Dextromethorphan abuse: When to seek help
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The bottom line
Dextromethorphan is an over-the-counter cough suppressant found in more than 130 cough and cold products. People who use it recreationally intentionally exceed recommended doses to experience dissociation and hallucinations.
Prevention tips
Talk to children and teenagers about the dangers of cough medicine misuse.
Get rid of any DXM-containing products once they are no longer needed.
Warn teens and young adults that mixing dextromethorphan (DXM) with alcohol or other drugs is extremely dangerous.
Be aware of slang terms for DXM misuse.
Watch for warning signs of DXM misuse, such as loss of interest in activities or hobbies, empty cough and cold medication containers, declining grades, and medicinal smells.
Watch for symptoms that could be related to DXM poisoning, such as loss of coordination, slurred speech, dizziness, hallucinations, and agitation.
This really happened
Case 1. Two boys, aged 17 and 19 years, purchased dextromethorphan powder over the internet after abusing OTC cough and cold products. They were found dead at the 17-year-old’s home after a sleepover. Next to them was a clear plastic bag of white powder labeled "dextromethorphan HBr (hydrobromide) 100 grams, not for human use". The cause of death in both cases was determined to be acute DXM poisoning.
A subsequent investigation found that the boys also repackaged DXM powder into gelatin capsules and were selling it to others in their high school. At least 3 nonfatal overdoses resulted from their repackaged DXM (Logan et al., 2009).
Case 2. A 16-year-old girl went to the nurse’s office at her school complaining of not feeling well and vomiting. She finally admitted to taking 16 tablets of an OTC combination cough and cold product containing DXM that morning. She was transported to an ED, where she told an emergency physician that she was just trying to treat a cold. The girl appeared drowsy, and her heart rate was elevated. The emergency physician contacted their poison center and was given information on the toxicity and treatment of DXM poisoning. The patient received intravenous fluids. Once her mental status and vital signs returned to baseline, she was sent home with a referral for outpatient drug abuse counseling.
What is dextromethorphan (DXM)?
Dextromethorphan (DXM) is a drug used medicinally to suppress coughing. It is most useful for treating dry, hacking, nonproductive coughs. First approved by the US Food and Drug Administration in 1958, it is an ingredient in more than 130 liquid or tablet drug products, most of which are available without a prescription and contain other active ingredients to treat symptoms of colds and flu. Over-the-counter (OTC) products with labels claiming cough suppression most likely contain DXM.
What to do if someone takes too much dextromethorphan
If you suspect someone has taken too much dextromethorphan, use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.
Why do people abuse dextromethorphan?
At high doses, DXM can produce altered consciousness and hallucinations, somewhat like ketamine, but also mania, panic, and extreme agitation. These last for several hours. DXM abuse goes by many slang names, including "dexing," "robodosing," "robofizzing," "robotripping," and "skittling." Regular misuse of DXM can lead to insomnia and dysphoria.
Reports of DXM misuse peaked in 2006. The subsequent decline in is thought to reflect public health efforts to reduce OTC medication misuse. In 2012, California became the first state to prohibit sales of DXM-containing products to minors. As of August 2026, least 20 other states have similar bans.
There are internet websites that claim to offer DXM powder for sale, provide instructions on the extraction of DXM from OTC products, and post firsthand descriptions of "trips." These websites should not be trusted.
Symptoms of dextromethorphan poisoning
Dextromethorphan (DXM) overdose can cause slow breathing, fast heart rate, increased blood pressure, dissociation from reality, seizures, coma, and death. When used at the dosage printed on the product label, DXM is a safe drug. Adding to the danger of DXM overdose is that DXM is often taken in combination with other drugs that can be toxic at high doses, like alcohol or acetaminophen.