Can You Overdose on DXM?
Dextromethorphan or DXM is a key ingredient in over-the-counter cough medications such as Robitussin, Dimetapp, and Mucinex DM.
Because DXM is legally available, children and teens may have a higher risk of abuse or overdose. Combining DXM with other drugs can be very dangerous.1
Learn more about dextromethorphan overdose and recovery, including:
Signs and Symptoms
A person can overdose on DXM either by intentionally or by accidentally ingesting a large amount of the drug. The risk of toxicity may be compounded since many cold and cough formulations with DXM contain additional pharmaceutical agents (such as acetaminophen, pseudoephedrine, and a variety of antihistamines).
The signs of a dextromethorphan overdose can vary from person to person, but often include:2
- Bluish-colored fingernails.
- Breathing problems.
- Blurry vision.
- Elevated heart rate.
- Muscle twitching.
- Nausea or vomiting.
What to Do
Call 911 immediately if you observe any of these symptoms in yourself or someone else. Getting proper medical attention for a DXM overdose can mean the difference between life and death.
Always stay with someone you suspect has suffered an overdose until emergency medical personnel arrive. Provide as much information as you can to medical personnel, including: 2
- The person’s age, weight, and condition.
- Name of the product.
- When they ingested it.
- How much they ingested.
- If the medicine was prescribed.
When the person who has overdosed first arrives at the hospital, a health care provider will take their vital signs, including breathing rate, temperature, heart rate, and blood pressure.
In addition to monitoring their vital signs, and conducting blood and urine tests, emergency medical personnel may treat a dextromethorphan overdose through:2,3
- Gastric lavage (stomach pumping).
- Nasogastric tube placement for administration of activated charcoal to help prevent further absorption of the drug from the digestive tract.
- Breathing support via a tube through the mouth into the lungs or a breathing machine (ventilator).
- Intravenous fluids.
- Naloxone to reverse the effects of the drug and supportive medical interventions to manage other symptoms, if necessary.
- Benzodiazepine medications to prevent seizures.
- Cooling measures to prevent hyperthermia.
Can You Die From a DXM Overdose?
Overdosing on DXM can be—but usually isn’t—fatal. Most deaths from overdose occur because people take dextromethorphan with other drugs or are involved in an accident.4
However, a 2009 research study investigated the deaths of 5 adolescents who had purchased dextromethorphan from the Internet. Despite the presence of other substances in their bloodstream, autopsies found that the primary cause of death was toxic levels of dextromethorphan.7
Long-Term Effects of Abuse
Dextromethorphan abuse may cause serious effects over time, such as:1
- Psychological dependence.
- Dysphoria (low-grade depression, feelings of dissatisfaction with life).
- Toxic psychosis, a condition resulting in loss of contact with reality and confusion.
Recovering From an Overdose
People can—and often do—survive and recover from a dextromethorphan overdose. According to the Drug Enforcement Administration (DEA), overdose does not generally result in severe medical consequences or death.4
Yet an overdose is often a sign of a substance abuse problem. To recover from a DXM addiction, it’s crucial to uncover the reasons the addiction began. For example, many people who use DXM to escape from everyday realities may have an undiagnosed depressive disorder, while those seeking feelings of euphoria or depersonalization may be dealing with underlying anxiety or issues related to trauma.
Seeking treatment in a recovery center can help prevent another overdose or long-term effects of DXM abuse, and it can also help address and heal the issues that led a person to develop an addiction.
Some of the more common treatment options for DXM addiction and overdose include:
- Inpatient treatment. Inpatient recovery for DXM overdose may involve detoxification, especially if the person has been using on a long-term basis.6 Generally, inpatient treatment involves a residential stay at a recovery center for anywhere between a few weeks to several months. Inpatient rehab centers may use a combination of individual and group therapy, recreational or music therapy, 12-step groups, and vocational training.
- Outpatient treatment. Some people may prefer outpatient recovery, which uses many of the same treatments as inpatient rehab but on a less intense scale. Outpatient dextromethorphan rehab usually involves attendance at a recovery center several times per week for several months to even a few years, depending on the extent of the problem.
- Dual diagnosis. In some cases, people abusing DXM also struggle with a mental health condition or abuse other drugs or alcohol. Dual diagnosis recovery centers offer integrated treatment plans that address both the mental health condition and the substance abuse disorder at the same time, which reduces the risk of relapse.
- 12-step groups. Based on the 12 steps of recovery outlined by Alcoholics Anonymous, 12-step groups can help people overcome DXM addiction through the support of others who have been in similar situations. Many people use 12-step groups in conjunction with other forms of treatment. Even after they complete formal treatment programs, some people continue to attend 12-step groups because they benefit from the support and structure of the group.
- A large number of dextromethorphan abusers are teenagers, who have special needs when it comes to addiction treatment. Teen recovery centers offer detox, medical supervision, and individual and group counseling with a focus on issues relevant to teenagers, including peer pressure, self-esteem, and body image.
How to Choose a Program
Some questions to ask when looking for a recovery center include:
- Where is it located? Think about whether you or your loved one would like to stay close to home or remove yourself from potential triggers and other temptations to use.
- How much does it cost? Inpatient tends to cost more than outpatient, but it may not offer the level of care you need. Insurance may cover all or a portion of the cost.
- How qualified are the staff? Look for staff who are licensed and credentialed in addiction treatment. It may help to meet with some of the staff beforehand and see if they are people you would like to spend time with in recovery.
- How long is the program? Inpatient programs are typically 28 to 30 days, 60 days, 90 days, or longer. Outpatient can last for a set duration of time or be open-ended.
- Does it offer aftercare and relapse prevention planning? Find out if the program staff will work with you on a plan for maintaining sobriety when you leave the treatment center.
Paying for Treatment
Generally, inpatient programs will be more expensive than outpatient. The cost will also depend on:
- The length of the program.
- Where it’s located.
- The amenities offered at the program.
Payment options for a dextromethorphan recovery center include:
- Insurance. Some insurance programs will cover all or a portion of the cost of addiction treatment.
- Sliding scale or payment plans. Some programs will work out a payment plan for you based on what you can afford to pay, or they may adjust the cost based on what you can pay.
- Medicare or Medicaid. These government-supported health insurance programs may also cover some of the cost of treatment.
- Financing options for treatment include taking out a loan, borrowing money from a savings account or 401(k), or crowdfunding.
Find a Recovery Center
- Center for Substance Abuse Research. (2013). Dextromethorphan (DXM).
- U.S. National Library of Medicine, Medline Plus. (2015). Dextromethorphan overdose.
- Chyka P.A., Erdman, A.R., Manoguerra, A.S., Christianson, G., Booze, L.L., Nelson, L.S., & Troutman, W.G. (2007). Dextromethorphan poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology, 45(6), 662–77.
- Drug Enforcement Administration. (2015). Drugs of Abuse: A DEA Resource Guide: DXM.
- Nemours Foundation. (2015). Cold and Cough Medicine Abuse.
- Mutschler, J., Koopmann, A., Grosshans, M., Hermann, D., Mann, K., & Kiefer, F. (2010). Dextromethorphan Withdrawal and Dependence Syndrome. Deutsches Ärzteblatt International, 107(30), 537–540.
- Logan, B. K., Goldfogel, G., Hamilton, R., & Kuhlman, J. (2009). Five deaths resulting from abuse of dextromethorphan sold over the internet. Journal of Analytical Toxicology, 33(2), 99–103.