Dextromethorphan withdrawal and dependence syndrome.
BACKGROUND
The N-methyl-D-aspartate (NMDA) antagonist dextromethorphan has been available in pharmacies without a prescription since 1954 as an antitussive agent. There is an alarming increase in reports of its abuse. Dextromethorphan is avidly taken, mainly by young people, as a psychoactive drug. The currently available data yield incomplete information about the extent of the problem and its significance for addiction medicine in Germany.


METHODS
We report the case of a 44-year-old man who became dependent on dextromethorphan through years of abuse, buying the substance for himself without a prescription in German pharmacies. He told us he had taken it regularly for six years. He had become dependent on dextromethorphan, ultimately taking it in a dose of 1800 mg daily. This led him to overt neglect of his work and leisure activities. A urine sample taken on admission to the hospital was found to contain dextromethorphan. During inpatient detoxification, he developed an vegetative withdrawal syndrome consisting of craving, diaphoresis, nausea, hypertension, and tachycardia. He was treated on our ward for three weeks, and a stay in a residential detoxification facility was planned thereafter.


CONCLUSIONS
Dextromethorphan is a psychotropic substance that carries a potential for abuse and dependence. On the basis of the currently available data, its reclassification as a prescription drug should be considered.
Mutschler
Jochen
J
Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg. jochen.mutschler@puk.zh.ch
Koopmann
Anne
A
Grosshans
Martin
M
Hermann
Derik
D
Mann
Karl
K
Kiefer
Falk
F
D000328:Adult; D000437:Alcoholism / Q000534:rehabilitation; D000996:Antitussive Agents / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003915:Dextromethorphan / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D018691:Excitatory Amino Acid Antagonists / Q000009:adverse effects; D006801:Humans; D008297:Male; D010343:Patient Admission; D012047:Rehabilitation Centers; D015813:Substance Abuse Detection; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D013695:Temperance
D000996:Antitussive Agents; D018691:Excitatory Amino Acid Antagonists; D003915:Dextromethorphan