Is dextromethorphan a form of morphine?
Dextromethorphan (DXM) (d-3-methoxy-N-methyl- morphinan) is the dextro isomer of levomethorphan, a semisynthetic morphine derivative. Although structurally similar to other narcotics, DXM does not act as a mu- receptor opioid (e.g. morphine, heroin).
DXM is a synthetically produced substance that is chemically related to codeine, though it is not an opiate. DXM is an ingredient in more than 140 over- the-counter cough and cold remedies and since the 1950s has gradually replaced codeine as the most widely used cough suppressant in the United States.
Dextromethorphan is in a class of medications called antitussives. It works by decreasing activity in the part of the brain that causes coughing.
Dextromethorphan is a synthetic, methylated dextrorotary analogue of levorphanol, a substance related to codeine and a non-opioid derivate of morphine.
Dextromethorphan is a weak noncompetitive N-methyl-D-as- partate (NMDA) receptor antagonist. It is metabolized in vivo to dextrorphan, a more potent noncompetitive NMDA antagonist that is the dextrorotatory enantiomer of the opioid agonist levorphanol.
Although structurally similar to other morphine derivatives, DXM is a non-narcotic cough suppressant since it is devoid of morphine-like effects [11].
Illicit use of DXM is referred to on the street as “Robo-tripping,” “skittling,” or “dexing,” derived from the products that are most commonly abused, Robitussin and Coricidin HBP.
Symptoms of a dextromethorphan overdose include: Breathing problems, including slow and labored breathing, shallow breathing, no breathing (especially in young children) Bluish-colored fingernails and lips. Blurred vision.
Dextromethorphan, referred to as DXM, is used as a cough suppressant in over-the-counter (OTC) cold and cough medicines. You can purchase it as a syrup, tablet, spray, or lozenges. It belongs to the morphine class of medications and possesses dissociative, stimulant, and sedative properties.
DXM may produce euphoria and mind-altering effects when taken in quantities greater than the recommended treatment dose. People who misuse DXM describe different “plateaus” ranging from mild distortions of color and sound to visual hallucinations and “out-of-body” sensations, and loss of motor control.
How does dextromethorphan compared to codeine?
Dextromethorphan lowered cough intensity to a greater degree than codeine (p less than 0.0008) and was considered the better antitussive by the majority of patients (p less than 0.001).
Although there is controversy about its effectiveness as a cough suppressant, the effects of DXM at high doses are well documented. At high doses, DXM can produce psychedelic symptoms including mania, panic, extreme agitation, and hallucinations.
Dextromethorphan is used to relieve coughs due to colds or influenza (flu). It should not be used for chronic cough that occurs with smoking, asthma, or emphysema or when there is an unusually large amount of mucus or phlegm (flem) with the cough.
Clinical pharmacology experiments indicated that dextromethorphan does not potentiate the euphorigenic and miotic actions of morphine. Morphine suppresses the dysphoric action of dextromethorphan.
Opioids are the only clearly effective centrally-acting anti-tussive drugs and are thought to work by suppressing the brainstem cough center through mu and kappa opioid receptor agonism. They are the first-line symptomatic treatment for severe, distressing cough.
Dextromethorphan is a levorphanol derivative and codeine analog commonly used as a cough suppressant and also a drug of abuse. Although similar in structure to other opioids, it has minimal interaction with opioid receptors.
Dextromethorphan reduces chronic pain by impacting the changes that occur in the nervous system associated with chronic pain. It also appears to reduce opioid tolerance and work synergistically with opioids so that they work more effectively for pain (See neurobiology of dextromethorphan, below.
Avoid taking isocarboxazid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, or tranylcypromine during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication.
Slight drowsiness/dizziness, nausea, or vomiting may occur. Rarely, some people may experience severe drowsiness/dizziness with normal doses.
Dextromethorphan is used to relieve coughs due to colds or influenza (flu). It should not be used for chronic cough that occurs with smoking, asthma, or emphysema or when there is an unusually large amount of mucus or phlegm (flem) with the cough.
What does dextromethorphan do to your brain?
Taking a lot of DXM causes hallucinations and out-of-body sensations similar to the ones caused by drugs like ketamine and PCP. These effects can last as long as 6 hours. DXM also can make users have trouble controlling their limbs and cause blurred vision, slurred speech, dizziness, and impaired judgment.
Adults and children 12 years of age and older—60 mg every twelve hours, as needed. Children 6 to 12 years of age—30 mg every twelve hours, as needed. Children 4 to 6 years of age—15 mg every twelve hours, as needed. Children and infants up to 4 years of age—Use is not recommended .
This medicine can cause changes in heart rhythms, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients.
Usual dose range based on dextromethorphan component: 20 mg PO every 4 hours as needed or 30 mg PO every 6 to 8 hours as needed. Maximum: 120 mg/day of dextromethorphan.
Maximum: 120 mg/day of dextromethorphan. 10 mg of the dextromethorphan component PO every 4 hours as needed. Some products are not intended for use in children under 12 years of age. 5 mg of the dextromethorphan component PO every 4 hours as needed.
Dextromethorphan-Bupropion Effective for Comorbid Anxiety, Major Depressive Disorder. Treatment with AXS-05 rapidly reduces anxiety symptoms in patients with major depressive disorder.
- Mild stimulation or intoxication.
- Euphoria.
- Hallucinations.
- Physical distortions.
- Extreme panic.
- Paranoia.
- Anxiety.
- Aggression.
Insomnia was reported more frequently in those who were given dextromethorphan, and drowsiness was reported more commonly in those who were given diphenhydramine.
DXM is an opioid without effects on pain reduction and does not act on the opioid receptors. When taken in large doses, DXM causes a depressant effect and sometimes a hallucinogenic effect, similar to PCP and ketamine.
Dextromethorphan and carbetapentane: centrally acting non-opioid antitussive agents with novel anticonvulsant properties.
Is dextromethorphan an opioid that can suppress cough?
Dextromethorphan is a medicine that helps stop coughing. It is an opioid substance. Dextromethorphan overdose occurs when someone takes more than the normal or recommended amount of this medicine. This can be by accident or on purpose.
Antidepressants, decongestants, and dextromethorphan (an ingredient in Robitussin, Delsym) are examples of medications that can cause false positive results. If you think you've had a false positive result on a urine drug test, talk to your healthcare provider.
Clinical pharmacology experiments indicated that dextromethorphan does not potentiate the euphorigenic and miotic actions of morphine. Morphine suppresses the dysphoric action of dextromethorphan.
Guaifenesin and hydrocodone combination is used to relieve cough and nasal congestion associated with the common cold. Hydrocodone is a narcotic antitussive (cough suppressant). It acts directly on the cough center in the brain to relieve cough.
Codeine is the most commonly used opioid medication in Canada. It is used to relieve cough and mild to moderate pain but it is addictive when used in high doses and used over a long period of time. The more you use codeine, the more your health is affected.
Dextromethorphan is a cough suppressant. It's usually well-tolerated but mild side effects may include nausea, drowsiness, and dizziness. More serious dextromethorphan side effects include serotonin syndrome. Dextromethorphan misuse is also possible, and this can lead to overdose.
Morphine and diamorphine are very addictive but are useful in treating severe distressing cough in patients with terminal illness such as bronchial carcinoma.
Adults and children 12 years of age and older—5 to 15 mg every two to four hours, as needed. Children 6 to 12 years of age—5 to 15 mg every two to six hours, as needed. Children 4 to 6 years of age—5 mg every four hours, as needed. Children and infants up to 4 years of age—Use is not recommended .
As morphine and codeine are derived from opium poppy seeds, the intake of relatively small amounts of poppy seeds may result in false-positives for opiates, including the consumption of poppy-seed cookies (having ~1 tsp of poppy-seed filling) or poppy-seed bagels.
False-positive opiate tests have reportedly been caused by dextromethorphan, diphenhydramine, quinine, quinolones, rifampin, verapamil, and poppy seeds. In the hopes of testing for medical adherence, some urine drug screens specifically include methadone.