Short communicationSide effects of dextromethorphan abuse, a case series
Introduction
Dextromethorphan (DXM), the d-isomer of the opiate agonist Levorphanol, is a highly effective and widely used antitussive drug. This drug has been used from 1960s and it has been in use for more than 40 years (Cranston & Yoast, 1999, Roberge et al., 1999). It is a non-competitive receptor anatagonist of the N-methyl-d-aspartate (NMDA) type of excitatory amino acid receptors that are involved in neuronal development and migration (Jahng, Zhang, Lee, & Kim, 2001).
It is a very safe drug and adverse drug reactions are reported infrequent and usually not severe by Bem and Peck (1992), Farfel and Seiden (1995), Ziaee, Akbari, Hoshmand, and Saman (in press). No randomized trial has yet examined the safety of DXM in such high doses but Andaloro, Monaghan, and Rosenquist (1998) showed that all classes of NMDA-receptor-antagonists induce embryonic death and congenital defects of the neural crest and neural tube.
DXM is not an addictive drug, but it is abused in addicted people, frequently. Abusers sometimes mix it with heroin, morphine and opiate or other substances abused to increase the pharmacological effects and decrease dependency to the mentioned drugs (Cranston & Yoast, 1999, Jasinski, 2000). Bidaga, Gianelli, and Popik (1997) showed that DXM probably decrease opiate withdrawal symptoms in heroin users undergoing detoxification. Also, it usually produces a substance dependence syndrome, that causes psychological dependency and not physical. It similar to other synthetics associated with the morphine line of chemistry has an extensive abuse potential (Murray & Brewerton, 1993).
Although a few cases of recreational abuse have been reported in the last 3 decades, an increased report of abusing the drug by adolescents and young adults is seen in literature (Darboe et al., 1996, Wolfe & Caravati, 1995, Yoo et al., 1996).
Dextromethorphan, alone or in combination with other drugs is widely available over-the-counter in Iran and during recent years abuse of DXM by Iranian young adults and adolescents has been registered (Ziaee et al., in press).
In this study, we intended to set exploring adverse effects resulting from consuming DXM by Iranian young adults without any medical indication as a licit drug.
Section snippets
Subjects and methods
Subjects were 58 volunteers between 18 and 30 years old who had consumed DXM at least one time from March 2002 to December 2003 without any medical indication. This study employed a case series design to investigate the DXM abuse side effects. Measures are according to participants' self reports of their symptoms. Individuals were excluded if they had current psychiatric diagnosis requiring psychiatric treatments.
The questionnaire included fifty items, some of which related to DXM effects
Results
Forty-eight males and five females participated in this study. The mean age of subjects was 23.4 years (range: 20–28 years old, SD = 1.83). Nine subjects (18.9%) did not have a history of consuming DXM for any medical purpose and other subjects had used DXM for chronic cough and cold with physician's prescription.
Twenty-nine subjects (54.7%) abused DXM more than 10 times and twenty-eight subjects (52.8%) had history of DXM abuse for more than 3 years. The mean of frequency of DXM abuse was 25.5
Discussion
Our purpose in this study was to assess adverse effect of DXM in young adult abusers. DXM is absorbed quickly from the gastrointestinal tract; (within 30 min) and its duration of effects is about 3–6 h (half-life of about 2–4 h) (Shaul, Wandell, & Robertson, 1977). So after DXM abuse, many side effects especially gastrointestinal adverse effect are seen during a few hours and it is more common than in the future days. Despite frequent consumption of DXM by our patients, they did not have to
Conclusion
Dextromethorphan abuse is a potential social problem in the future and availability of DXM over the counter to all age groups must be revised.
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