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Mechanism of Action

At therapeutic doses, DXM acts on the brain to suppress the cough reflex. At higher doses, it acts on the NMDA receptor as an antagonist, similar to dissociative anesthetics like PCP and ketamine. This action leads to altered sensory perception and dissociation.

Effects

• Therapeutic Effects:
  • Cough Suppression: Reduces the urge to cough, making it useful for treating coughs due to colds and other respiratory conditions.
• Psychoactive Effects (at higher, non-therapeutic doses):
  • Euphoria: Feelings of well-being and pleasure.
  • Dissociation: A sense of detachment from the body and surroundings.
  • Hallucinations: Visual and auditory distortions.
  • Altered Perception of Time: Time may seem to pass more slowly or quickly.
  • Impaired Motor Function: Difficulty with coordination and balance.

Dosage and Plateaus

Recreational users often refer to different “plateaus” of DXM effects, depending on the dose:

• First Plateau (100-200 mg): Mild stimulant effects, slight euphoria, and increased energy.
• Second Plateau (200-400 mg): Enhanced euphoria, mild hallucinations, and more noticeable dissociation.
• Third Plateau (300-600 mg): Stronger hallucinations, significant dissociation, and impaired motor function.
• Fourth Plateau (600-1500 mg): Intense hallucinations, profound dissociation, and potential for out-of-body experiences. Motor function is severely impaired.

Risks and Side Effects

• Short-Term Risks:
  • Nausea and Vomiting: Common side effects, especially at higher doses.
  • Dizziness and Drowsiness: Can impair the ability to perform tasks that require focus and coordination.
  • Increased Heart Rate and Blood Pressure: Stimulant effects can be dangerous for individuals with cardiovascular conditions.
  • Confusion and Agitation: Cognitive impairment and emotional instability.
• Long-Term Risks:
  • Psychological Dependence: Regular use can lead to dependence and compulsive drug-seeking behavior.
  • Cognitive Impairment: Potential for long-term memory and cognitive function issues with heavy use.
  • Liver Damage: Many DXM-containing products also have acetaminophen, which can cause liver damage in high doses.

Potential for Abuse

• Polysubstance Abuse: DXM is sometimes combined with other substances to enhance or modify its effects, increasing the risk of adverse reactions.
• Easy Accessibility: As an over-the-counter medication, it is relatively easy to obtain, leading to higher potential for misuse, particularly among teenagers and young adults.

Legal Status

• United States: DXM is legal and widely available in over-the-counter cough and cold medications. However, some states have restrictions on the sale of DXM-containing products to minors due to its potential for abuse.

Conclusion

Dextromethorphan (DXM) is a widely used cough suppressant with potential for abuse due to its psychoactive effects at higher doses. While it is effective for its intended therapeutic use, misuse can lead to significant physical and psychological risks. Awareness of the potential for abuse and careful adherence to recommended dosages is crucial. If you or someone you know is struggling with DXM abuse, seeking professional help and support is important to address the associated risks and health impacts.