From the Guidelines
Taking dextromethorphan with an SSRI is not recommended due to the risk of serotonin syndrome, a potentially life-threatening condition. This is because both medications affect serotonin levels in the brain, with SSRIs blocking its reuptake and dextromethorphan inhibiting serotonin reuptake and having other serotonergic effects 1. The combination of these medications can cause excessive serotonin levels, leading to symptoms such as mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity.
Some key points to consider when taking an SSRI and considering a cough suppressant include:
- Avoiding dextromethorphan-containing cough medicines like Robitussin DM and NyQuil
- Considering alternative cough remedies such as guaifenesin, throat lozenges, honey, or increased fluid intake
- Consulting a healthcare provider before taking any cough suppressant while on an SSRI, as they may recommend a specific product or dosage that minimizes risk
It's essential to prioritize caution when combining medications that affect serotonin levels, as the risk of serotonin syndrome is a serious concern. As noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders, serotonin syndrome can be triggered by combining serotonergic medications, and treatment requires hospital-based care and discontinuation of all serotonergic agents 1.
In terms of specific alternatives, guaifenesin is an expectorant that can help loosen mucus and make it easier to cough up, without the risk of serotonin syndrome. Throat lozenges and honey can also help soothe a sore throat and reduce coughing. Increased fluid intake can help thin out mucus and make it easier to expel. If cough suppression is necessary, a healthcare provider may recommend a specific product or dosage that minimizes the risk of serotonin syndrome.
From the Research
Safety of Taking Dextromethorphan with an SSRI
- The safety of taking dextromethorphan, a cough suppressant, with a Selective Serotonin Reuptake Inhibitor (SSRI) is a concern due to the potential risk of serotonin syndrome, a potentially life-threatening condition [(2,3,4,5,6)].
- Studies have shown that taking supra-therapeutic doses of dextromethorphan with a therapeutic amount of an SSRI can increase the risk of serotonin syndrome 2.
- However, the risk of serotonin syndrome is considered low when taking therapeutic doses of dextromethorphan with an SSRI 2.
- It is essential to be aware of the potential risks and monitor for signs of serotonin syndrome, such as agitation, confusion, and autonomic instability, when taking dextromethorphan with an SSRI [(3,4,5,6)].
Cases of Serotonin Syndrome
- There have been reported cases of serotonin syndrome after taking dextromethorphan, including cases where the individual was also taking an SSRI [(2,3,4,5,6)].
- These cases highlight the importance of being cautious when taking dextromethorphan with an SSRI and monitoring for signs of serotonin syndrome [(2,3,4,5,6)].
Treatment of Serotonin Syndrome
- In cases of serotonin syndrome, treatment may involve administering intravenous lipid emulsion, propofol, or other medications to manage symptoms [(4,6)].
- It is crucial to seek medical attention immediately if signs of serotonin syndrome occur when taking dextromethorphan with an SSRI [(2,3,4,5,6)].