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Substance education guide

Dextromethorphan (DXM)

Over-the-Counter Cough Suppressant & Dissociative at High Doses

Representative photo of Dextromethorphan (DXM)What it looks like
Image: The Drug Users Bible · CC BY 2.0 · Wikimedia Commons. Appearance varies; illicit products may look different or be counterfeit.

01 · How it works

Classification and primary mechanism

Dextromethorphan is a synthetic morphinan derivative, dissociative anesthetic, and non-opioid antitussive. Its active metabolite, dextrorphan, antagonizes NMDA receptors, while DXM also inhibits serotonin reuptake, activates sigma-1 receptors, and blunts norepinephrine reuptake.

02 · Immediate effects

Recognize the effects

Signs of Use

  • Uncoordinated robotic gait
  • Dilated pupils and nystagmus
  • Flushed skin or hives
  • Slurred, disconnected speech
  • Detachment from surroundings

Short Term

  • Dissociation and sensory distortion
  • Visual imagery and altered hearing
  • Increased heart rate and blood pressure
  • Nausea and vomiting
  • Disorientation and loss of pain sensation

Long Term

  • Cognitive and memory impairment
  • Dependence on dissociative effects
  • Liver injury from combination products
  • Persistent perceptual disturbances

03 · Long-term consequences

Serotonin syndrome & combination products

Large doses or combination cold medicines can cause liver injury, seizures, anticholinergic toxicity, or serotonin syndrome.

Medical emergency

Identifying an emergency

Rigid muscles, clonus, high fever, seizures, or severe delirium require emergency care.

Danger: Do not combine with SSRIs, SNRIs, MAOIs, or other serotonergic drugs
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