of fluids when you use this medication unless otherwise directed by your doctor. The fluid will help loosen the mucus in your lungs.If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. If your liquid form is a suspension, shake the bottle well before each dose.The dosage is based on your age, medical condition, and response to treatment. Do not increase your dose, take it more frequently, or use it for a longer time than directed. Improper use (abuse) of this medication may result in serious harm (including brain damage, seizure, death).Tell your doctor if your condition persists for more than 1 week, if it worsens, or if it occurs with rash, persistent headache, or fever lasting more than 3 days. These may be symptoms of a serious medical problem and should be checked by a doctor.

side effects

See also Warning section.

Drowsiness, dizziness, blurred vision, upset stomach, nausea, constipation, or dry mouth/nose/throat may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Tell your doctor right away if any of these unlikely but serious side effects occur: mental/mood changes (such as confusion, hallucinations), trouble urinating.Tell your doctor right away if any of these rare but serious side effects occur: fast/irregular heartbeat, seizure.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

precautions

See also Warning section.

Before taking this product, tell your doctor or pharmacist if you are allergic to any of its ingredients; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.If you have any of the following health problems, consult your doctor or pharmacist before using this medication: breathing problems (such as asthma, emphysema), diabetes, glaucoma, heart problems, high blood pressure, kidney problems, liver disease, seizures, stomach/intestinal problems (such as blockage, constipation, ulcers), overactive thyroid (hyperthyroidism), urination problems (such as trouble urinating due to enlarged prostate, urinary retention).This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Some brands of this product may contain sugar, alcohol, or aspartame. Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.Before having surgery, tell your doctor or dentist that you are taking this medication.Children may be more sensitive to the effects of this drug. In young children, antihistamines may cause agitation/excitement instead of drowsiness.Older adults may be more sensitive to the effects of this drug, especially dizziness, drowsiness, constipation, trouble urinating, or mental/mood changes. Dizziness, drowsiness, and confusion can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication may pass into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

drug interactions

See also Warning section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.Some products that may interact with this drug are: antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray), ketoconazole.Taking certain MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking isocarboxazid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, or tranylcypromine during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or other antihistamines (such as cetirizine, diphenhydramine).The ingredients in this product are available in many prescription and nonprescription products. Check the labels on all your medicines (such as pain/fever drugs, diet aids, or cough-and-cold/allergy products) because they may contain the same or similar ingredients. Using these drugs along with this product could increase side effects. Ask your pharmacist about using those products safely.This medication may interfere with certain lab tests (such as urine drug screening tests, urine 5-HIAA), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, agitation, confusion, flushing, hallucinations, yellowing eyes/skin, dark urine, seizures. In children, excitement may occur first, and may be followed by: loss of coordination, drowsiness, loss of consciousness, seizures.

notes

Keep all regular medical and laboratory appointments.Do not take this product for several days before allergy testing because test results can be affected.

PMC

CASE DESCRIPTION

Ms. J is a 40-year-old female Caucasian female with an extensive history of substance abuse. She began abusing alcohol at age 14 with the addition of marijuana, alcohol, opiate, and LSD use through her teen years. At age 18, following heavy usage of LSD and marijuana, Ms. J. experienced what she describes as her first “psychotic break.” The episode consisted of hyper-religiosity, auditory hallucinations, and delusions of persecution. These symptoms resolved despite continued use of LSD. She continued to abuse a combination of alcohol, marijuana, LSD, valium, and amphetamine-based products throughout her 20’s.

Ms. J first used DXM at age 29, reporting that she “loved it from the first try,” and felt that it “brought me closer to God.” DXM’s accessibility, low expense, and lack of detection on urine drug screens appealed to Ms. J. She reports her typical daily dose was 12 tablets of Corcidin™ Cough and Cold TID (providing 1080 mg/day of DXM total) or 9 tablets of Mucinex™ DM Maximum Strength TID (providing 1620 mg/day of DXM total). The recommended maximum daily dosing of DXM is 120 mg. For the next 5 years, Ms. J continued to abuse DXM an average of 3–4 times per month. After learning of her husband’s affair, she escalated to daily abuse of DXM, along with marijuana and alcohol, for roughly 6 months, averaging 3 hours of sleep nightly.

At age 35, Ms. J. reported a binge on an estimated dose of 3000–4000 mg of DXM. She was unable to recall any details of the binge; however, she did cause a motor vehicle collision. She then returned to her daily “dose” of DXM (1080–1620 mg/day) for roughly a year. The patient binged once more on 3000–4000 mg of DXM prior to signing her divorce papers. That night, she experienced the following vivid and traumatizing dream: “I dreamt my mother ripped my face off with her fingernails, cut some of my fingers and toes off, and ripped my arm off.” The next morning, she continued to suffer from delusions of persecution by her mother, which resulted in a failed attempt to stab her mother. The patient was then arrested and placed in a rehabilitation facility where she remained sober for 14 months. Within 2 weeks of her release, she resumed her alcohol abuse. Within 4 weeks, she was again abusing DXM. From the age of 37 to 39 years old, the patient would fluctuate between periods of sobriety, weekly DXM abuse, and daily DXM abuse.

In the 4 months prior to her presentation, the patient reports she used DXM once a month at her “average dose” of 1080–1620 mg/day. Her last use was 2 days prior to her hospital admission. Ms. J described her last ingestion as a “dirty high” due to her consuming 3 beers along with the DXM, a combination which she believes further precipitated her psychiatric decompensation.

Ms. J was admitted to our psychiatric unit after she was discovered sleeping in a stranger’s house and subsequently assaulted a police officer. Her initial clinical condition limited history gathering, though she reported PTSD, depression, and use of “all” illicit substances. On observation she displayed an irritable affect, labile mood and was suspicious of staff. A urine drug screen revealed only buprenorphine, for which the patient did not have a prescription. Based on her history of depression, she was started on Mirtazapine 15 mg nightly. However, despite the passage of several days for substance washout, she remained inappropriate, hostile, and displayed an illogical, disorganized thought process with delusions of misinterpretation. Following the addition of an antipsychotic, her behavior became more organized and appropriate. The patient then revealed her extensive history of DXM abuse. She was eventually stabilized on Olanzapine 10 mg nightly and Divalproex Extended Release 1,000 mg nightly. The patient ultimately spent twenty days in the hospital before the aforementioned symptoms resolved. She was continued on Mirtazapine, Olanzapine, and Divalproex ER at the time of discharge.

Delsym Side Effects

Generic Name: dextromethorphan

Medically reviewed by Drugs.com. Last updated on Jan 29, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Interactions
  • Pregnancy
  • More

Note: This document contains side effect information about dextromethorphan. Some of the dosage forms listed on this page may not apply to the brand name Delsym.

For the Consumer

Applies to dextromethorphan: oral capsule liquid filled, oral elixir, oral liquid, oral solution, oral suspension extended release, oral syrup

Along with its needed effects, dextromethorphan (the active ingredient contained in Delsym) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking dextromethorphan:

Symptoms of overdose

  • Blurred vision
  • confusion
  • difficulty in urination
  • drowsiness or dizziness
  • nausea or vomiting (severe)
  • shakiness and unsteady walk
  • slowed breathing
  • unusual excitement, nervousness, restlessness, or irritability (severe)

Some side effects of dextromethorphan may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common or rare

  • Confusion
  • constipation
  • dizziness (mild)
  • drowsiness (mild)
  • headache
  • nausea or vomiting
  • stomach pain

For Healthcare Professionals

Applies to dextromethorphan: compounding powder, oral capsule, oral disintegrating strip, oral drops, oral liquid, oral lozenge, oral solution, oral suspension extended release, oral syrup, oral tablet chewable

General

Adverse effects have included gastrointestinal disturbances such as stomach upset and diarrhea.

Nervous system

Frequency not reported: Drowsiness, dizziness, convulsions

Respiratory

Frequency not reported: Respiratory depression

Gastrointestinal

Frequency not reported: Vomiting, nausea, diarrhea, abdominal pain, gastrointestinal disturbance

Hypersensitivity

Rare (less than 0.1%): Fixed-drug eruptions

Psychiatric

Cases of abuse have been reported.

Frequency not reported: Mental confusion, excitation, insomnia, abuse

Dermatologic

Frequency not reported: Rash, angioedema, pruritus, urticaria

1. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0

2. Bostwick JM “Dextromethorphan-induced manic symptoms in a bipolar patient on lithium.” Psychosomatics 37 (1996): 571-2

3. Murray S, Brewerton T “Abuse of over-the-counter dextromethorphan by teenagers.” South Med J 86 (1993): 1151-3

4. Polles A, Griffith JL “Dextromethorphan-induced mania.” Psychosomatics 37 (1996): 71-4

5. Wolfe TR, Caravati EM “Massive dextromethorphan ingestion and abuse.” Am J Emerg Med 13 (1995): 174-6

6. Helfer J, Kim OM “Psychoactive abuse potential of Robitussin-DM.” Am J Psychiatry 147 (1990): 672-3

8. Stubb S, Reitamo S “Fixed-drug eruption due to dextromethorphan .” Arch Dermatol 126 (1990): 970-1

9. Knowles SR, Weber E “Dextromethorphan anaphylaxis.” J Allerg Clin Immunol 102 (1998): 316-7

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

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Medical Disclaimer

Ingredients

Per 5 ml:

  • Dextromethorphan 30mg (extended release cough suppressant)

The Dextromethorphan (DM for short) is a cough suppressant. It acts by blocking the cough reflex center in the brain. It will offer temporary relief (a few hours) to that nagging cough caused by a “tickle” in the throat. DELSYM is different than other cough suppressants because it is an extended release suspension designed to last for 12 hours.

WHEN TO USE

Frequent cough, no runny nose or nasal congestion. I use this type of medication for dry coughs especially at night if the cough prevents my child from going to sleep or staying asleep. Suppressing the cough will usually help your child get some much-needed rest for a few hours. Daytime coughs usually don’t bother a child and I only use a cough medication during the day if the cough is interfering with baby’s eating, napping and playing. If your child’s cough sounds very moist like he’s coughing on secretions and there is a lot of mucous in the nose, then I will use a “multi- symptom” combination of decongestant, antihistamine and cough suppressant. In this case it will also be important to follow the non-medical cold treatments as well.

SAFETY/SIDE EFFECTS

It is safe to use in children 12 months and older for upper respiratory illness (such as colds and sinus infections). If your child has a lower respiratory tract illness (like pneumonia, bronchiolitis or asthma) you should ask your physician before using cold or cough remedies. Side effects of nausea, dizziness, and drowsiness infrequently occur with DM-containing cough syrups.

DOSING CHART

Dose every 12 hours

<12 months Not recommended
12-23 months Ask your doctor
2-5 years Ask your doctor
6-12 years 5ml (1 tsp)
>12 years (>95lbs) 10ml (2 tsp)

August 28, 2013 October 2, 2017 Dr. Bill Sears

What Are the Risks of Abusing Dextromethorphan (DXM)?

Dextromethorphan is a cough suppressant commonly found in over-the-counter allergy, cold, and flu medications. At present, this medication can be found in over 120 OTC drugs. At the recommended doses on bottles or pill boxes, dextromethorphan – often abbreviated to DXM – is perfectly safe to use. The medication mildly suppresses areas of the brain that control coughing. The drug can also act as an expectorant, helping to break up congestion, and provide temporary relief for runny nose, watering eyes, and sinus congestion. Many medications with DXM also have acetaminophen, which is a common pain reliever.
Because DXM is legal and not as tightly controlled as prescription medications or illegal drugs, many people abuse cough medications at very large doses in order to get high. At large doses, DXM can have hallucinatory and euphoric effects, but it can also be very dangerous.

Article Snapshot
What Are the Risks of Abusing DXM?

  • Hallucinations and delusions
  • Memory loss
  • Impairment and self-injury
  • Vomiting
  • Liver damage
  • Tachycardia or cardiovascular harm
  • Seizures
  • Overdose
  • Psychological dependence
  • Withdrawal syndrome

Risks associated with DXM abuse are outlined below.

First plateau (100-200 mg): mild intoxication and stimulation

Second plateau (200-400 mg): euphoria and hallucinations (auditory, visual, and tactile)

Third plateau (300-600 mg): loss of motor coordination, distortion of vision, or impaired vision

Fourth plateau (500-1500 mg): dissociative sedation

Fifth plateau or sigma (1500-3000 mg): longer-lasting dissociative sedation, greatly increased chance of overdose symptoms

Hallucinations begin early at the second plateau and continue through until the individual is too sedated to react. Paranoia and delusions can occur concurrently with hallucinations, leading the person to believe that they are being spied on, chased, surrounded by danger or evil, or able to perform actions that they cannot (like flying). Violent thoughts and tendencies can occur at this point, leading the person to harm themselves or those around them. These incidents will increase in severity if the person continues to consume DXM.

  • Memory loss:This is a very common problem with intoxication on many substances, and DXM is no exception. When a person becomes seriously intoxicated on this drug, they will begin to experience blackouts or lose memories of what occurred while they were high.
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  • Impairment and self-injury:It is common for people suffering hallucinations, paranoia, and delusions to harm themselves. In addition, intoxication on DXM can lead to a loss of coordination, which can lead to further accidental self-injury.
  • Vomiting:This is a very common occurrence with DXM intoxication. A typical method of abuse involves quickly ingesting as much of a DXM drug (cough syrup, or cold and flu gel capsules) for the body to absorb the DXM before vomiting the medication. Other illicit methods of ingesting the drug, such as powder that is purchased online, prevent vomiting but lead to worse physical damage, including overdose.
  • Liver damage:Chronic abuse of DXM can lead to liver damage, as most drugs are filtered through the liver if ingested orally. Over-the-counter cough medications often have acetaminophen as well, and ingesting more than 350 mg of acetaminophen per day, for several days, can lead to liver toxicity.
  • Tachycardia or cardiovascular harm:Rapid heartbeat, high blood pressure, and changes to breathing rates are common during DXM intoxication. Heart attack can occur at high levels of DXM intoxication or due to an increased fight-or-flight response because of a paranoid delusion.

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  • Seizures:This is a specific complication of DXM overdose. Seizures can impair consciousness, coordination, and other brain activity. At their most dangerous, a drug-induced seizure can lead to permanent brain damage due to dangerous changes in neuron activity that destroy brain tissue.
  • Overdose:At large doses, DXM acts like a CNS (central nervous system) depressant. This means that the brain can shut down in the same way as with benzodiazepine or opioid overdoses. Symptoms of overdoseare dissociation from reality, stupor or unconsciousness with no response, reduced or stopped breathing, changes to heart rate and blood pressure, changes to body temperature, sweating and flushing, vomiting more than once, seizures, heart attack, and coma.
  • Psychological dependence:There is little information on the potentially addictive nature of DXM, but some people can become addicted to the intoxicating effects on a psychological level and chronically abuse DXM. Dependence could be associated with withdrawal effects, which can include depression, dysphoria, and insomnia.
  • Withdrawal syndrome:A case study involving a patient who entered rehabilitation for DXM addiction showed that the individual experienced withdrawal symptoms, including tachycardia, hypertension, nausea, sweating, and cravings for more DXM.

Treatment for DXM Abuse

Dextromethorphan continues to be an over-the-counter medication, although it has shown some potential for addiction and a high potential for abuse. It is important to get help as soon as possible for DXM addition or abuse problems. Medically monitored detox, individual and group therapy, and social support are extremely important elements of any rehabilitation program.

Robotripping

Dextromethorphan, also called DXM, is the active ingredient in many cough and cold medicines. When used as directed, the drug is safe and effective. But taking it in large doses can cause psychedelic effects similar to those of ecstasy.

Being high on DXM is known as robotripping. A robotrip can cause a host of physical and psychological effects, including muscle twitches, dizziness and hallucinations. These symptoms can be life-threatening and require immediate medical attention.

Symptoms of Robotripping

DXM is a hallucinogen. Many people high on dextromethorphan experience mild euphoria. But taking large amounts of the cough suppressant can lead to intense hallucinations and paranoia. These effects can cause violent behaviors that may result in assault or suicide.

Symptoms of robotripping include:

  • Agitation
  • Hallucinations
  • Delusions
  • Dissociation
  • Vivid nightmares
  • Impaired cognitive and perceptual functioning
  • Violent behaviors

The more dextromethorphan you take, the more severe your symptoms will be. Robotripping comprises four stages called plateaus. Higher plateaus occur at certain points as the dose of dextromethorphan increases.

Plateau 1

  • Total DXM dose: 100 to 200 milligrams
    • 35 to 60 milliliters of syrup
    • Four to six capsules
  • Symptoms: Euphoria and restlessness

Plateau 2

  • Total DXM dose: 200 to 500 milligrams
    • 60 to 185 milliliters of syrup
    • Seven to 18 capsules
  • Symptoms: Auditory and visual hallucinations and imbalance

Plateau 3

  • Total DXM dose: 500 to 1,000 milligrams
    • 185 to 375 milliliters of syrup
    • 18 to 33 capsules
  • Symptoms: Intense hallucinations, altered consciousness, partial dissociation, panic and mania

Plateau 4

  • Total DXM dose: More than 1,000 milligrams
    • More than 375 milliliters of syrup
    • More than 33 capsules
  • Symptoms: Delusions, hallucinations, full dissociation and a loss of control over body movements

Source: Canadian Medical Association Journal

In extreme cases, robotripping can result in toxic psychosis. This psychotic symptom is characterized by confusion and losing contact with reality. Individuals experiencing substance-induced psychosis have trouble rpecognizing their environment and communicating with others.

How Long Does a Robotrip Last?

The effects of dextromethorphan typically last from 2 1/2 to six hours, according to a 2014 study published in the journal Anesthesiology and Pain Medicine. But they can linger for much longer if DXM is used with other drugs.

Some people experience more intense robotrips than others. The duration and severity of a robotrip is contingent on a variety of factors, including a person’s metabolism, weight, history of DXM use and frequency of use.

DXM Overdose

When a person consumes too much dextromethorphan, an overdose can occur. The effects of a DXM overdose are more severe than those of robotripping. Whereas people high on DXM typically experience euphoria, individuals who overdose suffer from life-threatening symptoms.

According to the U.S. National Library of Medicine, symptoms of a DXM overdose include:

  • High or low blood pressure
  • Blurred vision
  • Rapid heartbeat
  • Bluish lips and fingernails
  • Slowed breathing
  • Nausea and vomiting
  • Elevated body temperature
  • Seizures
  • Coma

DXM overdose can result in death. If someone you know has overdosed on dextromethorphan, immediately seek medical assistance. It is best to call 911. In addition, the national Poison Help hotline can provide instructions on how to assist a person experiencing a DXM overdose.

Popularity of Robotripping Among Teens

Dextromethorphan is not regulated by the Controlled Substances Act, which means it is legal in the United States. Fifteen states have banned sales of DXM products to minors, but that hasn’t stopped many teens from accessing the drug.

Many adolescents abuse products containing DXM to experience hallucinations. According to the 2017 Monitoring the Future survey, about 3.2 percent of 12th-grade students reported misusing cough or cold medications in the past year.

Teens purchase medicines containing dextromethorphan from friends or over the internet. Others steal DXM products from stores. Coricidin HBP Cough & Cold, also called triple C, is a popular cough medicine of abuse among minors.

Some students use dextromethorphan throughout the day to maintain a consistent high. But the hallucinations and delusions of robotripping can require medical attention. Long-term misuse of DXM can cause learning problems, memory impairment and possibly addiction.

In many cases, parents are unaware of their child’s substance abuse. To prevent your children from misusing DXM, talk to them about the dangers of the drug. You should also monitor their internet activity and secure your medicine cabinet.

Treating DXM Overdose or Addiction

Most people do not become addicted to dextromethorphan. However, robotripping remains unsafe. Regular DXM use can cause individuals to develop a severe substance use disorder.

If someone has overdosed on DXM, he or she needs to be transported to a hospital. Treatment for a dextromethorphan overdose may include breathing support, medications that block the effects of the drug, laxatives, activated charcoal and intravenous fluids.

Hospital staff may employ aggressive cooling techniques to treat dangerously high body temperature or administer benzodiazepines to control seizures. Patients who have respiratory depression or are in a coma could receive naloxone, a narcotic overdose medication.

Professional treatment can reduce DXM abuse. People who are addicted to DXM or abusing the medication should receive a full psychiatric evaluation. Antipsychotic or antidepressant medications may be needed to alleviate mental health problems.

The most effective way to address a substance use disorder is to attend a rehab facility. According to the National Institute on Drug Abuse, cognitive behavioral therapy can assist people in changing their thoughts and behaviors toward dextromethorphan. Contingency management, a reward-based program, can also help people overcome cough medicine abuse issues.

dextromethorphan and doxylamine (NyQuil Cough)

Brand Names: NyQuil Cough, Robitussin Maximum Strength Nighttime Cough, Robitussin Nighttime Cough DM, Safetussin PM

Generic Name: dextromethorphan and doxylamine

  • What is dextromethorphan and doxylamine?
  • What are the possible side effects of dextromethorphan and doxylamine?
  • What is the most important information I should know about dextromethorphan and doxylamine?
  • What should I discuss with my healthcare provider before taking dextromethorphan and doxylamine?
  • How should I take dextromethorphan and doxylamine?
  • What happens if I miss a dose?
  • What happens if I overdose?
  • What should I avoid while taking dextromethorphan and doxylamine?
  • What other drugs will affect dextromethorphan and doxylamine?
  • Where can I get more information?

What is dextromethorphan and doxylamine?

Dextromethorphan is a cough suppressant. It affects the signals in the brain that trigger cough reflex.

Doxylamine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.

Dextromethorphan and doxylamine is used to treat cough, runny or stuffy nose, sneezing, itching, and watery eyes caused by allergies, the common cold, or the flu.

Dextromethorphan and doxylamine will not treat a cough that is caused by smoking, asthma, or emphysema.

Dextromethorphan and doxylamine may also be used for purposes not listed in this medication guide.

What are the possible side effects of dextromethorphan and doxylamine?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using dextromethorphan and doxylamine and call your doctor at once if you have:

  • severe dizziness or anxiety;
  • a light-headed feeling, like you might pass out;
  • little or no urinating; or
  • liver problems–nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • drowsiness, dizziness;
  • nervousness;
  • sleep problems (insomnia); or
  • feeling restless or excited (especially in children).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about dextromethorphan and doxylamine?

Do not use this medicine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Do not give this medication to a child younger than 4 years old. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children.

You should not use antihistamine medication to make a child sleepy.

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