Dextromethorphan (Koffex-DM) Can Be Used to Make Illicit Substances
Yes, dextromethorphan (DXM), the active ingredient in Koffex-DM, can be misused to create illicit effects and is frequently abused for its psychoactive properties when taken in supratherapeutic doses. 1
Abuse Potential of Dextromethorphan
- DXM is widely available as an over-the-counter cough remedy, often combined with antihistamines and/or pseudoephedrine, making it easily accessible for misuse 1
- When taken in amounts exceeding therapeutic recommendations (>2 mg/kg), DXM produces dissociative effects similar to those of ketamine and phencyclidine (PCP) 2
- The practice known as "Robotripping" involves intentional misuse of DXM-containing products to achieve psychoactive effects 1
Pharmacological Mechanism of Abuse
- At supratherapeutic doses, DXM acts as an NMDA receptor antagonist, which underlies its dissociative hallucinogenic effects 3
- These effects mimic other dissociative substances that have high abuse potential 3
- The drug can produce a toxidrome characterized by psychomotor agitation, hallucinations, and paranoia that is best described as Intoxication Delirium 1
Clinical Effects of DXM Abuse
- Acute toxic effects include nausea, restlessness, insomnia, ataxia, slurred speech, nystagmus, mood changes, perceptual alterations, inattention, disorientation, and aggressive behavior 4
- Massive ingestions can lead to serious physiological effects including tachycardia, hypertension, and respiratory depression 2
- Long-term abuse has been associated with cognitive deterioration, as documented in case reports 4
Prevalence and Public Health Impact
- According to the CDC and U.S. Department of Health and Human Services, illicit drug use is a significant public health concern with approximately 8.7% of the U.S. population aged ≥12 years reporting illicit drug use 5
- While specific statistics on DXM abuse are not provided in the guidelines, the increasing misuse places greater numbers of individuals at risk 1
- Abuse appeared to be the most significant hazard identified in spontaneous adverse event reporting for dextromethorphan 6
Management Considerations
- Management of DXM toxicity is primarily supportive 2
- Naloxone has been used to manage DXM toxicity but with conflicting reports of effectiveness 2
- Healthcare providers should be aware of the abuse potential of DXM and monitor for signs of misuse 2
- Pharmacists play a crucial role in controlling OTC access to DXM-containing products 2
Risk of Progression to Other Substances
- Persons who use drugs illicitly often use more than one drug through various routes of administration 5
- Over 50% of those who inject drugs illicitly also use other drugs through means such as inhalation, sniffing, smoking, or ingesting 5
- This pattern suggests that DXM misuse could potentially be part of a broader pattern of substance abuse 5
DXM abuse represents a significant concern due to its accessibility as an OTC medication and its potential for causing serious adverse effects when misused. Healthcare providers should remain vigilant about this form of substance abuse and be prepared to identify and manage cases of DXM toxicity.