Millions rely on over-the-counter (OTC) medications for temporary relief from cold and flu symptoms. For many, these products are often the first resort. In fact, 93 percent of American parents prefer to treat their children’s minor ailments with OTC medicines before seeking professional care.

In recommended doses, DXM products are low in toxicity and pose little risk of generating adverse effects. In high enough doses, however, DXM cough and cold medicines possess psychedelic, dissociative properties. This is why these medications continue to be substances of abuse, particularly among young people. 

One in 30 U.S. teens abused over-the-counter (OTC) cough medicines with dextromethorphan (DXM) to get high, according to 2018’s Monitoring the Future survey by the National Institute on Drug Abuse (NIDA). 

The issue is so prevalent that some states have passed age-18 sales laws to prohibit minors from gaining access to these medications. In 2019, West Virginia became the 18th state to pass such a law.

The reason for these prohibitions becomes clear when you consider what DXM can do to the brain and body at exceedingly high doses. Brain damage, however, is not among those risks, according to research.

However, DXM can be dangerous in many other ways. Read on to find out more about the physical and cognitive effects this common household product can produce.

What is Dextromethorphan?

DXM was approved by the U.S. Food and Drug Administration (FDA) in 1958 as an OTC antitussive after researchers supported its legitimacy and effectiveness as a cough suppressant. After DXM was approved, it was introduced as an OTC medication under the brand name of Romilar. Though popular, Romilar was pulled from shelves after reports of rampant misuse.

Drugmakers introduced abuse-deterrent DXM cough syrups like Robitussin, Dextro-Tussin, and Vicks-44. They were developed to have an unpleasant taste as a hedge against recreational abuse. 

In the 1970s, the FDA reviewed DXM and concluded that the drug was safe and effective.  

Despite the reports of abuse, a review panel determined this: “because of its low order of toxicity, it is probably the safest antitussive presently available.”

Over time, however, DXM medicines were developed to have more palatable flavors, leading to a surge in abuse. Because the internet has made the spread of information seamless, users were able to share knowledge about the effects and abuse potential of DXM. 

The internet also made it possible for users to access DXM in pill, powder, and capsule forms, bypassing the unpalatable cough syrups. Both developments led to a surge in DXM abuse. 

Today, DXM is available as a syrup, tablet, capsule, solution, suspension, lozenge, and spray. Plus, it is made available under various brand names, including Delsym, Vicks, Dimetapp, NyQuil, Theraflu, and Robitussin (the most popular and oldest brand). 

It also goes by a number of nicknames, which is de rigueur for substances of abuse: CCC, Triple C, Skittles, Robo, Poor Man’s PCP.

The Effects of DXM

At recommended doses, DXM medications produce no discernible psychoactive effects. However, when doses are excessively high, DXM can generate hallucinogenic effects that are comparable to phencyclidine (PCP) and ketamine.

The most commonly abused DXM products are the “extra-strength” cough syrups that contain 15 milligrams (mg) of DXM per teaspoon and the gel capsules and pills that have 15 mg per pill, according to NIDA.

The typical DXM dose range and rate that meets the amount recommended by manufacturers is 10 to 20 mg every four to six hours or 30 mg every six to eight hours. However, recreational users will far exceed those recommended amounts. Typically, they will take between 240 to 1500 mg in a single dose. Even heavier users can swallow between three to four bottles of cough syrup a day.

Physical and Cognitive Effects

No, DXM abuse does not lead to brain damage, if the research around it is to be believed. But abuse can lead to distressing symptoms and effects that can impact the brain and body.

When taken in exceptionally large amounts, DXM can produce a range of physical and cognitive effects. There is a practice that is referred to as “robotripping,” where a user will chug a large amount of a DXM syrup like Robitussin to get high — hence, the name. 

Taking such a large amount allows a user to absorb as much of the DXM as possible to feel its effects before vomiting.  

Some recreational users will grind up tablets into a fine powder and snort it to bypass the gastrointestinal distress caused by the cough syrup varieties. Nevertheless, such use can produce physical symptoms such as:

  • Nausea
  • Vomiting
  • Dizziness
  • Hot flashes
  • Rashes
  • Lethargy or hyperactivity
  • Rapid heartbeat
  • Sweating
  • Hypertension
  • Hypotension
  • Seizures

Because DXM has the properties of a psychedelic dissociative, intoxication can have users tripping to the point where they can experience hallucinations and a dulling of the senses to a degree where they feel cut off from the world around them. Users can also feel dysphoria that can lead to users experiencing an exacerbated out-of-body experience.

The cognitive effects associated with DXM include:

  • Anxiety
  • Visual and auditory hallucinations
  • Slurred speech
  • Euphoria
  • Paranoia
  • Panic attacks
  • Disorientation
  • Floating feeling
  • Altered perception of time

The U.S. Drug Enforcement Agency (DEA) outlined the abuse effects that occur at certain DXM dose levels, according to data the agency gathered from users. Those dose-dependent plateaus include:


Dose (mg)

Behavioral Effects



Mild stimulation



Euphoria and hallucinations



Distorted visual perceptionsLoss of motor coordination



Dissociative sedation

What DXM Overdose Looks Like

An exceptionally large DXM dose can produce adverse effects, which can be an indication of overdose. The symptoms of overdose include:

  • Unsteadiness
  • Changes in vision
  • Difficulty breathing
  • Fast heartbeat
  • Nausea
  • Vomiting
  • Drowsiness
  • Dizziness
  • Hallucinating (seeing things or hearing voices that do not exist)
  • Seizures
  • Coma

Cough Syrup bottles in a row

The rapid heartbeat, seizures, and hypotension symptoms require medical intervention, and most DXM-related overdoses can be treated in a hospital emergency room and do not result in serious medical complications or death.

However, the medication can be deadly when it is abused with alcohol or stimulants like caffeinated beverages, energy drinks, or attention-deficit/hyperactivity disorder (ADHD) drugs.

DXM can also compromise a user’s safety. For example, DXM cough syrups can impair the body to such a degree that being outside in public can be dangerous.

It can also cause someone to exhibit hyperactive movements, which can lead to accidents.

How Professional Addiction Treatment Can Help You

Addiction can make those aforementioned DXM symptoms worse, which can lead to overdose. Professional treatment can help you by removing the substance from your body through medical detoxification and treating the psychological aspects of addiction through counseling and therapy, services that occur in residential or outpatient treatment.  

Residential treatment is ideal for severe cases of addiction where DXM is abused with alcohol or other substances. In this type of program, you can live at the facility where you will receive treatment. 

Most DXM abuse problems can be treated through an outpatient program, which allows you access to therapy and counseling on a part-time basis and allows you to live independently. 

When your treatment ends, you can receive additional support from a recovery community such as the one a 12-step program provides. Such groups help many people who are recovering from addiction.

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