Medical Consequences of Over-the-Counter (OTC) Substance Abuse
John Brick in Handbook of the Medical Consequences of Alcohol and Drug Abuse, 2012
Dextromethorphan is a cough suppressant chemically related to opioids, but without significant opioid-like effects. It is especially popular because it is available over the counter. If unable to pay, some shoplift the drug (Boyer, 2004). Reasons suggested for the choice to abuse DXM follow:Availability: licit OTC is more likely than illicit or prescription drug abuse.Approval: cough syrup is more socially acceptable than other substances.Ignorance: less is known about the negative effects possible.Fear: cough syrup is less intimidating than powders, pills, or needles. (Darboe, 1996)
Preventive analgesia and beyond: current status, evidence, and future directions
Pamela E Macintyre, Suellen M Walker, David J Rowbotham in Clinical Pain Management, 2008
Surgical procedures for the four studies using dextromethorphan include upper abdominal surgery,181 colonic surgery,190 laparoscopic cholecystectomy,191 and lower body surgery.192 For all studies, dextromethorphan was administered by the i.m. route as a single bolus dose ranging between 20 and 120 mg, either before surgery,89, 190, 191 or before versus during surgery.181 Intramuscular dextromethorphan resulted in a preventive effect in three89, 190, 191[II] of the four studies; pain intensity was significantly lower between 24 hours190, 191[II] and three days89[II] after a single bolus dose of i.m. dextromethorphan. The one study181 that did not find a preventive effect did, however, show a short-term preemptive effect in that total patient-controlled analgesia (PCA) opioid consumption, as well as pain at rest and after movement six hours after surgery, were significantly lower in the group that received dextromethorphan 30 minutes before surgery versus 30 minutes before the end of surgery.
Infectious Disease: Upper Respiratory Infections and Otitis Media
Hilary McClafferty in Integrative Pediatrics, 2017
Dextromethorphan was approved by the FDA in 1958 and is a common ingredient in children’s over-the-counter medicines as a cough suppressant. It is a man-made chemical with similarities to opioids, but is non-addictive. American Academy of Pediatrics policy statements have raised concerns about dextromethorphan for decades because ultimately cough suppression is undesirable and often dangerous in children, especially in young children, who rely on their powerful gag reflex to protect their airway. Side effects include: irritability, agitation, and hallucinations (Academy of Pediatrics Committee on Drugs 1997).
Emerging drugs in the treatment of chronic cough
Published in Expert Opinion on Emerging Drugs, 2023
Danica Brister, Mustafaa Wahab, Moaaz Rashad, Nermin Diab, Martin Kolb, Imran Satia
N-methyl-d-aspartate receptors (NMDARs) are present throughout the central nervous system (CNS), are the target for the excitatory neurotransmitter glutamate and are thought to be pivotal for the initiation and maintenance of CNS plasticity in neuropathic pain [80,81]. Blocking NMDARs could therefore be a potential therapeutic target in RCC/UCC. Dextromethorphan, a weak antagonist of NMDARs, is used in many over-the-counter antitussive preparations, but compared with placebo, it reduces acute cough by no more than 17% [82]. Memantine is an approved medication for Alzheimer’s disease and is a low-affinity uncompetitive NMDAR antagonist, preferentially targeting already activated receptors. Importantly, memantine has previously been shown to block experimentally evoked coughs by inhalation of citric acid and bradykinin in conscious guinea pigs [83]. A small open-label feasibility and tolerability dose escalation study in 14 patients with RCC/UCC demonstrated that most patients could not tolerate a dose greater than 10 mg, with a median tolerated duration of only 38.5 days [84]. The most common adverse events reported were dizziness, tiredness, and drowsiness. Although this was not an efficacy study, there no significant improvement in awake cough frequency after treatment with memantine.
Combinations of dextromethorphan for the treatment of mood disorders - a review of the evidence
Published in Expert Review of Neurotherapeutics, 2023
Zamfira Parincu, Dan V. Iosifescu
First patented in 1949, dextromethorphan received FDA approval as a cough suppressant in 1958 and is one of the most common agents found in over-the-counter antitussives. Dextromethorphan has a complex pharmacology: an uncompetitive NMDA receptor antagonist, sigma-1 receptor agonist, serotonin and norepinephrine reuptake inhibitor, and α3β4 nicotinic acetylcholine receptors antagonist [21]. Even though dextromethorphan is structurally similar to opioid agonists, it has no direct activity at opioid receptors and does not exhibit the same CNS pharmacodynamic effects seen in opioid agonists, such as euphoria, respiratory depression, analgesia, dependence, or psychotomimetic properties [21,22]. However, at high doses, dextromethorphan shows similar dissociative properties to ketamine and phencyclidine (PCP), likely due to their shared NMDA receptor antagonism [23,24].
Effect of add-on amantadine to clonidine on opioid withdrawal symptoms in opioid-dependent patients detoxified with buprenorphine: a randomized controlled trial
Published in Journal of Substance Use, 2022
Mahboobe Bahrami, Gholamreza Kheirabadi, Arezoo Safari, Mohammad R Maracy
Memantine, amantadine, and dextromethorphan have been studied to treat opioid dependence. The efficacy of dextromethorphan (75 mg five times a day) in reducing withdrawal symptoms and cravings was validated in single-blind research employing dextromethorphan (75 mg five times a day). Also, it was demonstrated that memantine alone helps reduce subjective withdrawal syndrome symptoms. The authors suggested that memantine be used as an adjuvant medication in treating withdrawal symptoms (Comer & Sullivan, 2007). In a study evaluating amantadine effects on cocaine withdrawal, amantadine was more effective than placebo in alleviating cocaine withdrawal symptoms (King et al., 1994). Other trials have shown that amantadine is effective in reducing cocaine consumption and regulating withdrawal symptoms in cocaine addicts (Huber et al., 1999; Kampman et al., 2006).
Related Knowledge Centers
- Cough
- Stimulant
- Common Cold
- Cold Medicine
- Over-The-Counter Drug
- N-Methyl-D-Aspartic Acid
- Dextromethorphan/Bupropion
- Morphinan
- Sedative
- Dissociative