DXM is available at drugstores throughout the world, chemical suppliers, and (very rarely) as a street drug. Generally, however, I wouldn’t trust anyone saying he or she had DXM on the street; it’s probably ketamine, PCP, or something totally unrelated.
DXM is most commonly available in cough syrups, though some syrups contain other ingredients which can make you sick (or dead) if you take too much of them. It is also available in gelcaps and in some places in capsules, either alone or in combination with other ingredients.
DXM can also be extracted from cough medicines, and the extract can be taken orally, injected subcutaneously, intraperitoneally, intramuscuarly, or intravenously. It can probably also be snorted or used rectally (though why one would want to I don’t know). Smoking the free base is very difficult if not impossible. DXO (not DXM) free base can be smoked at 190 C (pers. comm.).
Some drugstores keep track of people who frequently buy DXM-containing cough preparations, especially if they buy multiple bottles at once or tend not to buy other things at the same time. This is less common in larger supermarket/drug stores. In some cities where DXM use has become popular (and come to public attention), sales have been restricted to adults. In Utah in the 1980’s, DXM was placed behind the counter due to recreational
use.
Finally, DXM is available from chemical suppliers, very few of which will sell to individuals.
Hopefully I’ll soon be finished with the “Find the DXM” page, which allows people to find out which DXM preparations are available in their areas. Don’t hold your breath, though; I’m a sysadmin at a small ISP and that doesn’t leave me with a lot of time.
DXM is widely available in cough syrups, both brand-name (such as
RobitussinTM or Vicks Formula 44TM) and store brands. Most DXM-containing cough syrups also contain one or more of the following other active ingredients: nasal decongestants, antihistamines, acetaminophen, or guaifenesin (see Section 4.11). As a rule, you want to avoid all of them.
Generally speaking, DXM cough syrups all taste nasty. This is for two
reasons: to cover up the (even nastier) taste of DXM itself, and to prevent recreational use. The generics tend to be less thick, and thus more drinkable, than the brand names. Some people prefer to mix the DXM with sodas; others find this only makes an already unpleasant task even more unpleasant. Your Mileage May Vary.
Most people who have used DXM cough syrups recreationally seem to prefer to take it on a mostly empty stomach, possibly with crackers or some other source of carbohydrates. I generally feel that you should avoid slamming your kidneys and pancreas with a lot of glucose at once; thus I think some crackers or chips beforehand would be advisable. Greasy food should be avoided both before and after taking DXM. Most people report that if carbonated drinks are ingested, they should be clear (e.g., 7 UpTM).
The German company “Dr Rentschler” makes a cough syrup called “tuss hustenstiller saft”.
There are “gelcaps” (liquid or gel filled capsules) available that contain DXM, but they tend to be brand-name only. The most frequent (if not only) brand in the US is Drixoral Cough Liquid CapsTM. They come in boxes of 10 or 20 gel capsules, each containing 30mg of DXM. The gel capsule itself is red colored; the liquid inside is actually clear (and tastes very, very bad). The capsules are somewhat large, and difficult if not impossible to take without liquid to wash them down. This brand also comes with a $0.50 or $1.00 manufacturer’s coupon inside, which some have taken to calling DrixoralTM Dollars (after Camel BucksTM, a fake currency coupon in CamelTM cigarettes which could be collected and “spent” on various stuff, unfortunately not including iron lungs and chemotherapy). Note that Drixoral also makes several other liquid and capsule products, all of which contain undesirable active ingredients besides DXM.
Recently, Drixoral Cough Liquid Caps have been getting harder and harder to find. The usual story from the drugstores is that they aren’t very popular; my suspicion is that they are too popular. Look around, and you will probably be able to find them. There is a rumor going around that the “new” gelcaps have something in the coating that induces nausea, but I have found no evidence for this whatsoever. The ingredient list hasn’t changed, and changing ingredients without making it public is strictly
Absorption from the gelcaps takes some time, and can be sped up somewhat by cracking open each gelcap in your mouth before it is swallowed. Note, however, that the liquid inside is apt to spurt out, and it tastes bad. Really, really bad - sour and bitter and cloying all at once with a stickiness that won’t go away. However, if you can stand it, you can become used to it after the first few gelcaps. You can also crack open the gelcaps and try to collect the liquid, but it tends to go everywhere.
Some people have claimed that gelcap DXM “feels” different from cough syrup DXM. This may be pure placebo effect, or it may be a result of the slower absorption (and thus more DXM vs. DXO) of gelcaps. It is also possible that the “inactive” ingredients in cough syrup may affect the experience by altering blood glucose levels. Most seem to prefer the gelcap “feel”
Dextrorphan is a metabolite of DXM (i.e., the body converts DXM to
dextrorphan). The conversion from DXM to DXO occurs via removal of the methyl group at position 6, a process called “O demethylation”. DXO is very similar chemically to DXM, and reacts with the same receptors in the body, but with a very different spectrum. Whereas DXM is strongest at the PCP2 and sigma receptors, DXO primarily targets the NMDA receptor (see Section 10).
The practical upshot is that the dissociative and intoxicating or “stoning” effects are stronger with DXO, whereas the stimulation, cognitive alterations, delusions, and psychotomimetic (literally, “psychosis-like”) effects are stronger with DXM. Most DXM users find some balance between the two to be the most pleasurable. Too much sigma activity is usually regarded as dysphoric (strongly unpleasant) and disturbing, and if prolonged, may be dangerous (101,135).
Fortunately, you don’t have to worry about converting DXM to DXO; the body does it for you via an enzyme called P450-2D6 or CYP2D6 (also called debrisoquine 4-hydroxylase). However, between 5 to 10% of the Caucasian population lacks this enzyme (12-15), and in the rest of us it can vary. Many drugs can temporarily block P450-2D6 from working (10-11) and thus alter the balance between DXM and DXO. For a list of these drugs, see
Section 15.1.
One of DXM’s metabolites, 3-methoxymorphinan, can itself block P450-2D6. As a consequence, taking a second dose some time after the first dose of DXM will probably increase the ratio of DXM to DXO in the bloodstream. Taking the dose all at once, on the other hand, will probably increase the relative amount of DXO. Generally, then, the quicker the dosing, the more DXO and less DXM, and the more NMDA blockade (like ketamine) and the less sigma and PCP2 activity. Subcutaneous injection leads to very little conversion from DXM to DXO.
When discussing effects, this text usually uses “DXM” to refer to both
dextromethorphan and its metabolite, DXO. A few people have used DXO specifically; one indicated that it did in fact have fewer cognitive
effects than DXM.
A variety of DXM-only pill brands are available throughout the world;
unfortunately, none are available in the US. Some of the brands include:
* Contac CoughCaps (Canada)
* Romilar (southeast Asia and others)
* Dr. Rentschler tuss hustenstiller retard kapseln (Germany)
* Everest (Taipei and others)
Please let me know if you learn of any others.
DXM pills typically contain 15 or 30 mg of DXM, but some (such as the Dr.
Rentschler brand, tuss Hustenstiller retard Kapseln) contain 60mg of DXM.
In the US, a new tablet brand, Coricidin Cough & Cold, is available.
Containing 30mg DXM and 4mg chlorpheniramine maleate (an antihistame),
these have become popular for lower plateau dosing, but can have extremely
unpleasant anticholinergic side effects (drymouth, blurred vision,
confusion, etc.) with higher doses. One person had to be hospitalized for
vomiting blood and entering respiratory arrest after taking a high dose of
Coricidin tablets. Even low doses often have unpleasant side effects and
may be very confusing. At the lower plateaus, the chlorpheniramine does
seem to alleviate the “Robo Itch” (see Section 6.1.3). The box is marked
“suitable for people with high blood pressure” (Coricidin has other tablets
available which are unsuitable for recreational use).
Furthermore, many Coricidin seem to report that frequent use leads to
increasingly severe nausea triggered by taking, or even looking at, the
pills. Some people have been known to puke in the drugstore from seeing the
box (one user reported that 30+ people he knows suffer from this). I have
no idea why this would happen.
Again, remember that the antihistamine in these tablets will change the
character of the DXM trip (not necessarily in a good way), potentially
increasing the degree confusion. Do not use this product except at first
and second plateau dosage! An overdose of antihistamine, while not
typically fatal, can be extremely unpleasant and has been reported to be a
frequent cause of “bad trips” from Coricidin. Most DXM users have
recommended not taking more than eight Coricidin tablets; some say not to
use this product at all.
There are a few brands of cough drops/lozenges which contain DXM without
other active ingredients. One such brand is SucretsTM (not the kind that
come in the tin; these come in a bag and are labelled as containing DXM).
Each lozenge contains 15mg DXM, as well as a number of inert ingredients
(primarily sucrose, flavoring, coloring, magnesium silicate). Some people
report the sucrets contain menthol; others don’t (I suspect there may be
different versions available). Other lozenges available contain from 7.5mg
DXM (a South African brand) to 30mg DXM. Revco carries a DXM lozenge
containing 5mg DXM each called HoldTM, which supposedly taste better than
Sucrets but are fairly expensive (and contain less DXM).
Since the inert ingredients present in these lozenges may cause nausea,
some people have managed to get rid of most of them by placing the lozenges
in a container of water and microwaving until fully dissolved, then
filtering through a coffee filter, discarding the precipitate (solid), and
drinking the liquid. Longer boiling seems to drive off the flavoring and
menthol without affecting the DXM.
Interesting side note: recently, in South Africa, cough lozenges containing
an abnormally high amount of DXM were illegally diverted from disposal and
resold, causing “moderately severe” toxicity in 24% of primary school
pupils using these lozenges (369).
DXM is not DEA scheduled in the USA (or most other parts of the world), and
consequently should be available via pharmaceutical chemical suppliers. For
example, Sigma Chemical Company (1-800-325-3010) lists DXM hydrobromide
(product D2531) for US $18.20 for 5 grams, US $128.45 for 50 grams. Note
that I have no affiliation with Sigma in any way; I just happened to have a
copy of their catalog handy when writing this.
In theory, it would be fantastically cheap and easy to order DXM this way;
in practice, it’s possibly difficult, and probably a Very Bad Idea. First
off, most chemical companies are wary about selling to individuals (and if
you’re not a legal adult, forget it). Secondly, there’s a significant
chance that your order will be reported to the DEA, and although it’s not
technically illegal, if enough people do this, that may change very
quickly.
Still, though, if you have the (possibly foolish) courage to try, there’s
no reason why this shouldn’t be a reasonable source. Just use your head.
And don’t mention the FAQ.
Recently, a few chemical resale companies have popped up, relying upon the
fact that many potentially useful chemicals can be sold legally to
researchers (for which there doesn’t seem to be a legal definition). Please
remember that it is your responsibility to make sure that ordering and
using DXM from a chemical supplier is legal in your area. Also, to my
knowledge no chemical supplier (at least, none you’re likely to run across)
warrants its product for human consumption. Buyer beware!
Currently I know of two companies selling DXM (other than Sigma and the
like, which won’t sell to individuals): Chemical Resale of Santa Barbara
and WANMAN Enterprises.
4.8.5.1 Chemical Resale of Santa Barbara
Chemical Resale of Santa Barbara (CRSB) offers a variety of chemicals to
independent researchers. CRSB explicitly forbids the use of these chemicals
for pharmaceutical use, illegal drug manufacture, explosives production, or
human consumption. They have a webpage at http://www.sb.net/wirehead.
Orders over US$100 must be made by company or personal check; orders under
US$100 may be made by money order (i.e., no paper trail). These aren’t
CRSB’s rules of choice, they’re California law, so don’t complain the CRSB
about it. I
A short disclaimer here: I have had no dealings with CRSB, and cannot
guarantee anything about them. Nobody on the Usenet drugs newsgroups who
has dealt with them has ever said anything negative about them (other than
their prices, which are understandable given the amount of legal paperwork
CRSB evidently goes through to be able to sell to researchers not
associated with established institutions). My personal belief is that they
are legit, and that in the case of ordering DXM it probably doesn’t matter
anyway, since DXM is neither scheduled nor prescription. Just remember that
this is for research purposes only.
Prices on DXM HBr have been decreasing, and CRSB runs specials, so check
their website for current pricing. The last time I checked, the prices were
10g for $92, 100g for $310. These prices are a bit stiff, but CRSB goes
through tremendous legal hassles to make numerous useful chemicals
available. All prices are US dollars.
Their address:
Chemical Resale of Santa Barbara
6 Harbor Way Suite #171
Santa Barbara, CA 93109-2353
Email: [email protected]
WWW: http://www.sb.net/wirehead
Another company which offers USP grade DXM is WANMAN Enterprises. I know
next to nothing about them except they gave me their address and prices for
inclusion in the FAQ.
Current prices are 10g for $50, 100g for $300, and 1kg for $1000 (US
dollars). Orders are shipped via private carrier (UPS, FedEx, etc). They
have a special of 50g for $100 to readers of the FAQ (mention you saw them
there). Certified check or money order should be made out to WANMAN
Enterprises.
Their address:
WANMAN Enterprises
7620 Vance Rd.
Kernersville NC 27284
[email protected]
I have also heard of a company in Texas that sells small quantities of DXM
(again, for research purposes I suppose), but do not know anything else
about them.
DXM can be extracted (see Section 11) and the extracted DXM can be taken
orally, either as free base or as salt (the free base should convert to the
hydrochloride salt in your stomach). DXM is commercially available as the
hydrobromide salt (as well as polistirex), but DXM extraction typically
results in DXM citrate (see Section 11.1.3). The free base tends to be
somewhat alkaline and should be avoided unless combined with food and/or
juice (or other acidic beverage). When taken on a mostly empty stomach, the
extract is generally (but not always) absorbed faster than cough syrups,
gelcaps, or capsules. Some extraction processes may convert some or all of
the DXM into dextrorphan (DXO). Extracted DXM, unlike cough syrups and
gelcaps, has no bromide toxicity (see Section 4.11.7).
DXM hydrobromide is reasonably soluble in saline, and I see no reason why
other acid salts shouldn’t be - though their long-term stability may be
doubtful. However, injection is a very dangerous way of using recreational
drugs, especially if the substance in question is not prepared specifically
to be injected. Some of the potential risks include: sterile abscesses,
torn or collapsed veins, bruising, muscle fiber damage, histamine release,
infection (hepatitis B, HIV, etc.), embolism (and possible resulting stroke
or cardiac arrest), increased chance of addiction, overdose, and people
mistaking you for a junky. True, most of these are unlikely, and if done
correctly injection is generally very safe. However, the key word is
correctly. If you’re still interested, consult a medical text; I’m not
going to teach you how to shoot up.
A few notes for those brave or stupid enough to still be interested.
Intravenous (IV) and intramuscular (IM) injection both seem to produce
similar results in animals, and IM injection is almost always safer. DXM
can also be injected intraperitoneally (IP), but that evidently requires
some skill. Subcutaneous (SC) injection (“skin popping”) leads to slower
absorption and a great increase in the amount of DXM relative to DXO. All
injected drugs should be completely pure, dissolved in the appropriate
physiological saline. In the case of SC (and possibly IM) injection,
injecting too large a volume of material can lead to a sterile abscess.
DXM can also theoretically be snorted although I don’t generally think this
is a very smart route; the nasal lining is very tender. DXM free base is
probably too alkaline to try this with. It can also probably be used
rectally, but somehow the thought of a cough syrup enema doesn’t thrill me.
Smoking DXM free base has been attempted several times by various people
without much success. DXM itself seems to vaporize at a fairly high
temperature, and is extremely harsh. To make matters worse, in typical DXM
extractions, some of the flavoring agents end up surviving the extraction
and they lend a definite unpleasant taste to the smoke.
I have received one report of a successful DXM freebasing experiment. The
person said that while it was nice to know it was possible, it was just too
much trouble to be worth it. Another person reported making the attempt and
suffering from a severe burning sensation in his lungs which ended up as an
asthma attack.
OK, I finally gave up on even trying to list commercial DXM preparations
because there are too many (not to mention they differ from place to place
even within the US). Instead, I list here the typical DXM formulas and
preparations you are likely to encounter.
* Pediatric Syrups (1-1.5mg/ml DXM)
There are several brands and generics of “Pediatric” formulation DXM
preparations. Intended for children, they contain very little DXM; on
the other hand, they usually taste better. In general though it’s a
waste of money and time to try and use pediatric DXM formulas for
recreational purposes.
* Regular Strength Syrups (2mg/ml DXM)
Many “regular strength” cough syrups contain 2mg/ml DXM. In the US,
the most notable example is Vicks Formula 44TM (which formerly
contained 3mg/ml). These are of course quite usable for recreational
purposes, although 3mg/ml syrups are preferred.
* “DM” Cough Syrups (2mg/ml DXM)
Most of the “DM” cough syrups (of which the notable brand is
Robitussin DMTM) contain 2mg/ml DXM as well as gauifenesin. During the
1980’s, many of these syrups contained 3mg/ml DXM but were reduced in
strength in response to recreational use. These syrups can also be
used recreationally, but note that the guaifenesin can cause nausea or
vomiting (see Section 4.11.3).
* Maximum Strength Cough Syrups (3mg/ml DXM)
The strongest syrups regularly available in the US are 3mg/ml and are
typically marked “Maximum Strength Cough” (of which RobitussinTM is
the most notable example). The generics are almost always called
“Tussin Maximum Strength Cough”. These are the most commonly used
syrups for recreational purposes.
* Concentrate Syrups (6mg/ml DXM)
There are a very few brands of “concentrate” syrups, which are
intended for institutions (or large families) who buy the concentrate
and dilute it, possibly adding flavoring. The only brand I’ve ever
heard of is PinexTM. Good luck trying to find these.
* Gelcaps (30mg DXM)
Drixoral Cough Liquid CapsTM are available in the US (and possibly
other places), and contain 30mg DXM in a gel capsule. These are
sporadically available; if you can’t find them in your area, try
elsewhere.
* Lozenges (7.5mg - 30mg DXM)
A few lozenges are available which contain DXM. In the US, the only
brand I’m aware of is SucretsTM, which contain 15mg of DXM (see above
notes on Section 4.8.4). Another brand containing 7.5mg DXM is
available in South Africa.
* Capsules and Tablets (15mg - 60mg DXM)
Various capsules and tablets are available throughout the world
containing only DXM (to my knowledge, none are available in the US).
These range from 15mg to 60mg per pill, with 15mg and 30mg being the
most common.
* DXM + Chlorpheniramine Capsules (30mg DXM)
Coricidin Cough and ColdTM tablets are available in the US with 30mg
DXM and 4mg chlorpheniramine maleate (an antihistamine). These are
suitable only for first and second plateau dosing (generally, ten
pills or less) due to the adverse effects (possibly dangerous) of
antihistamines at high doses. Be advised that some people react very
poorly to antihistamines. On the other hand, the antihistamine
evidently can prevent the dreaded “Robo Itch” (see Section 6.1.3).
Coricidin has other formulas which contain undesirable or dangerous
ingredients; the correct one is marked “suitable for people with high
blood pressure”.
* Miscellaneous
I have heard rumors of DXM available on the street in 240mg, 300mg,
and 600mg doses, but I cannot verify these rumors. The “DXM” may
actually be PCP, ketamine, or anything for that matter (but is
probably just extracted or purchaed DXM).
“Agent Lemon” (see Section 11.1.3) has also been made available in
some locations. Again, be advised that you are relying upon someone
else’s chemistry skills.
Good question. Part of the reason DXM isn’t terribly popular is that
drinking cough syrup is, well, disgusting. However, here is a suggested
method courtesy of “JR”:
Materials:
* 2 glasses
* A sink with COLD water
* cough syrup
* toothpaste
Procedure:
1. Fill one glass with water, the other with Robo. Keep the water running
(it makes the sensation less gross for some reason). Do not allow Robo
to be smelled under any circumstances!
2. Pinch nose shut with one hand
3. Sip water
4. Take 5-6 deep hyperventilative breaths
5. Slam the entire 8oz bottle of Robo at one time.
6. While still holding nose, drink remainder of water
7. Refill glass with water and drink the entire glass of water.
8. Repeat again, for a third glass of water.
9. Still holding your nose, spread toothpaste in your mouth, thoroughly
coating the inside of your mouth.
10. Release your nose, and exhale through both nose and mouth.
Minty fresh!
There are five main classes of active ingredients that are present in OTC
DXM-containing products: decongestants, antihistamines, guaifenesin,
analgesics, and alcohol. Each will be discussed in turn, followed by
“inactive” ingredients. With the possible exception of alcohol, all should
be avoided, although for differing reasons. Some of these other active
ingredients will make your experience unpleasant; others can kill you.
Additionally, some of the dyes and other “inactive” ingredients may cause
some people trouble.
There are three nasal decongestants that are used in OTC cough formulas in
the USA: PPA, pseudoephedrine, and phenyleprine (the latter is almost
always found with antihistamines). PPA is also known as phenylpropanolamine
(from which the acronym PPA is derived), norephedrine, and the IUPAC name
[alpha-(1-aminoethyl)benzyl alcohol]. Pseudoephedrine, known as the brand
name SudafedTM, has the IUPAC name [(+)alpha-(1-methylamino)benzyl
alcohol]. Phenyleprine is [(-)-3-hydroxy-alpha-(methylaminomethyl)benzyl
alcohol] (1-2).
These decongestants belong to a class of chemicals known as the
phenethylamines; this class also includes methamphetamine, MDMA (ecstasy),
MDA, etc., and tend to be DEA scheduled. Decongestants are not scheduled by
the DEA (this is USA laws) because they do not have significant
psychostimulant activity. Ephedrine, which is similar to pseudoephedrine,
and is (or was, depending on your state) available throughout truck stops
and mail-order pharmaceutical companies in the USA, does have mild
stimulant properties; thus its popularity as a form of “legal speed”. All
of these drugs stimulate the sympathetic nervous system (the “fight or
flight” system) and are thus called sympathomimetics.
What nasal decongestants do share with the more potent amphetamines is the
peripheral activity common to sympathomimetics, such as vasoconstriction
(constriction of blood vessels) and decreased nasal secretions (the good
side), and - with larger doses - insomnia, hypertension, heart rhythm
abnormalities, hemorrhaging, stroke, or death (the bad side) (8). Note that
these are extreme reactions, and that individual tolerance to
sympathomimetics tends to vary considerably. Tolerance can build quickly,
and a fatal dose for one person may have only a mild effect on another
person.
Because of the potential danger of hypertension, exceeding the recommended
dose of DXM and decongestant containing preparations may be asking for
trouble. Most people can probably handle it in smaller recreational doses,
but the peripheral “speediness” can be distinctly unpleasant. Anyone with
high blood pressure or the like has no business taking large quantities of
decongestants.
Finally, more recent research suggests that many of DXM’s potentially
disturbing side effects (see Section 6) might be potentiated by any
stimulant. Panic attacks, hyperthermia, hypertensive crisis, and the like
are notable examples. In extreme cases, stroke or brain hemorrhage may be
possible.
Conclusion: Possibly suitable for first plateau use only; otherwise avoid
these drugs!
The antihistamines operate by blocking histamine receptors (see Section
10.1 for an explanation of receptors). Peripherally, this has the effect of
reducing the symptoms of histamine activity (stuffy and runny nose, itchy
eyes, hives, rashes, etc.) associated with infections and allergies. In the
brain, histamine is partially responsible for wakefulness, and
antihistamines that cross the blood-brain barrier will cause sleepiness. In
fact, most OTC “sleeping pills” in the USA are really just antihistamines
(although melatonin is making inroads as an alternative). There are
antihistamines that do not cross the blood-brain barrier (e.g., SeldaneTM)
but these are prescription in the USA.
High doses of antihistamines can result in dizziness, impairment of
concentration, extreme sedation (or, paradoxically, insomnia), headache,
heart palpitations, dry mouth, gastric discomfort, delusions, and
abnormally high blood pressure. Doses of 30-60mg/kg have been fatal in very
young children; most adults, however, are very unlikely to overdose on
antihistamines. Death, when it does occur, is from cardiovascular collapse
or respiratory arrest (8). High doses of prescription antihistamines are
much more dangerous; do not mix DXM with prescription antihistamines!
The danger of an antihistamine overdose is very low when using a
DXM-containing product recreationally. However, you will most likely
experience some unpleasant symptoms, such as sleepiness, dry mouth, heart
palpitations, etc. These side effects increase as the dosage increases. A
very small amount of antihistamines might be useful in preventing
DXM-induced histamine release.
Conclusion: Traditional antihistamines may be suitable for first and second
plateau dosage levels, but should not be used at the upper plateaus. NEVER
use DXM with prescription, non-drowsy antihistamines!
Guaifenesin (gwye-FEN-a-sin) [3-(2-methoxyphenoxy)-1,2-propanediol] is an
expectorant; it increases the production of respiratory tract fluids, thus
making phlegm less viscous and easier to cough up. Guaifenesin has been
shown effective as an expectorant, but is of no use as a cough suppressant.
It is often combined with dextromethorphan. Guaifenesin should not be used
for chronic coughs or coughs accompanied by excessive phlegm (1-2).
High doses of guaifenesin tend to induce emesis (i.e., you puke). Other
effects from high guaifenesin doses are not well known, but probably not
serious. Some suggest that guaifenesin may act as a muscle relaxant at high
doses (an effect for which it is used in veterinary medicine).
Conclusion: as most people do not enjoy vomiting, I would recommend
avoiding guaifenesin-containing products.
Acetaminophen, also known as paracetamol and APAP, is the most common
analgesic (painkiller) present in cough suppressant formulas. It is closely
related to the NSAIDs (non-steroidal anti-inflammatory drugs) of which
aspirin and ibuprofen are the two most common examples. Unlike the OTC
NSAIDs, however, acetaminophen/paracetamol does not tend to irritate the
stomach, and thus its inclusion in cough syrups.
An acetaminophen overdose is very dangerous. Normally, acetaminophen is
metabolized (broken down) in the body by two separate pathways, both of
which lead to harmless metabolites. However, these two pathways can only
handle so much before saturating. At that point, the remaining
acetaminophen is metabolized by a cytochrome P450 liver enzyme. The
metabolite via the P450 pathway is toxic to the liver (2,8).
Furthermore, this doesn’t happen right away; it can take 16 hours before
any signs of liver damage show up. This delayed toxic effect has been
responsible for the rather painful deaths of some people who (accidentally
or not) overdose on acetaminophen, and then think they are fine when no
immediate problems occur. There is an antidote (acetylcystine), but it must
be administered within the first 12 to 16 hours.
The toxic dose of acetaminophen can be as low as 50mg/kg; for a 60kg person
this is only six acetaminophen tablets. This is unlikely but possible. DO
NOT UNDER ANY CIRCUMSTANCES USE RECREATIONALLY ANY DXM PRODUCT WHICH ALSO
CONTAINS ACETAMINOPHEN / PARACETAMOL!
As for aspirin and ibuprofen, the other two most common OTC painkillers,
both tend to irritate the stomach at high doses. I recommend against them,
especially if you have an irritable stomach. Never take large doses of
aspirin or ibuprofen if you have an ulcer.
Conclusion: avoid any product containing an analgeisc.
Most cough syrups contain some alcohol, to help dissolve the DXM (and other
drugs) and to numb the throat. With a few exceptions (such as NyquilTM),
the amount of alcohol is not usually very great. While alcohol does not, in
general, mix well with DXM as a recreational drug, the amount in cough
syrups should not cause trouble unless you are specifically sensitive to,
or attempting to avoid, alcohol. There are alcohol-free preparations
available; gelcaps and tablets are alcohol-free.
Some of the dyes used in cough formulas may give some people allergic
reactions. Most notable among these is tartrazine (FD&C Yellow #5).
Generally, these dyes are not a problem unless you take a lot of them
(which recreational DXM use may involve). If you think you may be allergic
to a dye, switch to a different brand (or more accurately, a different
color). It is also a good idea to keep an antihistamine (not a prescription
or non-drowsy one!) nearby in case an allergic reaction does occur.
DXM is usually ingested as a hydrobromide salt. Large amounts of bromide
ions can cause sedation and eventually lead to bromism (bromide poisoning),
which affects (among other things) the skin and nervous system (see Section
6.3.15. I don’t think this is terribly relevant for users of DXM
(recreational or not); however it is one more reason to avoid prolonged
high-dose use. You can avoid bromide ions by converting the DXM to free
base and/or hydrochloride salt (see Section 11.1). Some physicians do
believe that prolonged heavy use of DXM may lead to bromism (144).
Possibly. There may be laws making it a crime to use OTC medicines in any
way other than directed on the label. Not that this stops people from using
ephedrine (a bronchodilator) as a stimulant. Nor are you likely to get
caught and/or prosecuted; the authorities are much too busy infringing upon
our civil rights looking for the illegal drugs. But, remember - I
SPECIFICALLY instruct you NOT to use any medicine in a manner inconsistent
with its labeling.
Furthermore, suggesting to someone that they use DXM as a recreational drug
could also be violating a law - against prescribing drugs as a layperson.
Again, it’s not likely to happen, but it is possible.
DXM is a prescription drug in Sweden (9). It is prescription and scheduled
in Australia unless combined with other active ingredients. It may become
prescription in other countries. In drug stores in some areas it is kept
behind the counter, must be requested, and is only sold to adults.
A lot of reasons, actually. Beyond the obvious one that not everyone knows
about it are a number of reasons which may be more relevant. First and
foremost, DXM doesn’t appeal to everyone; in fact, it seems to follow a
“rule of thirds”. One third of people who try DXM like it, one third hate
it, and one third could care less.
Secondly, doing DXM is either disgusting or a time-consuming process for
most people. Cough syrup tastes bad, and is unpleasant to drink; even the
gelcaps become unpleasant to take after a few times due to their rather
large size. DXM can of course be extracted, but it is a time-consuming
process that requires enough effort to discourage those only casually
interested.
Third, DXM is to a certain extent “anti-addictive”, at least when used
occasionally. Because DXM blocks NMDA receptors (see Section 9 and Section
10.3), it prevents associating any pleasant effects of the drug with the
taking of the drug. Instead, the memories of taking the drug are associated
with sensations before the DXM kicks in, e.g., nausea.
Fourth, DXM trips can be extremely confusing, especially if the user
doesn’t have experience with psychedelics. The DXM trip is so unlike an LSD
or mushroom trip that people who take it expecting the latter are often
discouraged and do not repeat the experience.
Finally, DXM has a reputation as a “loser drug”, something people take when
nothing else is available. While it’s true that DXM is legal, and thus can
in fact be taken when nothing else is available, this doesn’t make it any
less powerful (or any safer) than illegal drugs.
In the past five years, research, especially research centered on NMDA
receptors, has uncovered more and more medical uses for DXM. Some of these
include:
Introduction to the FAQ v4.0
A lot has happened since I published Version 3 of the DXM FAQ; some of it
has been good, some not so good. I’d like to take a moment to address some
of these changes and some of my concerns. I still do not regret having
published the FAQ, and out of all the feedback I have received (including
letters from physicians, scientists, parents, and just plain druggies),
less than one percent has been negative. The reasons I gave for its
publication still apply, but those of you familiar with v3.0 will notice
that this version shows considerably less praise for DXM.
When I published the FAQ on Usenet (and then the World Wide Web), it was my
expectation that it would be of interest primarily to psychonauts,
experienced psychedelic users, and others who use drugs for
self-exploration and spiritual purposes. I knew, of course, that not
everyone who did DXM would use it with the intention of expanding the mind,
but I reasoned that, given the relative unpleasantness of consuming cough
syrup, and the “heaviness” of the DXM experience, most people would find
casual, recreational use of DXM unlikely. Things didn’t quite turn out how
I expected.
Also at that time there was a severe shortage of information from former
DXM users about adverse effects of long-term use. I had reasoned that
long-term use was probably not a good idea, but probably not terribly
dangerous. Of the people I had interviewed who had used DXM regularly, very
few had any problem with it, and those who did recovered when they stopped
using it.
Since then there has been a great increase in DXM use (or at least more
people are talking about it). My concern that the FAQ had started a “DXM
epidemic” turned out to be mostly baseless; the majority of new DXM users
seem to hear about it the same way that DXM users have always learned about
it: from their friends. Some do learn about it from the FAQ, but for the
most part you have to know about DXM in the first place before finding or
understanding the FAQ.
As I have spoken to more and more users of DXM, I have learned that more
people have negative experiences with the drug than I had expected. Most of
these are simply people who try it once, decide they don’t like it, and
never try it again. A few people, on the other hand, seem to be greatly
susceptible to DXM addiction and some of these have suffered long-term
health consequences. A very few may have suffered permanent brain damage
from extremely heavy use of DXM (e.g., an 8oz bottle of Maximum Strength
syrup every day). On the other hand, some people consume the same amount
for years seemingly without consequence. And while some people can consume
DXM regularly without psychological consequences, others suffer from severe
depression and psychotic breaks, even leading to a few cases of suicide
attempts.
This brings me to the most relevant new information about DXM: Olney’s
findings of NMDA Antagonist Neurotoxicity (NAN). There is great debate
right now whether NAN is relevant at recreational doses or not. In animals,
the dosage required to induce NAN is far in excess of the anaesthetic dose,
and humans typically take sub-anaesthetic doses of dissociatives. On the
other hand, there may be danger with long-term use at considerably lower
dosages that the animal models do not show.
The data from human experiences are hard to interpret. Many heavy PCP users
suffer obvious cognitive and motor impairment; however, PCP has neurotoxic
effects (in particular in the cerebellum) not shared by other dissociatives
including DXM or ketamine. Ketamine is probably a better approximation of
DXM, but very few people have done large amounts of ketamine for long
periods of time. A notable exception is John Lilly, who is a bit of a nut,
but was probably a bit of a nut before doing ketamine, and (at least the
last time I checked) he doesn’t seem to suffer from cognitive impairment.
There are a few DXM users who have suffered long-term consequences. Out of
approximately five hundred current and former DXM users I have heard from,
three have suffered lasting cognitive impairment. Additionally, there is
one published paper on cognitive impairment from chronic DXM use, although
the author suggests an underlying temporal lobe seizure disorder. DXM has
been shown to increase the frequency of complex partial seizures, and it’s
possible that it is the seizures, and not the DXM itself, which is causing
problems. Unfortunately, it has also been suggested temporal lobe
epileptics may also be more susceptible to dissociative addiction.
Hopefully much of this will be resolved in the next few years.
Until then, my official recommendation is not to use DXM at all. Since I
know this isn’t likely to happen, my own personal belief is that DXM is
probably pretty safe when used occasionally (e.g., once or twice a month)
at the lower plateaus, and rarely (e.g., once or twice a year) at the
higher plateaus. I have yet to hear from anyone who used DXM with this or
less frequency who has suffered any impairment, temporary or permanent.
Actually, to be technically correct, nobody using it once a week for less
than six months has ever seemed to have problems, but it’s always best to
keep a wide safety margin.
Another thing to keep in mind is that DXM in the upper plateaus is a
considerably different experience than the lower plateaus, and may be
better suited to spiritual or ritual use. Even at the lower plateaus, DXM
is not really well suited as a frequent recreational drug.
So what do you do then if you find yourself in that particularly human
condition of ennui (for which psychedelics are a most effective medicine)?
Well, ideally I’d suggest you hop on a plane to Amsterdam (or somewhere
else where 2CB and marijuana are legal). Unfortunately this isn’t an ideal
world, and flying across the Atlantic is outside the means of most of us
(including me). A more reasonable suggestion would be to do your part to
change the laws in this country so that psychedelics can regain their
rightful place as tools for mental, emotional, and spiritual exploration
and growth. Remember, the laws aren’t going to change unless we work to
change them.
In summary, I’m not nearly as convinced that DXM is a benevolent
psychedelic as I used to be. It is in many ways considerably more powerful
(and certainly more dangerous) than LSD or mushrooms. Like all psychedelics
it can profoundly change you; unlike others, these changes are not
necessarily under your control, especially if you are not very familiar
with yourself. DXM can be a great tool for spiritual rebirth, but it can
also turn you into a paranoid, antisocial asshole. I still believe that DXM
has a place among psychedelics, but do understand that it is not a
replacement for LSD, mushrooms, 2CB, or even ketamine. It is a unique and
uniquely powerful mind-altering drug, and one which I think most people
would do best to avoid.
William White
March 15, 1997
Introduction to the FAQ v3.0
This document is a FAQ (“fack”), i.e., a series of questions and answers.
The term comes from Usenet, and stands for Frequently Asked Questions.
These are the sorts of questions that people new to Usenet tend to ask
frequently. When these questions become frequent enough, the question and
its answer may be placed into the FAQ for the newsgroup (or for a topic
within the newsgroup). A few people use the term AFAQ (Answers to
Frequently Asked Questions), but most use FAQ to refer both to a frequent
question and to the document
This FAQ covers dextromethorphan (decks-tro-meth-OR-fan), the cough
suppressant commonly found in cough medicines available over-the-counter in
the USA and other parts of the world. Of course, dextromethorphan (DXM)
does more than suppress coughs; otherwise, there wouldn’t be so much
discussion about it on Usenet. The bizarre truth about DXM is that it is a
very potent psychoactive drug when taken in sufficient quantities. So if
you’ve ever heard about people drinking cough syrup for fun, well, now you
know why.
The trouble, however, is that most cough medicines have other ingredients
which can make you uncomfortable, sick, or dead, depending on the
ingredient and how much you take. Furthermore, even when pure, chronic or
heavy use of DXM may cause health problems. This document is intended to
combat potentially dangerous misinformation about the recreational use of
DXM, and to allow you to make an intelligent and informed decision about
DXM.
My own interest in DXM came quite by accident; once, while sick with the
flu, I misread the instructions on a bottle of cough syrup and drank two
shots from the included shotglass instead of two teaspoons. Soon after I
noticed that music and motion had become very satisfying experiences. This
left me puzzled, and my reaction was to go to the library and research DXM
through Medline, medical journals, and books.
Of course at that point I was hooked - not on DXM, but on
neuropharmacology. I decided to learn as much as I could about DXM, and
found it to be one of the most unique and interesting of all recreational
drugs in terms of how it works on the brain.
About this time I noticed a number of incorrect and potentially dangerous
posts (articles) about DXM appearing on alt.drugs. So, I decided to gather
the information I had and write a FAQ. It eventually became much more than
a FAQ, giving explanations and information in addition to answers, but by
then the name had stuck. The FAQ took me over 150 hours to complete - I
figured if I’m going to do it, I’d better do it right.
After publishing the DXM FAQ, the reports of DXM use started coming in.
People who had been using DXM but were uncomfortable talking about “getting
high off cough syrup” shared their stories with me. Some were good, some
were bad, some indifferent. I’ve been trying my best to get all of these
personal reports together into a coherent whole, but this FAQ is written in
my free time and I don’t get paid for it (although donations are acceptable
:^).
Please note that it is not my intention to get a bunch of people hooked on
cough syrup (actually addiction is very rare, but you get my point). It is
my intention for people to know the truth so they don’t make bad decisions
for lack of knowledge. DXM is not safe and harmless; nothing is. Nor is it
universally enjoyable; in fact, some find high-dose DXM experiences
terrifying. But I believe that people can only make good decisions, or
learn from bad decisions, if information is available. So please, use your
head!
William White
May 10, 1995
First and foremost I would like to thank my wife, Nicole, for providing me
with a seemingly endless supply of love and support, and for putting up
with my idiosyncrasies. I doubt anyone else could have coped with being
married to someone whose idea of fun is spending hours in a library
researching tripping off of cough syrup.
I would also like to thank Barbara Adeanna and Peter Zachariah Kramer who
helped me proofread the FAQ and who took the time to tell me when I was
confusing, unclear, or simply full of it. Additionally I would like to
thank them for their support and encouragement throughout the writing
process.
I would like to acknowledge Schering-Plough, Richardson-Vicks, and other
OTC pharmaceutical companies, for giving me something to write about. How
about bringing back DXM-only pills, folks?
The evolution of this document also owes a great deal to the participants
of Usenet alt.drugs, alt.psychoactives, and rec.drugs.psychedelic, notably
including P. L. and all the people who made hyperreal.com, the Lycaeum, and
other drug websites what they are today. And to the hundred or so people
who contributed their experiences to the FAQ, thank you; my understanding
of DXM came about because of your assistance.
I’d like to give a moment of thanks to the one and only person thus far who
has given me truly critical and negative feedback. I showed her feedback
(and the resulting exchange of email) to a friend of mine who is a
neuroscience researcher and physician, and my friend reassured me that this
person’s objections, although numerous, were also baseless. Still, it has
given me something to think about. As hard as it may be for some people to
believe, a big part of why I wrote the FAQ in the first place was out of
concern for people’s physical, emotional, and spiritual well-being.
Finally, thanks to my friend H., who taught me about DXM in the first
place.
This text covers the recreational and medical uses of dextromethorphan, a
cough suppressant in common use in over-the-counter (non-prescription)
cough medicines. This is version 4.0-Y (text).
1. Distribution in electronic form is permitted, free of charge, except
as otherwise specified below.
2. When distributed electronically, this document may be broken up into sections, provided all sections receive the same distribution and all are distributed within 1 day. (The exception is the Quick Reference Page, which may be distributed by itself).
3. When distributed by the author via Usenet, some sections may be omitted at the author’s discretion. Automatic redistribution (i.e., Usenet news) may legally duplicate this pattern of omissions.
4. You are permitted to make a printed copy of the electronic document for personal use, and encouraged to pay the US$10.00 license fee when convenient. Any additional printed copies may be made at a license fee of US$10.00 per copy, sent to my address (see below). You may also purchase bound, printed copies of this text for US$25.00 (including shipping and handling); email or mail me for more information.
5. Sale of this document in any form (electronic or printed) by anyone
other than the author without written permission is expressly forbidden.
6. When distribution in electronic form, this document must remain in the same format as received (e.g., ASCII, PostScriptTM, etc.). For information regarding specific formats, please contact me.
7. The HTML format hypertext files on my website may not be distributed without my approval; please use my site for them. You may, however, provide links to them.
8. Once a given version number has been released, no prior versions may be distributed without written permission. Please stick to this rule if you can; I try and keep the information in this document as up-to-date as possible.
9. This document may be cited as:
White, William E. (1995) The Dextromethorphan FAQ: Answers to
Frequently Asked Questions about Dextromethorphan, version 4.0.
Published in HTML at http://www.frognet.net/dxm
10. As I do not wish my motives to be misrepresented, no citation or
quotation of this document may be used so as to explicitly or
implicitly suggest that I am in favor of the illegal use of any drug
(legal or not), or any other illegal activity, subject to USA law.
11. No modified version of this document may be distributed in any form.
This text discusses some rather controversial topics. Currently, there are
laws in most places of the world that make it illegal to use certain drugs
for recreational purposes. It doesn’t take a genius to figure out that the
medical nature of the drugs in question has nothing to do with their legal
status (otherwise, alcohol would be illegal and we’d all be smoking dope).
In particular, a lot of people are making a lot of money from the illegal
drug trade. The distributors, manufacturers, and sellers of illegal drugs
are among them, of course. So are the law enforcement agencies and
politicians, and the manufacturers and distributors of legal drugs like
nicotine and alcohol. In the past few years, many scientists, physicians,
journalists, and others have suggested legalization as a way to reduce the
harm associated with the drug trade.
It is not my desire to address this topic in depth here. What is important
is that, in response to these suggestions, the proponents of the War on
Drugs (and its equivalents elsewhere) have become increasingly aggressive.
One of their goals is to prevent the dissemination of information about
recreational drugs (unless it’s their own propaganda). As such, anyone even
discussing drug use is walking on thin ice, and once you go about telling
people how to do it, the ice becomes a lot thinner.
I have no intention of being thrown into prison so that they are forced to
release rapists, murderers, and child molesters in order to make room for
me. I’m not planning to become a martyr any time soon; I’d much prefer for
the Drug Peace to come without violence (legal or physical). However, I
feel it is important to provide true information about drugs. J. S. Mill
argued very eloquently that if an idea is true, then it can only become
stronger when it is confronted with falsehood; to prevent debate in the
hope of protecting the “truth” only leads to lies. I agree entirely, and
quite frankly I think anyone even thinking of getting into politics should
be familiar with (and hopefully agree with) Mill and his arguments. Honest
and open discussion of drugs can only lead to better policy and less harm.
In any case, like so many others, I am walking on somewhat thin ice here,
and must take certain steps to protect myself. Thus the following rather
verbose disclaimer, which may or may not be worth anything in an actual
court of law:
It is not my intention to influence anyone to commit an illegal act. I
explicitly instruct all readers not to violate any international, national,
state, regional, city, or other applicable laws governing any of the
information presented in any document authored by me or made available by
me through electronic or other publishing methods, including this document.
Specifically, I hereby advise everyone not to ingest, inject, smoke, snort,
shove up your ass, or otherwise administer any legal or illegal drug
(except for legal drugs under order of a physician), or to engage in the
manufacture, distribution, synthesis, analysis, or other processing of any
legal or illegal drug, regardless of anything you may see in the
aforementioned documents. I advise everyone not to follow any procedures
listed. All information is presented for EDUCATIONAL PURPOSES ONLY!
None of the information in this document is guaranteed to be accurate or
valid in any way. Anyone attempting any such action or process takes full
responsibility for any outcome resulting from such, and neither I, nor my
access provider, nor any other subset of the Usenet/Internet or world
community (except for the person or persons attempting the action) may be
held responsible.
By proceeding past this Disclaimer, you agree to assume all responsibility
for any actions, legal or not, that you may take. If any part of this
disclaimer is found to be invalid, then all rights to access and distribute
this information are revoked.
There is the philosophy among some in the USA (and probably the rest of the world) that the best way to prevent people from making mistakes is to withhold information from them. For example, this is particularly noticeable in the case of sex education, where some assert that teaching children about sex is equivalent to giving them permission to copulate, and that, since no sex is perfectly safe, and since teenagers especially have a tendency to take risks (e.g., no birth control), we ought not to teach sex education in the schools. One might just as easily say that teaching children about cars is equivalent to giving them permission to drive, and that, since no driving is perfectly safe, and since teenagers especially have a tendency to take risks (e.g., racing down Main St.), we ought not to teach driving education in schools.
This misguided philosophy of “ignorance is strength” is just as often applied to information pertaining to drug use. In the case of drug use, however, good information is immediately useful towards preventing drug-related injuries. In the case of DXM, there are several possible mistakes people can make, and the chance for making a mistake is compounded by the fact that people hear “you can get high off cough syrup” as advertisement for DXM use. At best they are unprepared for the trip; at worst, they get hold of an acetaminophen-containing preparation and end up in the hospital or dead.
Make no mistake; this information will probably encourage some to try, and continue to use, DXM. That is not my intention. A few of these people may end up addicted, or at least habituated to the point of trouble. That is certainly not my intention. My intention is to make sure that everyone out there knows what the risks and effects of DXM use are, so that s/he can make intelligent choices for herself or himself. An intelligent choice is not always right, but it is fair, and you always learn from it.
This text sprung out of the Usenet newsgroups alt.drugsand alt.psychoactives, where about 1 or 2 questions a week about DXM would appear. After responding weekly, or in some cases daily, I decided to put together all the questions (and a few questions I thought would follow) and write a full explanation of DXM. Some of the material is fairly technical, but I thought it better to give too much information than not enough. It is distributed once a month (more or less) on the Usenet newsgroups rec.drugs.psychedelic and alt.drugs (until the latter disappears); please distribute it beyond Internet and Usenet (subject to the restrictions above).
It is my sincere hope that this type of information may help the Internet fulfill its potential as an information source. Those of us who have the time and ability to provide good information should feel obligated to do so; if we set a standard of high signal and low noise, perhaps others will follow.
Right now, DXM is legal for over-the-counter use in most places. This seems to be for two reasons primarily. First, there is no substitute for DXM that does not also have abuse potential. Nor is there likely to ever be one; everywhere the cough reflex can be blocked involves some type of receptor associated with recreational drug effects. Second, pharmaceutical companies don’t want to lose a major chunk of their income. DXM works as a cough suppressant, and it works well. Besides, nobody wants to have to go to the doctor to get a prescription every time they get a cold. However, it is possible that DXM-only preparations might disappear from the market. This would be unfortunate, both for recreational users and for the general public; the most likely additive - guaifenesin - makes some people
vomit even at low doses. Another possibility would be the addition of
something which would be harmless at regular doses but induce nausea (or other unpleasant effects) at recreational doses.
The best answer is probably prevention, which unfortunately involves two conflicting goals. On the one hand, it is essential that DXM related deaths do not occur - this was my primary motivation in making this FAQ in the first place. Several DXM cough medicines can be dangerous if consumed recreationally, due to the presence of other ingredients. There is also the problem of drug interactions, e.g., DXM + SeldaneTM, which can be fatal. On the other hand, the spread of information to keep people from hurting themselves is also likely to inform people who didn’t know about DXM, and will want to try it. DXM is still an unknown to many people (although not as big an unknown as most think - pockets of recreational DXM use have
existed as long as DXM has). I’ve come to the conclusion that I’d rather have a bunch of people doing it safely than a few doing it dangerously but then again, I’m also in favor of sex education.
Thus, I encourage anyone who may want to try DXM or tell her or his friends to try it (which I again explicitly tell you not to do) to make sure and emphasize all the risks and dangers involved. Don’t rush into high dosages. Don’t trip alone, or without a designated sober person. Don’t encourage people who are not psychologically mature to experiment with DXM. And please use common sense and be safe.
In the event that DXM-only preparations do get pulled, the best answer is probably to have an isolation method that will separate the DXM from other ingredients. In my opinion, the most likely additive is guaifenesin (although people were using Robitussin DMTM long ago, and just toughing out the inevitable extreme nausea). I’ve been working on a way to separate the DXM from guaifenesin, using commonly available substances, and producing a pure, safe product. We don’t want another “cat” (methcathinone) media-scare on our hands. Currently I offer a method for evaluation only; this method
is not proven. I’m posting it with the FAQ so that other people can give it their consideration. In conclusion I’d like to remind everyone that we may be walking on thin ice here. I’ve tried my absolute hardest to make this FAQ as accurate and scholarly as possible, so that if anyone who matters ever does get a look at it, they’ll get bored somewhere around the explanation of P450-2D6 polymorphism. Still, please use common sense.
I have tried to make this document useful for a variety of audiences, and as such it can sometimes get fairly technical. If confused, consult the glossary; if still confused, check with a basic neuropharmacology text. I unfortunately do not have the time to answer general questions about neuropharmacology; I’m employed full time at a small ISP, trying to finish my education, and married.
This document is broken up into chapters and sections by subject, with appendices, references, glossary, and index. At present, figures and diagrams are fairly minimal; I’m trying to improve that aspect. Also, sometimes I simplify things a bit. If you take exception to anything, email me with references and I’ll consider modifying it.
This document is distributed in three forms: ASCII text on Usenet; HTML on the World Wide web (http://www.frognet.net/dxm), and in printed form. I try to keep the HTML copy the most current, not an easy task considering the length of the document. I still haven’t found an HTML editor that beats vi.
The following additional formats will be made available as I have time to create them: Microsoft WordTM PostScriptTM and PDF. Email me for requests for any other format. Requests for oddball printer formats will be redirected to the bit bucket. Again, apologies; I just don’t have much time anymore.
If this is coming to you via Usenet, please note that the Usenet version is subdivided into sections; some news machines choke on very long files. I do not post the section on what you can synthesize from DXM, since it’s mostly specialized information. Email me if you want it. Otherwise, posting is once a month, with the DXM Quick Reference being posted biweekly. If I’m eating up your bandwidth, I’m sorry; recently a lot of DXM use has been going on and I want to make sure everyone has the facts available.
This section covers general information about dextromethorphan, herein referred to as DXM. IUPAC chemical names are in a sans serif font, in square brackets.
PLEASE NOTE that the UK (and European?) name of acetaminophen is paracetamol. It is also known as APAP. They all refer to the same substance.If you get nothing else out of this FAQ, let it be this: Remember that DXM is a powerful psychedelic which can be used safely, but must be used with care and respect for your own body and mind. DXM is not a safe drug, and it has not been well studied at recreational levels; whenever you use it you are taking a risk, possibly a big one. Please read and follow these basic guidelines:
[*] Not everyone likes DXM, and your experiences with it may be very
unpleasant. A very few have had such intense side effects from DXM
that their first trip lands them in the hospital. DXM is not a quick
and easy buzz, and getting good results with it can be hard,
sometimes unpleasant work.
[*] Do not use DXM on a constant or frequent basis! Like alcohol (and
unlike marijuana), constant or frequent (more than once or twice a week) use may be dangerous. Although not everyone seems susceptible, a very few daily high-dose users may have seriously and permanently fried their brains.
[*] Do not use DXM if you have a any of the following medical conditions: mental illness, epilepsy, seizures, liver or kidney disorders, hypertension, heart problems, or ulcers.
[*] Do not use DXM if you are pregnant or nursing. All dissociatives
adversely affect fetal development, and may lead to birth defects and mental retardation.
[*] Because some people can have severely adverse reactions to DXM never rush into a high dose. Instead, take no more than twice your last dose, and wait at least one week between doses. Yes, it may take you a month before you get to interesting territory, but that’s better than ending up in the hospital. Yes it can happen to you!
[*] Never exceed 20mg/kg (or 2000mg, whichever is lower) of DXM under any circumstances, and never exceed 15mg/kg (or 1500mg) unless you have a trip-sitter who is experienced and capable in the event of a medical emergency.
[*] Because of the potential for allergic or other adverse reactions to inert ingredients, always try a low dose first when taking a DXM product (syrup, gelcap, capsule, whatever) you haven’t taken before.
[*] Never experiment with hallucinogens without a sober person around to help you in case you get into trouble. This goes doubly for DXM, which is much more likely to induce abnormal and dangerous behavior than LSD.
[*] NEVER, EVER, EVER drive under the influence of any intoxicating
drug including DXM!
[*] Never use a product containing acetaminophen (also called paracetamol or APAP, and known by the brand name TylenolTM). Large doses of acetaminophen can cause liver damage or death. Many cough syrups contain acetaminophen so always read the label.
[*] Never take DXM with yohimbine (YoconTM)! To do so may be risking permanent brain damage!
[*] Never take DXM if you are taking a monoamine oxidase inhibitor
(MAOI). This also applies for one week before and two weeks after
taking a MAOI. MAOIs include some (rarely used) prescription drugs
for depression and Parkinson’s disease, a few recreational
ethnobotanicals (harmine and harmaline), and yohimbe bark. Mixing DXM and a MAOI has regularly been fatal.
[*] Do not take DXM with phentermine, fenfluramine, or the combination (phen-fen), all of which are used as prescription diet pills. This combination can cause serotonin syndrome.
[*] Never take DXM if you are taking, will take, or have taken within six weeks, the prescription antihistamine terfenadine (SeldaneTM), or any other prescription, non-drowsy antihistamine (e.g., ClaritinTM or
HisminalTM).
[*] Never take DXM with the SSRI antidepressants Desyrel (trazodone) or Serzone (nefazodone); these combinations have resulted in liver damage.
[*] Be very careful combining DXM with SSRI and tricyclic antidepressants
(i.e., those in common use), and never use DXM when taking more than one drug at a time for depression, due to the potential for serotonin syndrome.
[*] Avoid all products containing DXM and other active ingredients.
[*] Avoid BenylinTM brand products which seem to cause severe nausea.
Avoid any product with castor oil. Avoid Coricidin Cough and ColdTM at upper plateau doses due to the potentially dangerous effects of antihistamine overdose.
[*] Remember that DXM can sometimes trigger panic attacks in susceptible
individuals, especially those inexperienced with DXM. This is a major
cause (if not the major cause) of tachycardia (high heart rate) from
DXM. All the more reason not to rush in to anything.
[*] Always remember: recreational use of DXM is still a great unknown. The brain you are risking is your own.
Dextromethorphan hydrobromide is the water-soluble salt of dextromethorphan (DXM) and hydrobromic acid (that is, DXM hydrobromide is what you get when you react pure DXM with hydrobromic acid). DXM is a synthetic morphine analog, similar to levorphanol, but does not have any opiate-like effects. DXM has been in use in the USA for approximately 30 years, and has replaced codeine as an OTC cough suppressant (1-3).
DXM has been popular as an “underground” recreational drug for at least 30 years (3). It is probably one of the few OTC medicines with any serious recreational use potential (ephedrine might also qualify). It is both extremely safe and very effective as a cough suppressant.
DXM’s IUPAC name is [(+)-cis-1,3,4,9,10,10a-hexahydro-6-methoxy-11-methyl-2H-10,4a-iminoethanophenanthrene], and is also (and more commonly) known as 3-methoxy-17-methyl (9alpha,13alpha,14alpha)-morphinan; CAS-125-71-3 (1). Note: the 3-methoxy and 17-methyl groups are pointed out for later notes.
(Oh, just as a side note, I’m proud to say that for once I actually got the IUPAC name right all by myself - the Merck Index lists the same thing).
The recreational use potential of DXM has not, in general, been well known, either by drug users or by physicians. Not too long ago, many physicians denied that dextromethorphan was psychoactive at all; whether this was out of ignorance or a desire to prevent recreational use, I do not know (probably the latter). At present, there is an increasing body of knowledge about DXM’s potential for recreational use (and abuse) available in medical journals (3-7,132,136,139-141).
DXM is unique among recreational drugs for several reasons. First, it is pharmacologically unlike most other recreational drugs (PCP and ketamine being its nearest relatives). Second, its effects can vary considerably from individual to individual. Finally, it can cause quite different effects at different dosage levels, ranging from mild euphoria to full dissociation.
Cytochrome P450-2D6, also known as CYP2D6 or debrisoquine hydroxylase, is a
liver enyme which is extensively involved in metabolizing drugs. Many drugs
are metabolized by P450-2D6, and many drugs also inhibit it. Some people
are genetically lacking in the normal P450-2D6 variant, and physicians will
use DXM to determine which variant of P450-2D6 a patient has (10-11). About
5-10% of Caucasians and 0.5% of Asians seem to lack P450-2D6 entirely, or
have a very inactive mutation (12-15). In remaining individuals, its
activity can vary significantly due to genetic factors (15-18). Between
0.5% and 2% of the population has multiple copies of the P450-2D6 gene and
will metabolize 2D6-dependent drugs much more quickly than most people
(155).
Since many drugs become toxic at high doses, it is important to give the
proper amount to those people who will metabolize it differently than the
normal population. DXM is used to test metabolism by CYP2D6. The patient is
given a specific amount of DXM, and then the relative concentrations of DXM
and its metabolites are determined.
Some recent research suggests that susceptibility to lung cancer may be
related to P450 variant, and DXM may be an effective diagnostic tool for
predicting lung cancer susceptibility (376).
Dextromethorphan Polistirex is a time-release formulation of DXM; the “polistirex” refers to a sulfonated styrene-divinylbenzene co-polymer complex — basically, an edible plastic (1-2). It is occasionally spelled polystirex or polystyrex. Unlike the HBr salt, which is absorbed fairly quickly, this compound is intended for longer duration cough suppression. Most, but not all, people who use DXM recreationally tend to prefer the HBr form (which is also much more readily available). The polistirex preparation will probably increase the ratio of DXM to DXO (see next section).
Dextromethorphan polistirex may be more toxic than the hydrobromide version, possibly due to buildup of DXM in the bloodstream (143).
One area in which DXM (as well as other NMDA blockers; see Section 10.3)
shows great promise is in the prevention of brain damage resulting from
excitotoxicity (over-stimulation of nerve cells to the point of cell death)
and other types of nerve cell damage (19). DXM may reduce or eliminate the
brain damage resulting from conditions such as fever, hypoxia (lack of
oxygen) (20), ischemia (cutoff of blood to brain cells) (21-22), physical
injury (23), infection (such as poliomyelitis, encephalitis, and
meningitis), stroke, seizure, drug toxicity (24-25), electrical shock
(231), hypoglycaemia (243), and withdrawal from long-term dependence upon
certain drugs (notably alcohol, barbiturates, and benzodiazepines such as
ValiumTM) (26-29).
In the case of infection (and in particular poliomyelitis), it has been
demonstrated that the damage to the CNS often occurs not from the
infection, but from the body’s own defenses, and notably from a chemical
called quinolinic acid (a metabolite of tryptophan) (30,31). Quinolinic
acid is a very potent agonist (activator) at excitatory amino acid
receptors, of which NMDA is one type; DXM prevents quinolinic acid from
activating NMDA receptors. (Incidentally, the function of quinolinic acid -
if it has any - is not currently known; it may be involved in the immune
response).
As for physical trauma, hypoxia, seizure, stroke, etc., there are several
experiments which indicate that the majority of the damage again comes from
excitotoxicity at excitatory amino acid receptors. While DXM has shown
somewhat less success there (possibly due to other factors being involved),
it still has potential.
DXM is currently being evaluated as an anticonvulsant (32,33). The animal
data are somewhat conflicting, but the most accurate model of epileptic
seizures (called kindling) responds well to DXM. Preliminary studies in
humans indicates that even very low levels of DXM may help prevent
seizures. This effect is not, as was originally thought, due to NMDA
receptors; instead, it is probably due to sigma receptors or voltage-gated
ion channels (32).
Interestingly, DXM produces different side-effects in kindled
(seizure-susceptible) animals than in non-kindled animals (this may be due
to uncoupling of NMDA receptors). It is possible that humans susceptible to
seizure may experience different effects from recreational DXM use.
DXM seems to enhance the painkilling ability of opiates without adding to
the side effects, and in practice the patient can lower the dose of opiates
while maintaining analgesic effect (37). As an added bonus, DXM seems to
prevent opiate tolerance (see next section). DXM by itself has only
marginal analgesic effect if any (373,375).
DXM, as well as other dissociatives, seems to prevent and even reverse
tolerance to (and thus physical addiction to) many drugs. In the case of
opiates, DXM has been used to treat withdrawal symptoms (169). DXM plus
diazepam (ValiumTM) was tested and found to be more effective at combating
the symptoms of heroin withdrawal (goose flesh, tremors, pupil dilation,
joint pains, etc.) than chlorpromazine (ThorazineTM) plus diazepam (34). A
further study verified this and found that adding tizanidine (an alpha-2
adrenergic agonist) to the DXM+diazepam cocktail was even more effective
(133).
Dissociatives have also been found to reverse or prevent tolerance to
cocaine (247), nicotine (249), and alcohol (232), and some researchers have
suggested that DXM (and other NMDA antagonists) may be universally useful
in most if not all drug addictions.
DXM is being investigated as a treatment for various diseases due mostly to
its NMDA antagonist effects. The most promising results have been in
treating shingles, a disease which primarily affects the elderly wherein a
dormant viral infection flares up and attacks peripheral nerves. DXM can
block the (often excruciating) pain from this flareup, and may prevent
peripheral nerve damage (370). It may also be effective at treating herpes
pain (368).
Some chronic neurodegenerative diseases may be treatable with DXM. Notable
among these include ALS (Lou Gehrig’s Disease) (168), although more recent
research seems to show that DXM may not be a useful treatment for ALS
(363). Even “Mad Cow” disease (and other prion diseases) may respond to
treatment with DXM (362).
DXM has also been used to treat mental retardation (35), and Parkinson’s
disease (36). DXM may even have be useful in treating lung and other
cancers (38) and preventing tissue rejection in transplants (263) due to
the (poorly understood) effects of sigma ligands on tumor cells and the
immune system (see Section 10.2).
Some papers have suggested that dissociatives have antidepressant effects
(208,212,223,245,250), while others dispute this (225,229). Finally, the
dissociative qualities of DXM may be of use; ketamine has been used to calm
children in order to perform genital exam in cases of suspected sexual
abuse (184-186).
Please read through this section if you are taking (or have or will be
taking) other drugs in addition to DXM.
DXM should not be used (either recreationally or at normal dosage levels)
by people who are taking a monoamine oxidase inhibitor (MAOI, rhymes with
“wowee”) - either a prescription MAOI or a recreational one such as
harmaline. Note that there is considerable confusion among drug users about
what is and isn’t a MAOI. MAOIs include a few drugs prescribed for
depression and Parkinson’s disease, and a few rare recreational drugs
derived from exotic plant sources (harmine and harmaline, from Syrian Rue
and Yagé, for example). ProzacTM, MDMA, cheese, beer, SeldaneTM, etc., are
not MAOIs - they are things to avoid when taking a MAOI. If you are taking
a prescription MAOI you will almost certainly know, as your physician will
have (hopefully!) told you to avoid eating aged cheeses. Combining DXM and
a MAOI has been fatal (3)!
Fluoxetine (ProzacTM) is a cytochrome P450-2D6 inhibitor (39) and will
change the characteristics of a DXM trip somewhat, increasing the ratio of
DXM to DXO. Other P450-2D6 inhibiting drugs, which include many
antidepressants, will probably do the same; see Section 15.1. The duration
of the trip may be greatly extended by P450-2D6 inhibitors; some users have
reported effects lasting 12 to 24 hours past the normal duration. The
potency of DXM may also be enhanced via other mechanisms by fluoxetine
(40).
Combining DXM with the antidepressants Desyrel (trazodone) or Serzone
(nefazodone) has been reported to cause liver damage!
One user reported that combining DXM with bupropion (Wellbutrin[tm])
resulted in a prolonged (3+ day) hangover and an increase in adverse side
effects.
Fluoxetine and other SSRI antidepressants, as well as tricyclics and
lithium (and of course MAOIs) may interact with DXM to cause serotonin
syndrome (see Section 6.2.9). This condition, although rarely fatal, is not
terribly pleasant. Vascular disease may increase the chance for serotonin
syndrome with DXM + antidepressants (364), and other disease conditions may
do so as well. Some DXM users who have taken DXM while on antidepressants
have reported unpleasant reactions that sound a lot like serotonin
syndrome, so you might want to watch out. Some of the symptoms of serotonin
syndrome include muscle rigidity, confusion, diarrhea, incoordination,
low-grade fever, sweating, muscle tremor, mania, agitation, exaggerated
reflexes, and nausea.
Do not take DXM with the diet drugs phentermine, fenfluramine, or phen-fen;
this combination can also cause serotonin syndrome.
DXM should not be taken (recreationally or at normal dosage levels) with
the prescription antihistamine terfenadine (SeldaneTM). This combination
has been fatal (41). Terfenadine has been implicated in other drug
interactions, incidentally. The reason for this interaction seems to be
that terfenadine, which is normally metabolized by a P450 enzyme, induces
heart irregularities when it builds up. DXM may saturate the P450 enzymes
that normally metabolize terfenadine. Incidentally, this probably applies
to other non-drowsy antihistamines, such as ClaritinTM and HisminalTM as
well; avoid combining them with DXM.
Some people find that nicotine (cigarettes) causes severe nausea when
combined with DXM. Others have noticed a general increase in physical
discomfort and “bad trips” from combining the two. Some research has
suggested that cigarette smoke inhibits monoamine oxidase (378,379) in
which case cigarettes could greatly increase the chance of unpleasant side
effects.
Both opiates and dissociatives have strong side effects which can limit
their usefulness in pain treatment. When the two are combined, however, a
synergistic effect occurs, and patients can lower the dose of both drugs to
the point where side effects are minimalized (236,267,278). Dissociatives
prevent tolerance to opiates (248) and can alleviate opiate withdrawal
(254). On the other hand, combining the two may increase the chance for
respiratory depression and fatal overdose.
Marijauna and DXM is a frequently used combination, albeit one which has
seen little research. Competitive NMDA blockade enhances marijuana
catalepsy (210), and conceivably noncompetitive blockade would as well.
Dizocilpine, a dissociative used in research, decreases the analgesic
effects of marijuana (214), and causes downregulation of anandamide
receptors (THC receptors) (218).
Dissociatives may block the depletion of 5HT (serotonin) caused by MDMA
(ecstasy) (241). However, there is also the potential for hypertensive
problems, so I wouldn’t advise this combination. Methamphetamine produces
vacuolation of neuron terminals due to a collapsed vesicular proton
gradient (181) (translated into English, this means that speed damages
brain cells by breaking open the little bubbles of neurotransmitters inside
the cells). However, dizocilpine (and presumably other dissociatives) may
prevent this (219). It also seems to block methamphetamine induced 5HT
depletion (241).
Antidepressants and dissociatives seem to interact as well, not necessarily
in a good way. Both desipramine and dissociatives increase prefrontal lobe
dopamine activity; the combination is highly synergistic (277). Even worse,
dissociatives may actually reverse the antidepressant effect (229).
Dizocilpine reduces 5HT2 receptor density (212), and increases 5HT binding
in the hippocampus and striatum (252). On the other hand, one paper found
that dizocilpine helped antidepressants in some tests (245,250).
Finally, dissociatives block tolerance to many drugs, including alcohol
(232), cocaine (247), nicotine (249), and morphine (248).
There are other cough suppressants available, of course, but none of them
are likely to take the place of DXM.
Noscapine is a natural ingredient in opium, and is related to papaverine.
It doesn’t seem to have any opiate-like effects (other than cough
suppression) and is not constipating. It may be a NMDA/sigma ligand like
DXM. Adverse effects and effects of overdose include drowsiness, dizziness,
headache, nausea, allergic rhinitis, conjunctivitis, and skin rashes. I
have no idea whether it has recreational effects at high doses, but I
wouldn’t advise finding out. Oral adult dose is 25mg-50mg 3-4 times daily.
Opiates are of course still used as cough suppressants; the most common is
codeine, which is still used for severe coughs (although some research
suggests it is no better than DXM). Other opiates have been used for severe
cough. As an interesting bit of trivia, heroin was first marketed for cough
suppression.
The recreational effects of opiates are fairly well known, and are in any
case beyond the scope of the DXM FAQ.
A variety of substances have been used as topical anaesthetics to numb the
throat, including phenol and methol. These have no recreational use
potential (and in general are highly toxic in overdoses).
As DXM itself, probably not; nobody bothers to look for it. There has been
some anecdotal evidence that DXM can cause false positives for opiate
tests, but one paper (374) disputes this. There may be more reliable
evidence that DXM can cause false positives for PCP and possibly cocaine.
So keep this in mind before using DXM if you have to take a drug test. If
worse comes to worse, you can always claim you had a bad cold, and ask them
to do a test which will discriminate between opiates and DXM. Good luck!
This section discusses some of the effects you might expect to feel if you
were to use DXM recreationally (which I recommend against, of course). The
effects listed are generally positive, and reflect the results of people
who have positive experiences with DXM.
Some people have negative experiences with DXM! For these people, the DXM
“trip” may just be several hours of dizziness, nausea, hot flashes, and
confusion, with several days of hangover. This is the main reason why most
DXM users suggest starting with a first plateau dose.
It depends on what you consider “enjoyable”. Roughly one third of the people who try DXM like it enough to ever repeat the experience; one third hates it, and one third doesn’t enjoy it enough to drink cough syrup. Among those who do enjoy it, most report that their more “profound” DXM experiences were in many ways also very unpleasant, challening, and have a strong dysphoric undertone. Experienced psychedelic users seem to enjoy DXM more than the inexperienced. Generally speaking, enjoyable DXM experiences require putting a lot of emotional and psychological energy into the experience.
DXM does not provide a simple high like marijuana, and it is not a
substitute for other psychedelics. Many people will not enjoy it; before considering DXM, remember that you may hate the experience. If you are looking for a cheap buzz or a gentle ride, you probably won’t like DXM.
This is a difficult question to answer, because DXM’s effects tend to vary
widely depending on the person, their set and setting, other drugs, their
physiology, and so on. DXM, probably more than most drugs, tends to exert
its (recreational) effects in separate stages or “plateaus”, rather than
being linearly dose-dependent. Within a given plateau, a given set of
effects will occur (at a roughly dose-dependent strength). On the other
hand, once the next plateau is reached, the feeling may change entirely. A
reasonable analogy is water - it exists in three states (solid, liquid, and
gas) which all can exist at varying temperatures (e.g., hot water and cold
water), but which have different characteristics.
DXM and its metabolite, dextrorphan (DXO), produce different sets of
effects. Normally, DXM is converted mostly or entirely into DXO, but with
recreational doses, the conversion enzyme (P450-2D6) may saturate, leaving
a mixture of DXM and DXO. Furthermore, another of DXM’s metabolites -
3-methoxymorphinan - can also block this enzyme, so that taking divided
doses leads to more DXM and less DXO than taking a combined dose of the
same amount.
DXM’s effects are in some ways much more subtle than DXO’s. Whereas DXO
produces a heavy “stoning” or intoxicating effect, DXM by itself is only
lightly intoxicating. DXM, however, can alter the thought processes,
leading to highly abnormal, psychosis-like mental states. It is possible
that DXM, via sigma activation, may induce a mental state similar to that
of schizophrenia. Whether or not this is fun to you is, of course, up to
you.
DXM seems to exhibit at least four definable plateaus based solely on
dosage, and an additional plateau is notable from a specific dosing regimen
(see below, Section 5.9). I previously listed three plateaus; then four;
now I’m listing five (although “Plateau Sigma” doesn’t occur at dosages
higher than the fourth plateau). Evidently, dosages above the fourth
plateau lead to full anaesthesia, psychosis, coma, and/or death.
Not everyone notes distinction between the first and second plateaus, or
between the third and fourth plateaus. Others suggest that each effect of
DXM has a dosage level at which it starts, and (in some cases) a dosage
level at which its effects are no longer noticeable (being overpowered by
other effects). Some people will disagree with this classification method,
but I think this is the best way to represent DXM’s effects. Both the third
and fourth plateaus have significant dissociative characteristics, much
like ketamine.
The most important thing to keep in mind is that the effects in different
plateaus are often very different. For example, on the first plateau, DXM
tends to have a stimulant effect. Upon reaching the second plateau,
however, the stimulant effect may no longer be present.
The beginning of the comedown off of a DXM trip can come abruptly. Often,
the user will know when it’s starting to end by noticing the return of
normal sensory processing. Coming down from there may take a significant
amount of time. A second DXM trip too soon after coming down is not a good
idea due to the potential for side effects and psychotic episodes (227).
Wait at least three days and preferrably two weeks between each DXM trip.
The following table can be used as a general guideline for the plateaus.
For convenience I give example dosages in gelcaps and 3mg/ml syrup for 75kg
and 150lb adults; adjust up or down by the amounts indicated per 10kg or
25lb. Calculating with the mg/kg is more accurate, but it’s easy to make
mistakes when using non-metric measures. These dosages are as DXM
hydrobromide.
Dosage will vary considerably from person to person, by as much as 5 times!
Also, these mg/kg figures should evidently be adjusted down for higher mass
(e.g., maybe 6mg/kg to 13mg/kg third plateau for a 150kg adult). Note that
kg = pounds * 0.45.
I have included a new category in this table: “Usenet Suggestions”. This is
a combination of suggested dosage guidelines from Usenet, and may more
accurately represent the plateau dosage of DXM in regular users (the
original plateau levels were based mostly on occasional users).
Table 1: DXM Plateaus and Dosages
Plateau First Second Third Fourth
Dosage Range
(mg/kg) 1.5-2.5 mg/kg 2.5-7.5 mg/kg 7.5-15 mg/kg >15mg/kg
Usenet Suggestions
(mg/kg) 2.7 mg/kg 6.4 mg/kg 9.4 mg/kg 18mg/kg
Gelcaps (30mg) for 4 to 6 6 to 18 18 to 37
75kg adult gelcaps gelcaps gelcaps >37 gelcaps
Adjust per 10kg 1/2 to 1 1 to 2.5 2.5 to 5 5 gelcaps
gelcap gelcaps gelcaps
Gelcaps (30mg) for 3 to 5 5 to 17 17 to 34
150lb adult gelcaps gelcaps gelcaps >34 gelcaps
Adjust per 25lb 1/2 to 1 1 to 2.5 2.5 to 5.5 5.5 gelcaps
gelcaps gelcaps gelcaps
Syrup (3mg/ml) for
75kg adult 37 to 62 ml 62 to 187 ml 187 to 375 ml >375 ml
Adjust per 10kg 5 to 8 ml 8 to 25 ml 25 to 50 ml 50 ml
Syrup (3mg/ml) for 2 tbsp to 2 2 oz to 5.5 5.5 oz to 11
150lb adult oz (1/4 cup) oz (2/3 cup) oz (1 1/3 cup) >11oz
Adjust per 25lb 1 tsp to 2 2 tsp to 1 oz 2 tbsp to 2oz 2 oz
tsp (1/8 cup) (1/4 cup)
The specific effects at each plateau will be listed according to the
following categories: Sensory, Cognitive/Emotional, Motor, and Memory.
Additionally, the lower two plateaus are considered together, as are the
upper two plateaus.
The four dosage plateaus can be divided into two groups based on a certain
degree of similarity: the lower plateaus and the upper plateaus. The lower
two plateaus share many features and some of these will be considered here.
A generalization would be that the lower two plateaus are more
“recreational” than the upper plateaus. Specifically, they have
considerably less hangover, do not generally involve serious disruption or
breakdown of sensory processing, and are more similar to other intoxicants.
DXM in the lower two plateaus has been compared to a cross between MDA and
alcohol. It tends to intensify emotional responses and feelings of meaning
from external events. At the lower plateaus there is usually enough motor
control to be able to engage in physical activites (although, like MDMA and
MDA there are reasons why you may not want to, including dehydration and
overheating).
Most find sensory input is still understandable, although there are
peculiar changes which will be discussed below (notably flanging). At the
lower plateaus it is still possible to interact extensively with the
outside world, and one can watch and follow reasonably complex plots in
movies, and have complex conversations.
Although DXM is in many ways not a good “casual” drug most people have used
it without adverse effect at the lower plateaus. Interestingly, many people
who have use DXM at the upper plateaus eventually find that the lower
plateaus no longer offer much enjoyment. There are a lot of potential
reasons for this (see Section 7.6); I think most of it is simply that DXM
at the upper plateaus changes one’s expectations about its effects and
gives one familiarity with its memory inhibition.
No, it isn’t. Sometimes people get confused because DXM’s stereoisomer (basically, the mirror image molecule), called levomethorphan, is an opiate. In two dimensions the molecules look identical, but in three dimensions, they are mirror images of each other. DXM no more fits into opiate receptors than a left-hand threaded screw will fit into a right-hand threaded nut.
In fact, DXM doesn’t bind at any opiate receptors, doesn’t have opiate painkilling effects, and isn’t cross-tolerant with opiates. It is only out of sheer chance that when DXM was invented, its origins were among the opiates; DXM’s cough suppressant effects are completely different in mechanism from the cough suppressant effects of opiates.
No, in fact from speaking with many people who have tried it, only about one third of the people who try it ever take it again. One third seem to absolutely hate it, and the last third couldn’t care less. Among the third who do like it, the majority (around 80% of those who like DXM) take it once a month or less.
Part of the problem is that not everyone gets the interesting sets of
effects (see Section 5). To some, the DXM trip is just a moderate buzzing sensation and a feeling of being slightly drunk. So your mileage may vary.
A few people really enjoy DXM, and use it weekly; a very few (less than 5% of those who like DXM) use it more than twice a week. Keep in mind that I have not assessed the error margin on these figures, and that they reflect a biased sample of the population. I hope to have more accurate figures after completing a survey of DXM users.
