Drug information provided by: IBM Micromedex
Along with its needed effects, a medicine 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:
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 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
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Portions of this document last updated: Nov. 01, 2022
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Dextromethorphan is a cough suppressant found in many over-the-counter cold and flu medications, including cough syrups.
When codeine, a mild opioid narcotic, was moved to Schedule III and required a prescription for purchase, drugs containing dextromethorphan were popularized since the active ingredient was believed to be safer.
Unfortunately, dextromethorphan has been shown to be habit-forming and intoxicating. It is now a drug of abuse that can even cause a life-threatening overdose when a person consumes too much. Nonmedical abuse of DXM can lead to experiences that are reportedly similar to those caused by PCP or ketamine. It is legal for purchase, although many states may require a driver’s license or other identification to prove purchasers are of age.
Although dextromethorphan alone can cause intoxication, other drugs often found in cold or flu medicines can enhance the ingredient’s effects. These include analgesics like acetaminophen, antihistamines, and decongestants like pseudoephedrine.
Dextromethorphan Dosing and Intoxication
Intoxication from a nonmedical dose begins between 15 and 30 minutes after ingestion, as the stomach digests the drug, and the effects typically last for 3-6 hours. At 1500 mg or more, a person is likely to overdose on dextromethorphan. This is 5-10 times the recommended dose of any over-the-counter medicine containing DXM.
Overdose Symptoms
Symptoms of an overdose on dextromethorphan include:
- Breathing problems, especially irregular or shallow breathing
- Bluish tint under the fingernails or on the lips due to lack of oxygen
- Blurred vision
- Blacking out
- Vomiting
- Stomach or intestinal spasms
- Hallucinations
- Restlessness
- Anxiety or paranoia
- Convulsions
- Dizziness
- Extreme drowsiness
- Changes in blood pressure, either too high or too low
- Muscle twitches
- Heart palpitations
- Elevated body temperature
Common behavioral symptoms from DXM overdose include hyperexcitability and somnolence. If a person displays either, or both, of these symptoms, they may be experiencing an overdose. Also, if a person appears to experience hallucinations or psychosis, they may be overdosing on DXM.
Dangerous
physical symptoms of dextromethorphan overdose include tachycardia, slow breathing, changes in blood pressure and body temperature, and seizures. It is important to get help for a person suffering from a DXM overdose before these symptoms begin because they are more likely to lead to coma or death.
What to Do During a Dextromethorphan Overdose
If a person is overdosing on DXM, they require emergency medical attention. Call 911 immediately. There are no drugs that counteract a DXM overdose; the only way they can survive the condition is to get help in a hospital immediately.
In the hospital, a dextromethorphan overdose will be treated with several emergency procedures to stabilize the individual. Some of these may include:
- Activated charcoal to absorb the remaining DXM
- Blood and urine tests to understand how much has been consumed
- Breathing support
- Electrocardiogram to measure heart activity
- IV fluids to maintain hydration and nutrients in the body
- Laxatives to help the body expel DXM faster
- Gastric lavage, or stomach pumping, to remove the drug
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Why Do Dextromethorphan Overdoses Occur?
However, some people are simply poor metabolizers. People who fall into this category do not metabolize medications as efficiently as the average person. Typically, these people should take smaller doses than recommended for over-the-counter or prescription medicines to avoid intoxication, addiction, and overdose. However, a person may not know that they fall into this category until it is too late. It is important to know the symptoms of overdose, and if they are experienced, call 911 or go to the nearest emergency room.
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DXM and Serotonin Syndrome
This is not an overdose of DXM, but it is a very dangerous condition that requires emergency medical attention. People experiencing serotonin syndrome or those witnessing someone who is, should call 911 immediately.