Medical uses Edit

Generic dextromethorphan cough syrup. Cough suppression Edit The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), as well as those resulting from inhaled particle irritants.[8] However, controlled studies have found the symptomatic effectiveness of dextromethorphan similar to placebo.[9] Neuropsychiatric disorders Edit In 2010, the FDA approved the combination drug dextromethorphan/quinidine for the treatment of pseudobulbar affect (uncontrollable laughing/crying). Dextromethorphan is the actual therapeutic agent in the combination; quinidine merely serves to inhibit the enzymatic degradation of dextromethorphan and thereby increase its circulating concentrations via inhibition of CYP2D6.[10] In 2016, the ASA released a promising study with the combination of dextromethorphan with pregabalin, acetaminophen, and naproxen which showed a decrease in postoperative pain intensity (preemptive analgesia).[11]

Contraindications Edit

Because dextromethorphan can trigger a histamine release (allergic reaction), atopic children, who are especially susceptible to allergic reactions, should be administered dextromethorphan only if absolutely necessary, and only under the strict supervision of a healthcare professional.[12]

Adverse effects Edit

Overdose Edit

Interactions Edit

Dextromethorphan should not be taken with monoamine oxidase inhibitors (MAOIs)[12] due to the potential for serotonin syndrome, which is a potentially life-threatening condition that can occur rapidly, due to a buildup of an excessive amount of serotonin in the body. Caution should be exercised when taking dextromethorphan when drinking grapefruit juice or eating grapefruits, as compounds in grapefruit affect a number of drugs, including dextromethorphan, through the inhibition of the cytochrome p450 system in the liver, and can lead to excessive accumulation and prolonged effects. Grapefruit and grapefruit juices (especially white grapefruit juice, but also including other citrus fruits such as bergamot and lime, as well as a number of noncitrus fruits[17]) generally are recommended to be avoided while using dextromethorphan and numerous other medications.

Pharmacology Edit

Chemistry Edit

History Edit

Society and culture Edit

Marketing Edit It may be used in generic labels and store brands, Benylin DM, Mucinex DM, Camydex-20 tablets, Robitussin, NyQuil, Dimetapp, Vicks, Coricidin, Delsym, TheraFlu, Charcoal D, Cinfatós and others. It has been used in counterfeit medications.[42] Recreational use Edit Main article: Recreational use of dextromethorphan Dextromethorphan gel capsules Over-the-counter preparations containing dextromethorphan have been used in manners inconsistent with their labeling, often as a recreational drug.[36] At doses much higher than medically recommended, DXM and its major metabolite, dextrorphan, acts as an NMDA receptor antagonist, which produces dissociative hallucinogenic states somewhat similar to ketamine and phencyclidine.[43] Along with other drugs such as ketamine or phencyclidine, also known as PCP, there is a street name for dextromethorphan-infused substances which is also known as "Angel". It may produce distortions of the visual field – feelings of dissociation, distorted bodily perception, excitement, and a loss of sense of time. Some users report stimulant-like euphoria, particularly in response to music. Dextromethorphan usually provides its recreational effects in a non-linear fashion, so that they are experienced in significantly varied stages. These stages are commonly referred to as "plateaus". These plateaus are labeled between one and four, one being the lowest and so on. Each plateau is said to come with different related effects and experiences.[44] Teens tend to have a higher likelihood to use dextromethorphan-related drugs as they are easier to access, and an easier way to cope with psychiatric disorders.[45]

Research Edit

Dextromethorphan/quinidine is also under investigation for the treatment of a variety of other neurological and neuropsychiatric conditions besides pseudobulbar affect, such as agitation associated with Alzheimer's disease and major depressive disorder.[10]

See also Edit