Dextromethorphan (DM) - Friend or Foe?

Dextromethorphan (DM) has been a major component of most over-the-counter cough suppressing medicines since the middle of the twentieth century. It is presently found in Robitussin, Coricidin and over 120 other cough remedies, either alone or in combination with other drugs. Compared to the previous commercial cough remedies, which contained morphine or codeine, DM was a welcome substitute.

Congress did not recognize the addiction potential of the opiates until 1906, when they passed the Pure Food and Drug Act requiring a listing of all ingredients in medicines. Even so, Bayer continued to sell their medicinal, heroin-laced cough syrup until 1913. Congress took a firmer stand the following year with the Harrison Act, which restricted the sale of products containing opiates
However, dextromethorphan (DM) is a semi-synthetic morphine derivative, which in high dosages is considered hallucinogenic. It is the drug of choice of many adolescents. Fifteen to thirty mg taken three to four times daily is the recommended cough syrup dosage. At this level conscious-altering effects are rare. but high concentrations of DM are available online in tablet and gel cap forms. At concentrations ranging from 100 mg to 1500 mg, perceptual effects grade from mild stimulation through euphoria, hallucinations, distorted visual perception, loss of motor coordination to dissociative sedation and, in rare cases, death. DM was considered for inclusion in the Controlled Substance Act in 1970, but was rejected due to a reported lack of opiate-like abuse potential. Additions to the Controlled Substances Act are reviewed periodically. Dextromethorphan is still under consideration.

The consensus appears to be that, although the drug can be addictive in high dosages, if taken as directed, it is relatively harmless. But, does it do any good as a cough suppressant? The American Academy of Pediatricians determined in a 1997 study that over-the-counter cough medicines did nothing to relieve cough and cold symptoms or help children sleep. Furthermore, a double-blind study of 105 children, ages two to eighteen with upper respiratory tract infections, carried out by Dr. Ian M. Paul of Pennsylvania State University in 2007 found that dextromethorphan (DM) was no better than no treatment in producing symptomatic relief of nocturnal cough and sleep difficulty. In this study buckwheat honey outperformed dextromethorphan (DM) in relieving these symptoms.

These test results suggest that DM does not qualify as a friend and, in certain cases, may be considered a dangerous foe.

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