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

Dear Anonymous, Reader, and robocop,

It's great that you're asking questions about what is in common over-the-counter (OTC) medicines! A common active ingredient in NyQuil, Robitussin, and other cough suppressants is the ingredient dextromethorphan or DXM. This works to reduce cough when used as indicated on the label. So, why might someone use a cough suppressor recreationally? Consuming DXM in very large amounts, known as “robo-tripping”, “dexing”, or “going pharming,” induces a high of visual and auditory effects similar to taking ketamine or phencyclidine (PCP). When used as directed, medications with DXM can often be effective OTC treatments for cold and flu symptoms. However, using it by taking higher doses than what’s recommended or combined with other substances can pose a host of short and long-term health risks, including death in some cases. 

DXM works directly on the brain to suppress coughing. By taking doses of DXM higher than recommended, those same mechanisms activated to stop coughing are amplified and may cause mildly euphoric and stimulating effects similar to other drugs some people use recreationally. The effects of DXM resemble ketamine and PCP since they’re all N-methyl-D-aspartate (NMDA) receptor agonists, meaning they all block NMDA receptors in the brain in the same way. When these receptors are blocked, it may cause an out-of-body experience and psychosis. However, unlike PCP and ketamine, DXM isn’t currently detectable on a standard drug screening. Before you head over to the drug store, be aware that in addition to the buzz, the potential risks of taking DXM include:

Short-term effects (which may vary with the amount taken and are temporary):

• Confusion
• Drowsiness
• Rapid heartbeat
• Blurred or double vision
• Numbness in fingers and toes
• Impaired motor control
• Dizziness
• Nausea, vomiting, and other abdominal pain
• Hallucinations
• Seizures

Long-term effects (these may vary with frequency of misuse):

• Liver damage
• Kidney damage
• Becoming addicted to DXM
• Learning and memory impairment
• Death

While misusing DXM by itself can be risky, using it with other drugs, alcohol, or anti-depressants can pose harmful and potentially fatal consequences. In some medicines, DXM is combined with other active ingredients, especially in medicines that relieve multiple cold and flu symptoms. Depending on the type of cold and flu medicine you buy, it may contain acetaminophen (a pain reliever and fever reducer), pseudoephedrine (a nasal decongestant), guaifenesin (an expectorant or mucus-thinner), or chlorpheniramine (stops allergy symptoms). These ingredients each pose health risks depending on the frequency of abuse, the amount taken, and other drugs (prescription or recreational) that you’re taking simultaneously. When taken with alcohol or certain types of antidepressants (such as selective serotonin reuptake inhibitors and monoamine oxidase inhibitors), the effects of DXM and DXM in combination with other substances can be amplified, and potentially lethal. Consumption in extreme quantities (referred to as DM toxicity) with antidepressants can lead to serotonin syndrome or an overproduction of serotonin, with symptoms such as rapid heartbeat, high fever, and loss of consciousness.

Misusing medications with DXM or DXM combinations once or twice, assuming you aren't on an antidepressant, drinking alcohol, or also taking other drugs, may not cause severe health consequences. However, making a habit of it could certainly result in some health concerns, all of which aren’t yet fully understood. The best bet is to take cold and flu medications as directed to relieve your cold symptoms.

If you were looking into different ways to experience a high, you may also consider other ways that come with fewer potential risks. The Q&A Natural highs may help to share more info about experiences that can elicit similar feelings without the health risks. If you’re concerned about your use of DXM (or with drugs of any kind), you may want to speak to a mental health professional or health care provider to learn more about how you can get support. That being said, in an emergency with suspected overdoses of any substance, it’s best to seek immediate medical attention — the risks of DXM are nothing to sneeze… er, cough at.