Dextromethorphan Can Produce a High When Taken in High Doses

Yes, patients can get high on dextromethorphan when taken at doses significantly higher than therapeutic recommendations. 1, 2

Therapeutic Use vs. Recreational Abuse

Dextromethorphan (DXM) is an FDA-approved cough suppressant that temporarily relieves cough due to minor throat and bronchial irritation 3
At therapeutic doses (30-60 mg), DXM is safe and effective for cough suppression 4
When consumed at inappropriately high doses (over 1500 mg/day), DXM can induce psychosis characterized by PCP-like psychological symptoms, including delusions, hallucinations, and paranoia 1
This recreational abuse of DXM is known as "Robotripping" and has become increasingly prevalent, especially among younger adolescents 5, 6

DXM is a synthetic analogue of codeine that acts centrally to suppress the cough reflex 4
At high doses, DXM produces dissociative effects similar to PCP, including sensory enhancement and hallucinations 7
The major active metabolite, dextrorphan (DXO), contributes significantly to the psychoactive effects 2
Genetic variations in metabolizing enzymes can result in large inter-individual variability in the pharmacological and toxicological effects produced 2

First plateau (100-200 mg): Mild stimulation similar to marijuana effects 5
Second plateau (200-400 mg): Euphoria and hallucinations 5
Third plateau (400-600 mg): Dissociative effects and impaired motor function 5
Fourth plateau (>600 mg): Complete dissociation, out-of-body experiences, and potentially dangerous physical effects 5, 6

Psychomotor agitation, hallucinations, and paranoia characterized as Intoxication Delirium 5
Poor psychomotor performance on standardized field sobriety tests 7
Horizontal and vertical gaze nystagmus 7
Overall signs of central nervous system depression 7
In severe cases, symptoms may persist and require treatment with antipsychotics and mood stabilizers 1

DXM is readily available over-the-counter and relatively inexpensive 1
It is not detected on standard urine drug screens, making it an under-recognized cause of substance-induced psychosis 1
With chronic use, tolerance and withdrawal have been noted along with prolonged psychiatric sequelae 5
DXM abuse is particularly concerning in younger populations (16-20 years) who may be at higher risk for broader substance abuse patterns 6, 7

Some states have begun to limit the quantity of DXM sold or restrict sales to individuals over 18 years of age, though there is currently no federal ban or restriction 1
Early identification and treatment of DXM abuse may be important in preventing broader substance abuse, particularly in younger adolescents 6
Severely intoxicated patients may require significant medical attention, though most cases improve with supportive care alone 6

Healthcare providers should be aware of the potential for DXM abuse, especially when prescribing or recommending cough medications 1, 6
When used as directed for cough suppression (30-60 mg), DXM has a superior safety profile compared to opioid alternatives 4
For therapeutic use, standard over-the-counter dosing is often subtherapeutic, with maximum cough reflex suppression occurring at 60 mg 4