Dextromethorphan

Dextromethorphan (DXM or DM) is a medication most often used as a cough suppressant in over-the-counter cold and cough medicines. It is sold in syrup, tablet, spray, and lozenge forms. Dextromethorphan (DXM or DM) is a medication most often used as a cough suppressant in over-the-counter cold and cough medicines. It is sold in syrup, tablet, spray, and lozenge forms. It is in the morphinan class of medications with sedative, dissociative, and stimulant properties (at lower doses). In its pure form, dextromethorphan occurs as a white powder. DXM is also used recreationally. When exceeding approved dosages, dextromethorphan acts as a dissociative anesthetic. It has multiple mechanisms of action, including actions as a nonselective serotonin reuptake inhibitor and a sigma-1 receptor agonist. DXM and its major metabolite, dextrorphan, also act as an NMDA receptor antagonist at high doses, which produces effects similar to, yet distinct from, the dissociative states created by other dissociative anesthetics such as ketamine and phencyclidine. It was patented in 1949 and approved for medical use in 1953. The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), as well as those resulting from inhaled particle irritants. However, controlled studies have found the symptomatic effectiveness of dextromethorphan similar to placebo. In 2010, the FDA approved the combination drug dextromethorphan/quinidine for the treatment of pseudobulbar affect (uncontrollable laughing/crying). Dextromethorphan is the actual therapeutic agent in the combination; quinidine merely serves to inhibit the enzymatic degradation of dextromethorphan and thereby increase its circulating concentrations via inhibition of CYP2D6. In 2013, a randomized clinical trial was conducted at Tabriz University of Medical Sciences in Tabriz, Iran, that indicated dextromethorphan may help reduce the overall discomfort and duration of withdrawal symptoms associated with opioid use disorder. When combined with clonidine, dextromethorphan reduced the overall time needed for withdrawal symptoms to peak by 24 hours while also reducing the severity of the symptoms compared to Clonidine alone. In 2016, the ASA released a promising study with the combination of dextromethorphan with pregabalin, acetaminophen, and naproxen which showed a decrease in postoperative pain intensity (preemptive analgesia). Because dextromethorphan can trigger a histamine release (allergic reaction), atopic children, who are especially susceptible to allergic reactions, should be administered dextromethorphan only if absolutely necessary, and only under the strict supervision of a healthcare professional.