What are the long-term effects of tripping on cough medicine?

Dear Anonymous and robocop, 

While many assume that over-the-counter (OTC) medications are always safe, there is a reason health care providers say take as directed. Dextromethorphan (DXM) is a cough suppressant found in many OTC cold medications. It can be sold as a single ingredient or in combination with other drugs like antihistamines and decongestants. When taken in high doses, DXM acts as a dissociative drug, meaning that it can cause you to feel detached from your physical body or environment. Drugs containing DXM became popular because many people believed that they were safer than codeine, which requires a prescription to purchase. However, DXM is derived from opioids and can be habit-forming. Taking too much can also lead to a life-threatening overdose. Over time, regular use of DXM can also cause long-term effects on the brain and body. Curious to know more about the short and long-term effects? Read on! 

What are the short-term effects of using DXM? 

The recommended dosage of DXM for cough relief is 15 to 30 milligrams (mg) every four hours, which produces little to no side effects aside from the anticipated cough suppression. When taken in large doses for non-medical purposes, DXM usually produces effects that start within 30 to 60 minutes and last for around six hours. These may include:  

• Euphoria 
• Impaired motor function 
• Numbness 
• Dissociation 
• Increased heart rate and blood pressure 
• Sweating 
• Visual and auditory hallucinations 
• Confusion 
• Psychosis  

The effects of DXM may depend on how much you take. Taking 100 to 200mg may cause mild to moderate stimulation but taking more than 300mg can cause hallucinations and impaired motor function. At 600mg or more, extreme sedation and dissociation may set in. 

How do set and setting influence the short-term effect of DXM? 

A person’s mood (also known as the “set”) can influence the effects of DXM. For example, ff you feel stressed or anxious before taking a large amount of DXM, you may have an unpleasant experience. Physical environment (the “setting”) can also affect your experience. For example, using DXM in a calmer and familiar environment can contribute to a pleasant experience. On the other hand, using DXM in a noisy and unfamiliar environment may result in a negative experience.  

Can you overdose on DXM? 

Taking too much DXM can cause a life-threatening overdose. A person is more likely to overdose if they take 1500mg or more. That is five to ten times the recommended amount of any OTC medication containing DXM. Symptoms of overdose include:  

• Blurred vision 
• Loss of consciousness 
• Bluish tint under fingernails or on lips 
• Vomiting 
• Hallucinations 
• Convulsions 
• Extreme drowsiness 
• Heart palpitations 
• Hyperexcitability 

Overdosing on DXM is dangerous. It can cause slow breathing, changes in blood pressure, and seizures which can lead to coma or death. If someone is experiencing any of these symptoms after using DXM, you should call for medical assistance. 

What are the long-term effects of DXM? 

Beyond the short-term effects and immediate risk of overdose, using DXM regularly can cause long-term effects on the brain and body. As DXM is habit-forming, using it can lead to dependence, meaning that you may feel as if you need it to get through the day. Without it, you may experience cravings and feelings of withdrawal. You can also build up a tolerance to DXM over time and may need to take larger amounts to get the same effect. Long-term use of DXM can also damage brain function and memory, increase the risk of psychosis, and contribute to liver damage. 

What happens if you mix DXM with other drugs? 

Mixing DXM with other drugs can have unpredictable effects. Alcohol and DXM are both depressants, meaning that they reduce activity in the brain and spinal cord. Taking both together can enhance their effects and increase the risk of overdose, breathing difficulties, vomiting, and unconsciousness. With higher amounts of DXM, even a small amount of alcohol can cause a severe interaction. Mixing DXM with stimulants like ice, speed, or cocaine can also lead to increased heart rate, panic attacks, or heart issues.  

DXM also interacts with some psychiatric medications. Taking DXM with selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants can cause too much serotonin to flood the brain, causing symptoms like agitation, delirium, and seizures. A similar effect can happen when DXM is mixed with MDMA (commonly known as ecstasy). Some cough medications also combine DXM and other drugs such as paracetamol. Using large amounts of DXM mixed with paracetamol can cause liver damage. 

How can you reduce harm when using DXM? 

While it is always recommended to take medications with DXM as directed, if you’re choosing to use DXM recreationally, it’s best to start with a smaller dose and observe how you react. It’s also a good idea to measure the dose to keep track of how much you’ve had. Using it in a comfortable environment with people you trust, without mixing other drugs or alcohol, can also help to reduce negative side effects. If you have liver, heart, or breathing issues, it may be best to refrain from using DXM. 

If you’re a college student, your school may have support programs and services for students who are navigating their relationship with substances. If you’re concerned about your use of DXM, you may want to consider speaking with a mental health professional or health care provider to learn more about how you can get support.   

Take care,