title: Dextromethorphan abuse: clinical effects and management.
abstract: OBJECTIVE
  To describe the epidemiology, patient presentation, and clinical management associated with dextromethorphan (DM) abuse.
  
  
  METHODS
  PubMed/Medline search using terms dextromethorphan and abuse through July 2008, bibliographies of selected publications, epidemiology tracking databases.
  
  
  METHODS
  By the authors.
  
  
  METHODS
  English language-published review articles, clinical trials, and case reports that described the epidemiologic and toxicologic profile of DM were included.
  
  
  RESULTS
  DM is a relatively inexpensive and easily accessible over-the-counter (OTC) medication intended for use as an antitussive. Increasingly, illicit use of the drug has been reported. At clinical doses, the drug produces few adverse effects. However, when abused in large quantities (>2 mg/kg), the drug has been associated with a dissociative effect similar to those described by ketamine and phencyclidine abusers. Massive ingestions of the drug may be associated with untoward effects, including tachycardia, hypertension, and respiratory depression. Overdose symptoms may also be associated with coformulated products such as antihistamines and sympathomimetic amines. Management is primarily supportive. Naloxone has been used to manage DM toxicity but with conflicting reports of effectiveness.
  
  
  CONCLUSIONS
  Recent reports indicate that DM is often abused by individuals seeking its dissociative effects. Clinicians should be aware of the abuse potential of DM. Pharmacists might be particularly cognizant of the risks involved with DM abuse as they control OTC access to the drug.
authors.affiliation: Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY 40536, USA. froma2@uky.edu
authors.forename: Frank
authors.initials: F
authors.lastname: Romanelli
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Smith
mesh_terms: D000818:Animals; D003915:Dextromethorphan / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006801:Humans; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015813:Substance Abuse Detection
chemical_list: D003915:Dextromethorphan