Dextromethorphan (DXM) and Alcohol: a Dangerous Interaction

Dextromethorphan (DXM) is the most popular cough suppressant sold in the United States.

Robitussin is a popular brand for cough suppressants. Some, but not all, of their products contain DXM.

According to the National Capital Poison Center, more than 6,000 people visit emergency rooms from DXM toxicity or overdose annually.

DXM is commonly misused with alcohol. A 2018 report found 1 in 30 teens misuse DXM, and 6 in 10 teens misuse alcohol. Seventeen percent of 12th graders reported binge drinking in 2017.

Drinking alcohol with DXM increases the risk of toxicity and can cause serious health problems.

What is DXM?

DXM is a common cough suppressant. It’s been around since 1958. More than 100 different cough and cold products have it, including some from Robitussin. DXM works by curbing the cough reflex in the brain to reduce coughing.

The maximum daily recommended dose of DXM is 120 milligrams (mg) taken in divided doses. At recommended doses, DXM is safe with few side effects.

When DXM is misused, larger doses are taken to get a “high” or hallucinogenic effect.

Effects of DXM

DXM is one of the most common over-the-counter (OTC) products adolescents misuse.

You may think DXM is relatively safe since it’s available OTC. But a lot of these cough and cold products have other ingredients in them, like acetaminophen, antihistamine, and guaifenesin. These can cause a buildup of side effects, which can be dangerous.

The effects of an overdose are similar to ketamine or phencyclidine (PCP), causing a floating or out-of-body sensation. Higher doses gradually increase health risks.

Depending on the dose taken, the effects may last for 6 hours. When used with alcohol, the effects last longer. We’ll discuss why that might happen a little later.

“Robo-tripping” is a slang term for misusing DXM cough medicine. The drug is sometimes mixed with soda or candy to mask the unpleasant taste of cough syrup.

Some other popular names for DXM misuse include:

• robo-dosing
• candy
• skittles
robo
• tussin
• triple C
• red devils
• velvet
• vitamin D
• dexing

Short-term side effects

Some common side effects of DXM misuse include:

• dizziness
• drowsiness
• dry mouth
• fast heart rate
• headache
• nervousness or restlessness
• nausea and vomiting
• upset stomach, diarrhea, or constipation

Long-term side effects

Long-term heavy use of DXM can cause toxicity and tolerance to the drug. Tolerance means you need more of a substance to feel its effects.

Severe reactions from DXM overdose can include:

• difficulty speaking and confusion
• trouble with vision and coordination
• slow breathing
• dangerous drop in body temperature
• pale or blue in the face
• seizures
• hallucinations, mania, and paranoia
• increased heart rate
• sweating
• nausea and vomiting
• tremor
• agitation

This isn’t a full list of all side effects. Check with your doctor or pharmacist if you’re experiencing side effects from DXM use.

In some cases, DXM overdose can result in death. If you or someone you know has taken DXM and is experiencing any of the above symptoms, call 911 immediately.

Effects of alcohol

Moderate social drinking is common and accepted around many parts of the world.

But binge drinking, which means having too many drinks in one sitting, can harm your body in many ways. Immediate reactions can include problems with balance, movement, and judgment.

According to the National Institute on Alcohol Abuse and Alcoholism, excess alcohol consumption can cause problems with many of our biggest organs, like the:

• heart
• brain
• liver
• kidneys

What happens when you mix DXM and alcohol?

Both DXM and alcohol have depressant effects on the brain. That means taken together, they have a more powerful impact.

They both dull your senses and slow down your coordination and judgment. Mixing the two can also cause severe nausea and vomiting, sometimes lasting for hours.

Side effects of DXM and alcohol can last for several days, depending on the person and the drug mix.

Both can affect your breathing. In severe overdose, it can lead to death from respiratory failure, which means you stop breathing.

Interactions and side effects

How strongly you react to using both alcohol and DXM together depends on many factors, including your:

age
• genetics
sex
• existing health problems
• other drugs used together

Co-use can increase the common side effects of both, like becoming dizzy or drowsy, and increased heart rate.

One of the biggest risks with DXM and alcohol co-use is the potential for additional harmful effects and stress on the liver. The side effects of DXM are stronger when taken with alcohol.

Quite a few cold and cough medicines that have DXM also have acetaminophen, the active ingredient in Tylenol. Overdosing on these multi-ingredient products increases the risk of liver toxicity and liver failure.

Your body can develop tolerance to DXM and alcohol with continued use. This means your body gets used to them, and you need higher doses to get the same results.

Your risk for overdose increases the more you take of either substance, because your liver gets overworked trying to metabolize them. You might also experience withdrawal symptoms if you suddenly stop taking them.

Pregnancy risks

While risks for alcohol use during pregnancy are well known, the effects of DXM use in pregnancy aren’t clear. But large doses of DXM with binge drinking can increase health problems for both the mother and fetus.

Before using any OTC cough or cold products, always check with your doctor.

Avoid using alcohol combined with DXM during pregnancy.

Precautions

Other medications and drugs can interact with DXM and alcohol, increasing harmful effects on the body. These include stimulant drugs like amphetamines and depressant drugs like benzodiazepines.

High doses of DXM can cause dangerous drug interactions with monoamine oxidase inhibitors (MAOIs). This is a class of medications used to treat depression.

Using them together increases the risk of serotonin syndrome, which can raise blood pressure and heart rate to unsafe levels. Alcohol can increase these risks.

Other antidepressant drugs that can interact and cause serotonin syndrome are:

• fluoxetine
• paroxetine

Signs of misuse

Some signs of misuse include:

• drowsiness
• slurred speech
• pinpoint pupils
• balance or movement problems

Signs of overdose include:

• breathing difficulty
• turning blue in the face

Substance use disorder, or addiction, is more serious and complicated than one- time misuse. It’s the repeated use of a drug despite negative consequences. Many factors go into why someone may develop a substance use disorder. This includes:

• genetics
sexage
• environmental
• social reasons

Some signs of a substance use disorder can include:

• changes in behavior, sleep, and mood
• losing interest in daily life and relationships
• not able to focus on work or other regular activities
• cravings
• tolerance
• withdrawal symptoms

Where to get help

If you suspect a DXM or alcohol overdose, call 911 immediately.

Rehabilitation programs (inpatient or outpatient), therapy, support groups, or a combination of all three can help people recover from a substance use disorder. In some cases, medications can also help, like for alcohol use disorder. There are no medications that treat DXM addiction.

If you or someone you know has a substance use disorder, these organizations can offer confidential, free support and treatment referral:

• Alcoholics Anonymous
• SAMHSA Treatment Provider Locator
• Support Group Project

The bottom line

DXM and alcohol misuse is common. Teens often misuse DXM, mistakenly thinking it’s safer because it’s OTC.

Alcohol and DXM co-use increase the risk of injury to major organs, like the heart and liver.

Talk with your doctor or pharmacist about the risks and interactions of OTC and prescription medications taken with alcohol.

Read more on: addiction, alcohol