Dextromethorphan (DXM) is the most popular cough suppressant sold in the United States.
According to the National Capital Poison Center, more than 6,000 people visit emergency rooms from DXM toxicity or overdose annually.
DXM is commonly misused with alcohol. A 2018 report found 1 in 30 teens misuse DXM, and 6 in 10 teens misuse alcohol. Seventeen percent of 12th graders reported binge drinking in 2017.
Drinking alcohol with DXM increases the risk of toxicity and can cause serious health problems.
DXM is a common cough suppressant. It’s been around since 1958. More than 100 different cough and cold products have it, including some from Robitussin. DXM works by curbing the cough reflex in the brain to reduce coughing.
The maximum daily recommended dose of DXM is 120 milligrams (mg) taken in divided doses. At recommended doses, DXM is safe with few side effects.
When DXM is misused, larger doses are taken to get a “high” or hallucinogenic effect.
DXM is one of the
You may think DXM is relatively safe since it’s available OTC. But a lot of these cough and cold products have other ingredients in them, like acetaminophen, antihistamine, and guaifenesin. These can cause a buildup of side effects, which can be dangerous.
The effects of an overdose are similar to ketamine or phencyclidine (PCP), causing a floating or out-of-body sensation. Higher doses gradually increase health risks.
Depending on the dose taken, the effects may last for 6 hours. When used with alcohol, the effects last longer. We’ll discuss why that might happen a little later.
Some other popular names for DXM misuse include:
- triple C
- red devils
- vitamin D
Short-term side effects
Some common side effects of DXM misuse include:
- dry mouth
- fast heart rate
- nervousness or restlessness
- nausea and vomiting
- upset stomach, diarrhea, or constipation
Long-term side effects
Long-term heavy use of DXM can cause
Severe reactions from DXM overdose can include:
- difficulty speaking and confusion
- trouble with vision and coordination
- slow breathing
- dangerous drop in body temperature
- pale or blue in the face
- hallucinations, mania, and paranoia
- increased heart rate
- nausea and vomiting
This isn’t a full list of all side effects. Check with your doctor or pharmacist if you’re experiencing side effects from DXM use.
In Case of emergency
In some cases, DXM overdose can result in death. If you or someone you know has taken DXM and is experiencing any of the above symptoms, call 911 immediately.
Moderate social drinking is common and accepted around many parts of the world.
But binge drinking, which means having too many drinks in one sitting, can harm your body in many ways. Immediate reactions can include problems with balance, movement, and judgment.
According to the National Institute on Alcohol Abuse and Alcoholism, excess alcohol consumption can cause problems with many of our biggest organs, like the:
Both DXM and alcohol have depressant effects on the brain. That means taken together, they have a more powerful impact.
They both dull your senses and slow down your coordination and judgment. Mixing the two can also cause severe nausea and vomiting, sometimes lasting for hours.
Side effects of DXM and alcohol can last for several days, depending on the person and the drug mix.
Both can affect your breathing. In severe overdose, it can lead to death from respiratory failure, which means you stop breathing.
How strongly you react to using both alcohol and DXM together depends on many factors, including your:
- existing health problems
- other drugs used together
Co-use can increase the common side effects of both, like becoming dizzy or drowsy, and increased heart rate.
One of the biggest risks with DXM and alcohol co-use is the potential for additional harmful effects and stress on the liver. The side effects of DXM are stronger when taken with alcohol.
Quite a few cold and cough medicines that have DXM also have acetaminophen, the active ingredient in Tylenol. Overdosing on these multi-ingredient products increases the risk of liver toxicity and liver failure.
Your body can develop tolerance to DXM and alcohol with continued use. This means your body gets used to them, and you need higher doses to get the same results.
Your risk for overdose increases the more you take of either substance, because your liver gets overworked trying to metabolize them. You might also experience withdrawal symptoms if you suddenly stop taking them.
While risks for alcohol use during pregnancy are
Before using any OTC cough or cold products, always check with your doctor.
Avoid using alcohol combined with DXM during pregnancy.
High doses of DXM can cause dangerous drug interactions with monoamine oxidase inhibitors (MAOIs). This is a class of medications used to treat depression.
Using them together increases the risk of serotonin syndrome, which can raise blood pressure and heart rate to unsafe levels. Alcohol can increase these risks.
Other antidepressant drugs that can interact and cause serotonin syndrome are:
Some signs of misuse include:
- slurred speech
- pinpoint pupils
- balance or movement problems
Signs of overdose include:
- breathing difficulty
- turning blue in the face
- social reasons
Some signs of a substance use disorder can include:
- changes in behavior, sleep, and mood
- losing interest in daily life and relationships
- not able to focus on work or other regular activities
- withdrawal symptoms
If you suspect a DXM or alcohol overdose, call 911 immediately.
Rehabilitation programs (inpatient or outpatient), therapy, support groups, or a combination of all three can help people recover from a substance use disorder. In some cases, medications can also help, like for alcohol use disorder. There are no medications that treat DXM addiction.
If you or someone you know has a substance use disorder, these organizations can offer confidential, free support and treatment referral:
DXM and alcohol misuse is common. Teens often misuse DXM, mistakenly thinking it’s safer because it’s OTC.
Alcohol and DXM co-use increase the risk of injury to major organs, like the heart and liver.
Talk with your doctor or pharmacist about the risks and interactions of OTC and prescription medications taken with alcohol.