Dextromethorphan

Dextromethorphan: An Overview

Introduction:
Dextromethorphan (often abbreviated as DXM) is a medication commonly used as a cough suppressant. It is found in many over-the-counter cold and cough remedies and is known for its effectiveness in reducing the urge to cough.

Chemical and Pharmacological Profile:

• Chemical Class: Dextromethorphan is a synthetic derivative of the morphinan class, structurally related to opioids but with distinct pharmacological properties.
• Mechanism of Action: DXM works primarily by acting on the central nervous system, specifically on the sigma-1 and NMDA receptors, which help suppress the cough reflex. Unlike opioids, it does not produce significant analgesic or addictive effects at therapeutic doses.

Uses:

• Medical Use: Dextromethorphan is used to treat coughs caused by colds, bronchitis, or other respiratory illnesses. It is valued for its ability to suppress dry, hacking coughs without causing drowsiness or addiction when used appropriately.

Potential for Abuse and Misuse:

• At higher doses, DXM can cause hallucinations, euphoria, and dissociative states, leading some individuals to misuse it recreationally. This misuse can be dangerous, resulting in side effects such as dizziness, nausea, agitation, hallucinations, and in severe cases, respiratory depression or neurotoxicity.

Side Effects:

• Common side effects include dizziness, drowsiness, nausea, and stomach discomfort.
• Serious adverse effects are rare but can include allergic reactions, hallucinations, or serotonin syndrome, especially when combined with other serotonergic drugs.

Legal and Safety Considerations:

• Due to its abuse potential, some regions regulate the sale of products containing DXM, especially to minors.
• It is important to use DXM only as directed and avoid exceeding recommended dosages.

Conclusion:
Dextromethorphan is a valuable medication for managing coughs safely when used responsibly. However, awareness of its potential for misuse is essential to prevent adverse health consequences.

Dextromethorphan, sold under the brand name Robitussin among others, is a cough suppressant used in many cough and cold medicines.^[6] In 2022, the US Food and Drug Administration (FDA) approved the combination dextromethorphan/bupropion to serve as a rapid-acting antidepressant in people with major depressive disorder.^[7]

It is in the morphinan class of medications with dissociative and stimulant properties (at lower doses). 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.^[8] In its pure form, dextromethorphan occurs as a white powder.^[9]

When exceeding approved dosages, dextromethorphan acts as a dissociative hallucinogen. It has multiple mechanisms of action, including actions as a nonselective serotonin reuptake inhibitor^[10] and a sigma-1 receptor agonist.^[11][12] Dextromethorphan and its major metabolite dextrorphan also block the NMDA receptor at high doses, producing effects similar to those of other dissociative anesthetics such as ketamine, nitrous oxide, and phencyclidine.