Dextromethorphan, or DXM, is a cough suppressant that is an ingredient in over-the-counter (OTC) cold medications. When people take DXM in high doses, it can cause hallucinations and feelings of euphoria. However, overdosing on DXM can be dangerous.

When people take the correct dosage of a cough medication, DXM does not pose a risk. However, some people misuse it in the hope of achieving a “high.” In these cases, the side effects can be severe.

Read on to learn more about DXM, its effects, and how to recognize when someone is misusing it.

DXM is a drug in many OTC cold and cough medications. It is an antitussive – meaning a cough suppressor – that helps a person stop coughing by blocking the cough reflex in their brain.

With correct use, experts consider medications that contain DXM to be safe. Many pharmacies and supermarkets sell medications containing DXM. These are available in many forms, including:

  • tablets
  • cough syrups
  • capsules

DXM is neither illegal nor a controlled substance in the United States because it has legitimate health uses and is not meant for recreational use.

People may use various street names for DXM, including:

  • CCC
  • Dex
  • Poor Man’s PCP
  • Robo
  • Rojo
  • Skittles
  • Triple C
  • Velvet
  • Orange Crush
  • Red Devils

People may misuse DXM in several ways. Traditionally, DXM misuse involved drinking large amounts of cough syrup. However, DXM medications are now available in tablet or capsule form, making it easier for a person to ingest large quantities of the drug.

A person can also obtain DXM in powder form on the internet, which they may snort through the nostrils. Buying DXM powder online is very dangerous, as a person may not know what the powder actually contains.

The amount of DXM a person requires to feel a high can depend on their body weight. The recommended medicinal dose of DXM for an adult is 15⁠ – ⁠30 milligrams (mg) three or four times a day. However, a person who wants to use DXM to get high may take 250⁠ – 1,500 mg in a single dose.

There are many different terms for misusing DXM, such as:

  • robotripping
  • skittling
  • dexing
  • robodosing
  • robofizzing

When a person takes DXM at the dosage that a doctor or pharmacist has recommended, it rarely has side effects.

However, in large quantities, DXM can produce serious and possibly dangerous side effects.

The Drug Enforcement Administration (DEA) provides a table identifying the effects of DXM at different doses:

Additionally, the DEA notes that high doses of DXM can produce various side effects, such as:

  • confusion
  • inappropriate laughter
  • agitation
  • paranoia
  • sensory changes, such as the feeling of floating
  • overexcitability
  • tiredness
  • slurred speech
  • sweating
  • high blood pressure
  • nausea
  • vomiting
  • involuntary eye movements

Research from 2021 notes that at doses of 600 mg or more, DXM can cause complete disassociation and coma. The researchers also state that overdosing on DXM can cause:

  • seizures
  • increased heart rate of more than 100 beats per minute
  • psychosis
  • dilated pupils
  • difficulty breathing
  • rhabdomyolysis, a breakdown of muscle tissue that can lead to kidney failure

In some cases, it can even be fatal.

Emergency room staff can generally treat most DXM overdoses successfully. The DEA notes that the majority of DXM-related deaths are due to mixing the drug with other substances, such as alcohol.

If a person is misusing DXM, they exhibit certain signs or behaviors. Anyone with concerns that a person they know is misusing DXM can look out for the following signs:

  • loss of interest in activities or hobbies
  • empty cough and cold medication containers
  • medicinal smells
  • declining grades in adolescents
  • loss of coordination
  • slurred speech
  • agitation
  • hallucinations
  • dizziness

The National Capital Poison Center states that people aged 12–25 years account for approximately half of DXM-related emergency room visits each year. This may be due to its availability, as well as online information on how to “trip” successfully on DXM.

Although it is not an illegal substance, at least 12 states have legislation that prohibits the sale of medication containing DXM to people under the age of 17 years.

A person can help prevent their child from misusing DXM by talking with them about its harmful effects. The Substance Abuse and Mental Health Services Administration suggests doing the following when talking with a child about drug or alcohol use:

  • letting them know that drug misuse is something people disapprove of
  • being compassionate and letting them know that their health and safety are important
  • providing a safe space where they can speak about any concerns or questions they have about drug use
  • providing them with information on drug misuse and its effects
  • addressing the issue of peer pressure and discussing how to say no

Anyone misusing DXM who wishes to stop should speak with a doctor. The doctor can offer advice on what treatments may work best for them.

A person who has been misusing DXM for an extended period may experience withdrawal symptoms once they stop taking it. During the first week of DXM withdrawal, the symptoms can include:

Over the next 3 weeks, a person coming off DXM may experience:

Withdrawal symptoms can make coming off DXM difficult. However, it is important that a person stays strong during this time. A doctor may be able to provide a person with medications to help with withdrawal symptoms.

Therapy can be beneficial for a person with a substance use disorder. The National Institute on Drug Abuse suggests the following forms of therapy:

  • Cognitive behavioral therapy (CBT): CBT can help a person identify and avoid any triggers for their drug use. This can mean avoiding certain people or places.
  • Multidimensional family therapy: This form of therapy helps adolescents who have a drug addiction, as well as their families. It aims to explore any patterns of drug misuse in the family and improve family functioning.
  • Contingency management: Contingency management uses positive reinforcements to help a person stop using drugs.
  • Motivational interviewing: This form of therapy helps encourage and motivate a person to abstain from drugs.

If a person experiences serious side effects after misusing DXM, they should seek emergency medical help. It is possible to treat DXM overdoses successfully with supportive care.

Once a person has received successful treatment for a DXM overdose, they can generally go home if they have no symptoms after 6 hours.

People with complications may need to stay in an intensive care unit until they recover. Examples of complications include rhabdomyolysis, in which the death of skeletal muscle tissue releases substances that cause kidney failure into the blood, and an abnormally high body temperature.

DXM can cause a person to develop psychosis. This can lead to suicidal thoughts or violent outbursts. A person who develops psychosis following DXM misuse may require psychiatric help.

DXM is a drug that is an ingredient in many OTC cough and cold medications. DXM is safe to take in the recommended dosages. A person can take DXM in various forms, such as syrup, tablets, or powder.

People who misuse DXM take large doses to experience a high. This can be dangerous and lead to serious side effects, such as coma, psychosis, or death.

If a person has concerns that someone they know is misusing DXM, they can look out for certain signs. A person may be able to help prevent their child from taking DXM by speaking with them about its dangerous effects.

Anyone who is misusing DXM and wishes to stop should speak with a doctor, who can offer advice on the best treatment approach.

If a person experiences any serious side effects when taking DXM, they should seek immediate medical help.

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