Dextromethorphan hydrobromide(DXM HBr) is the water-soluble salt of
dextromethorphan (DXM) and hydrobromic acid and the most common form of
DXM itself is a synthetically produced substance related to codeine,
but without the analgesic, sedating, or constipating effects of opiates.
It has replaced codeine as the most widely used over-the-counter cough
suppressant. It is sold under the brand names Benylin DM, Pertussin,
Vicks Formula 44 and Robitussin Pediatric among others. Used for this
purpose it is both extremely safe and very effective. DXM, though, is
one of the few over-the-counter medicines with any serious recreational
use/abuse potential. Used recreationally, often on the club circuit, it
is referred to as “Robo”, “X” or “rome”.
DXM has been in use in the USA for approximately 30 years. In the mid
1980s, though, several deaths following ingestion of large doses of
dextromethorphan prompted the Swedish government to restrict this
compound to prescription-only status. It is, however, still widely
available over-the-counter in the United States. The pharmaceutical
potential of dextromethorphan does not appear to have been fully
explored yet. According to recent studies (performed predominantly on
animals), the substance also has shown promise in fighting both epilepsy
and Parkinson’s disease. Other studies though, have indicated possible
fetal abnormalities and brain damage in test cases. Remarkably, very
little is known definitively about DXM or its long-term effects.
When used as intended for cough suppression, typical dosages
run about 10 to 20mg. every 4 hours or 30mg every 6 to 8 hours. When
used recreationally, dosages are generally much higher, in the range of
250 to 1500 mg. taken as a single dose.
Source: B. Brands, B. Sproule, and J.
Marshman (Eds), Drugs and Drug Abuse: A Reference Text, 1998, Ontario:
Addiction Research Foundation, pp. 571-2.
The method of use varies as the drug is available over-the-counter in
capsules, lozenges, tablets, oral suspension and cough syrup.
Source: Physicians Desk Reference
Lower doses cause euphoria, stupor, excitability and changes
in muscle reflexes.
Large doses in the range of 250 to 1500 mg are known to cause
euphoric and hallucinatory effects. Proper dosages are, however, very
specific to the person taking the drug. There is a fine line between a
dose causing pleasant effects and one that may cause negative effects
ranging from mildly unpleasant– skin irritation, shortness of
breath, dizziness, temporary sexual dysfunction, nausea and hangovers–
to more serious ones like coma, brain damage, liver damage, respiratory
distress and death. Generally, the more serious side effects are a
result of combining DXM with alcohol and other drugs.
Physical Dependence: Unknown
Psychological Dependence: Moderate
As has been noted, little is known about DXM with respect to
long-term use and addiction. DXM is thought to be a moderately
habit-forming substance with no physical addiction. It should be noted,
though, that virtually any substance can be addictive, to a greater or
lesser degree, depending on the user. It is a generally accepted notion
among treatment professionals that the addiction, whether physical or
psychological, is the problem, not the specific substance. Below are
some treatment programs that may be useful for DXM users as well as
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